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Lindqvist, Rikard. "Hospital length of stay : register-based studies on breast-cancer surgery /". Stockholm, 2005. http://diss.kib.ki.se/2005/91-7140-312-4/.
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Westerberg, Marcus. "Diagnosing Metastatic Prostate Cancer Using PSA:A Register-Based Cohort Study with Missing Data". Thesis, Uppsala universitet, Tillämpad matematik och statistik, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-322012.
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Klaff, Rami. "Disease-Specific Survival in Prostate Cancer Patients : Results from the Scandinavian Prostate Cancer Group (SPCG) Trial No. 5 and Regional Cancer Register Data". Doctoral thesis, Linköpings universitet, Institutionen för klinisk och experimentell medicin, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-132385.
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Introduction Prostate cancer (PCa) is the most common cancer among men in Sweden. The clinical course varies considerably, which makes it difficult to predict the prognosis in the individual case. In order to explore the early as well as the late course of the disease, large study groups and population-based cohorts are necessary. Aims To explore factors that influence the long-term outcome of men with low-risk tumours in a population-based register, to predict the long-term course, and to assess the mortality rate for men with prostate cancer (Paper I) To analyse long-term outcome and to investigate factors associated with long-term survival in patients with metastases to the skeleton (Paper II) To analyse early androgen deprivation treatment (ADT) failure and to define clinical predictors associated with short survival due to early ADT failure in prostate cancer patients with bone metastases (Paper III) To analyse the prognostic significance of the extent of bone metastases in relation to other pretreatment variables in prostate cancer patients, and to explore the impact of bone metastases on quality-of-life (Paper IV) Material and methods The study groups were assembled from The South East Region Prostate Cancer Register (SERPCR), and The Scandinavian Prostate Cancer Group (SPCG) Trial No. 5. In the first study, prognostic factors and long-term disease-specific mortality rates of low-risk prostate cancer patients from the early PSA era were analysed. In the second study, patient-related factors, quality-of-life (QoL) and long-term survival in 915 PCa patients with bone metastases (M1b) under ADT, were analysed. In Study III factors predicting primary failure to respond to ADT were identified. Study IV explored the impact of the extent of bone metastases on survival and QoL for these men. Result and conclusions The long-term disease-specific mortality of low-risk localised PCa is low, but the annual mortality rate gradually increases. This indicates that some tumours slowly develop into lethal cancer, particularly in men 70 years or older and with a PSA level ≥ 4 μg/L. From the SPCG Trial No. 5, a subgroup of patients with M1b disease and favourable set of predictive factors survived more than 10 years under ADT with an acceptable QoL. Independent predictors of long-term survival were identified as performance status (PS) < 2, limited extent of bone metastases, and a PSA level < 231 μg/L at the time of enrolment in the trial. However, four independent clinical predictors of early ADT failure could be defined. Men exhibiting these features should be considered for an alternative treatment. Patient grouping based on three categories of extent of bone metastases related to PS, haemoglobin, and QoL at presentation, as independent predictors of mortality, may provide improved accuracy of prognosis.
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Holmström, Benny. "Early diagnosis and treatment of prostate cancer : observational studies in the National Prostate Cancer Register of Sweden and the Västerbotten Intervention Project". Doctoral thesis, Umeå universitet, Urologi och andrologi, 2011. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-42843.
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Prostate-specific antigen (PSA) testing has caused a steep increase in the incidence of prostate cancer, especially the incidence of localised low risk disease. In order to decrease the overdiagnosis accompanied by PSA testing, analysis of inherited genetic variants have been suggested as potential tools for clinical assessment of disease risk. With the aim of minimizing overtreatment and postpone side-effects of curative treatment for low risk prostate cancer, active surveillance, a treatment strategy with initial surveillance and deferred radical prostatectomy at the time of progression has evolved. The aim of this thesis was to study the validity of PSA (paper I) and inherited genetic variants (paper II) for early diagnosis of prostate cancer, to assess the extent of PSA testing in Sweden (paper III), and to study the safety of deferred radical prostatectomy in localised low to intermediate risk prostate cancer (paper IV). The study designs were i) case-control studies nested within the Västerbotten intervention project (paper I and II), ii) observational study in the Cancer Register of Sweden (paper III), and iii) observational study in the NPCR Follow-up study (paper IV). PSA had a high validity in predicting a prostate cancer diagnosis with an area under the receiver operating characteristics (ROC) curve of 0.86 (95% CI, 0.84 to 0.88). A combined test, including PSA, the ratio of free to total PSA, and 33 single nucleotide polymorphisms (SNPs) in a genetic risk score, increased the area under curve to 0.87 (95% CI, 0.85 to 0.89). The estimated uptake of PSA testing among men aged 55 to 69 years increased from zero to 56% between 1997 and 2007 and there were large variations in the uptake of PSA testing between counties in Sweden. After a median follow-up time of eight years there was no significant difference in presence of any one or more adverse pathology features or prostate cancer specific mortality after primary compared to deferred radical prostatectomy in localised low to intermediate risk prostate cancer. Results from these studies indicate that PSA and the hitherto identified SNPs are not suitable biomarkers in single-test prostate cancer screening. It is possible to estimate the uptake of PSA testing on a population level. Initial surveillance and deferred radical prostatectomy represent a feasible treatment strategy in localised low to intermediate risk prostate cancer.
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Bjerke, Jeanette. "Att dö med trycksår". Thesis, Uppsala universitet, Institutionen för folkhälso- och vårdvetenskap, 2011. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-161984.
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Bakgrund: Trycksår är en lokal skada av huden. Skadan ligger ovanför ett benutskott och orsakas av tryck eller en kombination av tryck skjuvning eller friktion. Smärta från trycksåret är ett vanligt förekommande problem som påverkar livskvaliteten negativt. Syfte: Syftet med studien var att undersöka förekomsten av trycksår i livets slutskede samt att se om personer med smärta och trycksår är smärtskattade med VAS/NRS. Syftet var även att se om det fanns något samband mellan trycksår och smärta. Metod: Metoden som använts var en retrospektiv deskriptiv undersökning med kvantitativ ansats. Insamling av data skedde via frågor tagna ur dödsfallsenkäten. Uppgifterna togs ur Svenska palliativregistret samt via journalgranskning. Resultat: Förekomsten av trycksår under 2008-2010 var mellan 29 - 33 %. Under perioden dog 95 (30 %) personer med trycksår, 83 % av dessa trycksår var kategori 1 eller 2 sår. Av de som avled med trycksår upplevde 78 % smärta sista veckan i livet, 59 % hade smärtskattats med VAS/NRS där det visade sig att 69 % skattade över 3 på VAS/NRS skalan. Medianen på VAS/NRS var 6. Inget signifikant samband mellan trycksår och smärta påvisades. Slutsats: Personal som vårdar personer i livets slutskede bör ha en god kunskap om hur, varför och när trycksår uppkommer mot slutet av livet och även ha ökad kunskap om kroppens smärtmekanismer samt vilken symtomlindring som fungerar. Nyckelord: god död, palliativvård, cancer, Svenska palliativregistret.Background: Pressure ulcers are a local damage of the skin. The damage is above a bony prominence caused by pressure or a combination of pressure shear and friction. Pain from the pressure ulcer is a common problem that affects quality of life negatively. Aim: The aim of this study was to investigate the incidence of pressure ulcers in palliative care and to see if people with pain and pressure ulcers are pain assessed by VAS/NRS. The aim was also to see if there was any correlation between pressure ulcers and pain. Method: The method used was a retrospective descriptive study with quantitative approach. Data collection was done through questions taken from the Swedish death inquiry. The data were taken from the Swedish palliative register and through journal review. Results: The incidence of pressure ulcers during 2008-2010 was between 29 – 33 %. During the period died 95 (30%) with pressure ulcers, 83% of these pressure ulcers were category 1 or 2 wounds. Of those who died with pressure ulcers 78 % experienced pain last week of life, 59 % had pain assessed by VAS/NRS that showed that 69% estimated above 3 on the VAS/NRS scale. The median on VAS/NRS was 6. No significant correlation between pressure ulcers and pain were found. Conclusion: Staff who care for people in end of life care should have a good knowledge of how, why and when pressure ulcers occur towards the end of life, they should also have greater knowledge of the body's pain mechanisms and pain relief that works. Keywords: Good death, palliative care, cancer, Swedish palliative register.
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Martinsson, Lisa. "Quality improvement in palliative care : the role of a national quality register and perceptions of information during palliative chemotherapy". Doctoral thesis, Umeå universitet, Onkologi, 2015. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-102264.
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Introduction There is a need in palliative care for development of structured methods to assess quality and support improvement. This need is present both within and outside specialised palliative care. Honest information from physicians is regarded as an important part of palliative care. Information about the transition to end-of-life care (ITEOL), conveyed by physicians to patients, has also been described as a ‘breakpoint conversation’. Quality registers enable monitoring and improvement of quality of care, and clinical research. The Swedish Register of Palliative Care (SRPC) is a Swedish national quality register that collects data from hospitals, hospices, nursing homes and home care, with an end-of-life questionnaire (ELQ) about palliative care content focusing on the last week of life. Aims Study I – The aim was to examine the validity of the ELQ from the SRPC. Study II – The aim was to examine whether participation in the SRPC increases the quality of palliative care over a three-year period regarding eight items in the ELQ. Study III – The aim was to examine whether an educational intervention for physicians and nurses in nursing homes and hospitals increases the proportion of patients who receive ITEOL. Study IV – The aim was to describe how patients with cancer perceive the information they receive from physicians during palliative chemotherapy. Methods Study I – Data from 100 medical records and data from the paper versions of the ELQ filled in at a specialised palliative unit were compared with data reported to the SRPC. Study II – Data from eight items in the ELQ reported to the SRPC from all healthcare units that had reported patients continuously during a three-year period were compared year-by-year with logistic regression. Study III – Two municipalities (in charge of nursing homes) and two hospitals were randomised to receive an interactive half-day course about ITEOL for physicians and nurses. Four hospitals and four municipalities were assigned matched controls. The proportion of patients who received ITEOL before and after the intervention was measured with the ELQ. The effect of the intervention was analysed with a multivariable logistic regression model. Study IV – Fifteen semi-structured interviews with patients with incurable cancer were conducted, transcribed verbatim and analysed with qualitative content analysis. Results Study I – The questions in the ELQ showed a congruity of 22% to 100% when comparing data from medical records with data reported to the SRPC. Eight questions fell below 80%. The paper versions filled in at the unit and the data reported to the SRPC showed a congruity of between 91% and 100%. Study II – The prevalence of six symptoms decreased. The prescription of PRN (pro re nata – ‘as needed’) medications for pain, nausea, anxiety and death rattle increased. A higher proportion of patients died in their place of preference. The patient’s next of kin was more often offered a follow-up appointment after the patient’s death. There was no change in the proportion of patients or next of kin who received ITEOL. Study III – The proportion of patients in the intervention group who received ITEOL increased from 35.1% (during a six-month period before the intervention) to 42.0% (during a six-month period after the intervention). The proportion in the control group increased from 30.4% to 33.7%. The effect of the intervention was significant (p=0.005) in the multivariable model. Study IV – Three categories were disclosed during the analytical process: ‘living with a death sentence’, ‘depending on chemotherapy’, and ‘living with uncertainty’. Conclusions A national quality register has the potential of contributing to quality improvement in palliative care. Study I showed varied validity in the ELQ, implying a need to modify the questionnaire. Study II showed that participation in the SRPC was covariant with quality improvements in end-of-life care over time. Study III showed that more patients received ITEOL after an educative half-day intervention directed to physicians and nurses. Study IV showed that patients undergoing palliative chemotherapy perceived that their disease was incurable and deadly, and that conditions for future treatment and survival were uncertain.
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Roué, Tristan. "Épidémiologie des cancers en Guyane : Analyse des données du registre des cancers de Guyane". Thesis, Antilles-Guyane, 2014. http://www.theses.fr/2014AGUY0743/document.
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L'objectif du registre des cancers de Guyane est de collecter l ensemble des tumeurs invasives et/ou in situ survenues depuis le 1er janvier 2003 chez des patients vivant en Guyane, quels que soient la localisation de la tumeur, le lieu de diagnostic et de traitement. Cette thèse a pour but de décrire la population atteinte d un cancer afin d améliorer les connaissances sur cette maladie et ainsi de permettre aux actions de santé publique d être plus efficaces.De 2003 à 2009, le taux d incidence des cancers standardisé sur l âge était, dans les deux sexes, 30% inférieur en Guyane par rapport à la France métropolitaine et n était pas différent de celui d Amérique du Sud.Nous avons comparé l incidence, la mortalité et la survie relative des patientes atteintes d un cancer invasif du sein (CIS) et des patientes atteintes d un cancer invasif du col de l utérus (CIC) entre la Guyane et la métropole.Le ratio incidence/mortalité indiquait que les cancers du sein étaient de plus mauvais pronostic en Guyane par rapport à la métropole.La survie relative des femmes atteintes d un CIS était inférieure en Guyane par rapport à la France métropolitaine.En Guyane, le taux standardisé d incidence du cancer du col de l utérus était 4 fois plus élevé qu en métropole. Les femmes vivant dans l intérieur de la Guyane semblaient être diagnostiquées à un stade plus tardif et plus souvent sur symptômes que les femmes du littoral. L accès aux soins des migrants est un challenge et une source d inégalité de santé. La détection précoce des cancers à travers des programmes de prévention est cruciale pour améliorer la survie par cancer et notamment chez les patients étrangersThe objective of the cancer registry of French Guiana is to compile all patients living in French Guiana with malignant invasive pathology and/or in situ lesions starting January 1st 2003 in persons living in French Guiana, whatever the tumoral location and the place of diagnosis and care. This study aimed to describe the population with invasive cancer to improve the knowledge about this disease in order to target public health interventions more effectively.The age standardised incidence rate was 30% times lower than in France in both sexes and the same than in South America.We compared incidence and relative survival of patients with invasive breast cancer (IBC) and patients with invasive cervical cancer (ICC) between women from French Guiana and metropolitan France.The ratio between incidence and mortality showed that the prognosis of IBC in French Guiana was worse than in metropolitan France.The relative survival rate among women with IBC in French Guiana was lower than among women in metropolitan France.In French Guiana, the age-standardized incidence rate of cervical cancer was four times higher than in France. Women living in remote areas seemed to be diagnosed later and more often following symptoms.Access to care for migrants is challenging and sustains health inequalities. Early detection through prevention programs is crucial for increasing cancer survival notably for foreign-born patients. Further studies with more patients and other variables could improve the knowledge about these diseases
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Stoebner, Anne. "Le registre des tumeurs de l'Hérault : incidence 1986-1988 : comparaisons avec les principaux registres français". Montpellier 1, 1991. http://www.theses.fr/1991MON11050.
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Arnaud, Catherine. "Analyse comparative des méthodes d'évaluation de l'exhaustivité des registres de tumeurs : propositions pour le registre de l'Hérault". Montpellier 1, 1992. http://www.theses.fr/1992MON11040.
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Puyade, Mathieu. "Parcours de soins des patients atteints d'hémopathies malignes en Poitou-Charentes". Thesis, Poitiers, 2017. http://www.theses.fr/2017POIT1407/document.
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La réduction des inégalités d'accès aux soins a toujours été un axe majeur des politiques de lutte contre le cancer. Alors qu'il existe de nombreuses études en cancérologie solide, peu d'études avec une méthodologie correcte existent en onco-hématologie, notamment chez les patients atteints de Myélome Multiple (MM). Cette maladie a vu son pronostic transformé par l'arrivée de nouvelles thérapeutiques dont l'usage a été rapidement intégré dans les recommandations de la Société Française d'Hématologie. L'objectif de travail intitulé Parcours de Soins des patients atteints d'hémopathie maligne en Poitou Charentes était donc de décrire et d'analyser les écarts aux recommandations, en prenant le MM comme premier exemple. Grâce au registre des Cancers Poitou-Charentes et à l'exhaustivité des cas qu'il assure, notre travail a permis de déterminer des variables associées à une inégalité d'accès aux soins. Ces variables sont démographiques (âge, distance entre le domicile et l'hôpital), liées à la tumeur (maladie symptomatique ou non), mais aussi organisationnelles (niveau de l'hôpital, passage en réunion de concertation pluridisciplinaire). De plus nous avons pu montrer que ces inégalités avaient un impact sur la survie globale des patients, notamment chez les plus âgés. Notre travail se poursuit par une analyse plus fine de la survie globale et l'étude des longs survivants du Myélome Multiple. A plus long terme, nous souhaitons appliquer cette approche à d'autres hémopathiesFrench national Cancer plans aimed to reduce health care inequalities. These inequalities are well known in solid cancers but few data with correct methodology exist in Hematology, especially in Multiple Myeloma (MM). The new treatments in this disease have dramatically improved Overall Survival. So guidelines of the Société Française d'Hématologie have quickly recommended the use of these new drugs. The aim of our work: Care Pathway of patients with hematological malignancies in Poitou Charentes area was to describe and analyze non compliance to guidelines. Based on the exhaustivity of the Poitou Charentes Cancer Registry, our work revealed variables associated with healthcare inequalities. They were demographical (age, distance between home and hospital), tumor-related (symptomatic MM or not) but also organizational (level of the hospital, multidisciplinary meeting). Moreover we showed that those inequalities had a negative impact on overall survival, especially in elderly people. Our work continues with more accurate analysis of overall survival and a study on MM long survivors. Longer-term studies would be to transfer this approach to other hemopathies
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Défossez, Gautier. "Le système d'information multi-sources du Registre général des cancers de Poitou-Charentes. Conception, développement et applications à l'ère des données massives en santé". Thesis, Poitiers, 2021. http://theses.univ-poitiers.fr/64594/2021-Defossez-Gautier-These.
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Les registres du cancer sont au plan international l’outil de référence pour produire une vision exhaustive (non biaisée) du poids, de la dynamique et de la gravité du cancer dans la population générale. Leur travail de classification et de codage des diagnostics selon des normes internationales confère aux données finales une qualité spécifique et une comparabilité dans le temps et dans l’espace qui les rendent incontournables pour décrire l’évolution et la prise en charge du cancer dans un environnement non contrôlé. Leur travail repose sur un processus d’enquête rigoureux dont la complexité est largement dépendante des capacités à accéder et à rassembler efficacement toutes les données utiles concernant un même individu. Créé en 2007, le Registre Général des Cancers de Poitou-Charentes (RGCPC) est un registre de génération récente, débuté à une période propice à la mise en œuvre d’une réflexion sur l’optimisation du processus d’enregistrement. Porté par l’informatisation des données médicales et l’interopérabilité croissante des systèmes d’information, le RGCPC a développé et expérimenté sur 10 ans un système d’information multi-sources associant des méthodes innovantes de traitement et de représentation de l’information fondées sur la réutilisation de données standardisées produites pour d’autres finalités.Dans une première partie, ce travail présente les principes fondateurs et l’implémentation d’un système capable de rassembler des volumes élevés de données, hautement qualifiantes et structurées, et rendues interopérables sur le plan sémantique pour faire l’objet d’approches algorithmiques. Les données sont collectées pluri annuellement auprès de 110 partenaires représentant sept sources de données (cliniques, biologiques et médico-administratives). Deux algorithmes assistent l’opérateur du registre en dématérialisant une grande partie des tâches préalables à l’enregistrement des tumeurs. Un premier algorithme crée les tumeurs et leurs caractéristiques (publication), puis un 2ème algorithme modélise le parcours de soin de chaque individu selon une séquence ordonnée d’évènements horodatés consultable au sein d’une interface sécurisée (publication). Des approches de machine learning sont testées pour contourner l’éventuelle absence de codification des prélèvements anatomopathologiques (publication).La deuxième partie s’intéresse au large champ de recherche et d’évaluation rendu possible par la disponibilité de ce système d’information intégré. Des appariements avec d’autres données de santé ont été testés, dans le cadre d’autorisations réglementaires, pour enrichir la contextualisation et la connaissance des parcours de soins, et reconnaître le rôle stratégique des registres du cancer pour l’évaluation en « vie réelle » des pratiques de soins et des services de santé (preuve de concept) : dépistage, diagnostic moléculaire, traitement du cancer, pharmaco épidémiologie (quatre publications principales). L’appariement des données du RGCPC à celles du registre REIN (insuffisance rénale chronique terminale) a constitué un cas d’usage veillant à expérimenter un prototype de plateforme dédiée au partage collaboratif des données massives en santé (publication).La dernière partie de ce travail propose une discussion ouverte sur la pertinence des solutions proposées face aux exigences de qualité, de coût et de transférabilité, puis dresse les perspectives et retombées attendues pour la surveillance, l’évaluation et la recherche à l’ère des données massives en santéPopulation-based cancer registries (PBCRs) are the best international option tool to provide a comprehensive (unbiased) picture of the weight, incidence and severity of cancer in the general population. Their work in classifying and coding diagnoses according to international rules gives to the final data a specific quality and comparability in time and space, thus building a decisive knowledge database for describing the evolution of cancers and their management in an uncontrolled environment. Cancer registration is based on a thorough investigative process, for which the complexity is largely related to the ability to access all the relevant data concerning the same individual and to gather them efficiently. Created in 2007, the General Cancer Registry of Poitou-Charentes (RGCPC) is a recent generation of cancer registry, started at a conducive time to devote a reflection about how to optimize the registration process. Driven by the computerization of medical data and the increasing interoperability of information systems, the RGCPC has experimented over 10 years a multi-source information system combining innovative methods of information processing and representation, based on the reuse of standardized data usually produced for other purposes.In a first section, this work presents the founding principles and the implementation of a system capable of gathering large amounts of data, highly qualified and structured, with semantic alignment to subscribe to algorithmic approaches. Data are collected on multiannual basis from 110 partners representing seven data sources (clinical, biological and medical administrative data). Two algorithms assist the cancer registrar by dematerializing the manual tasks usually carried out prior to tumor registration. A first algorithm generate automatically the tumors and its various components (publication), and a second algorithm represent the care pathway of each individual as an ordered sequence of time-stamped events that can be access within a secure interface (publication). Supervised machine learning techniques are experimented to get around the possible lack of codification of pathology reports (publication).The second section focuses on the wide field of research and evaluation achieved through the availability of this integrated information system. Data linkage with other datasets were tested, within the framework of regulatory authorizations, to enhance the contextualization and knowledge of care pathways, and thus to support the strategic role of PBCRs for real-life evaluation of care practices and health services research (proof of concept): screening, molecular diagnosis, cancer treatment, pharmacoepidemiology (four main publications). Data from the RGCPC were linked with those from the REIN registry (chronic end-stage renal failure) as a use case for experimenting a prototype platform dedicated to the collaborative sharing of massive health data (publication).The last section of this work proposes an open discussion on the relevance of the proposed solutions to the requirements of quality, cost and transferability, and then sets out the prospects and expected benefits in the field of surveillance, evaluation and research in the era of big data
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Amado, João Manuel da Costa. "Epidemiologia e registos de cancro : Contribuição de um registo de base populacional". Doctoral thesis, Universidade do Porto. Reitoria, 1994. http://hdl.handle.net/10216/10236.
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Amado, João Manuel da Costa. "Epidemiologia e registos de cancro : Contribuição de um registo de base populacional". Tese, Universidade do Porto. Reitoria, 1994. http://hdl.handle.net/10216/10236.
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Gharavi, Catherine. "Récidive après traitement conservateur pour cancer du sein : registre des cancers de Côte d'Or". Dijon, 1996. http://www.theses.fr/1996DIJOM038.
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Teixeira, Vânia Sofia Martins. "Custos diretos do tratamento do cancro do cólon no Algarve". Master's thesis, Universidade Nova de Lisboa. Escola Nacional de Saúde Pública, 2012. http://hdl.handle.net/10362/9351.
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RESUMO - O cancro colorretal é um dos tumores mais comuns nos países desenvolvidos e um grave problema de saúde pública. Em Portugal constitui a terceira causa de morte por cancro em ambos os sexos e a segunda para cada sexo separadamente. A sua importância tem vindo a aumentar devido aos custos pessoais e sociais, surgindo internacionalmente como a segunda doença oncológica com os custos económicos mais elevados. No contexto atual, onde os gastos continuam a aumentar e os recursos são limitados, é importante tornar acessível aos decisores políticos o valor dos custos do cancro do cólon, para comparar opções para a prevenção e tratamento desta doença, no momento de afetar os recursos e financiamento do cancro.
O objetivo do estudo é medir os custos diretos do tratamento do cancro do cólon na região do Algarve no ano de 2007. Para além da caracterização sociodemográfica e clínica dos doentes, pretende-se relacionar os custos das diferentes tipologias de diagnóstico e tratamento com os estádios da doença, com a idade e com o sexo.
Propõe-se um estudo retrospetivo, analítico, transversal, que segue a abordagem custos da doença baseada na prevalência, adotando a perspetiva dos serviços de saúde. A principal fonte dos dados é a plataforma do ROR-Sul, extraindo-se a população constituída por todos os doentes com diagnóstico de cancro do cólon entre 1 de janeiro de 2007 e 31 de dezembro de 2007, residentes no distrito de Faro (n=170). Para a valorização dos custos recorre-se às Portarias que regulam as tabelas de preços dos serviços do Sistema Nacional de Saúde, à contabilidade analítica dos hospitais e ao Infarmed. Os resultados serão analisados através do Statistical Program for Social Sciences (SPSS) versão 20. De forma a verificar a existência de diferenças estatísticas, em termos de médias e da existência de relações, entre as variáveis sociodemográficas e clínicas utilizaram-se vários testes.
Consideramos que este estudo será um importante ponto de partida para posteriores análises económicas completas, em termos dos seus custos e suas consequências, nomeadamente a realização da análise custo-efetividade de programas de prevenção primária e secundária do cancro do cólon.ABSTRACT - Colorectal cancer is one of the most common tumours in developed countries and a serious public health issue. In Portugal, it is the third leading cause of cancer death in both sexes and the second for each sex separately. Its importance has been increasing due to personal and social costs, internationally emerging as the second most expensive cancer disease. In the current environment, where costs continue to increase and resources are limited, it is important to give to policy makers an accurate value of the costs of colon cancer, enabling to compare options for prevention and treatment of this disease, when the moment comes to allocate resources and funding for cancer treatment. The aim of the study is to measure the direct costs of colon cancer treatment in Algarve region in 2007 year. Besides sociodemographic and clinical characterization of the patients, we intend to relate the costs of different types of diagnosis and treatment stages of the disease, with age and sex. We propose a retrospective, analytical and a cross study, following an approach based on the costs of disease prevalence, adopting a health services perspective. The main source of data is the platform of the ROR-Sul, extracting the population consisted by all patients diagnosed with colon cancer between January 1st and December 31st 2007, residents in the district of Faro (n=170). For the costs assessment, it was followed local legal rules in force that regulates the price lists of the National Health System services, hospitals cost accounting and national drug authority (Infarmed). The results will be evaluated by using the Statistical Program for Social Sciences (SPSS) version 20. In order to check for statistical differences in terms of averages and the existence of relationships between the sociodemographic and clinical variables, several tests were made. We believe that this study will be an important starting point for further economic complete analysis in terms of its costs and its consequences, namely the realization of cost-effectiveness of programs for primary and secondary prevention of colon cancer.
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Galvin, Angeline. "Accès aux soins et pronostic des personnes âgées atteintes d’un cancer : analyse des déterminants à partir de données issues de registres des cancers et de cohortes en Gironde". Thesis, Bordeaux, 2017. http://www.theses.fr/2017BORD0900/document.
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Le vieillissement de la population associé à un nombre croissant de cancers constituent une réalité épidémiologique qui soulève des interrogations sur l’accès aux soins et le pronosticdes sujets âgés avec un cancer, pour lesquels des disparités ont été mises en évidence. Toutefois, les études présentent plusieurs limites dont l’absence de facteurs spécifiques aux personnes âgées (PA). L’objectif de ce travail était d’étudier les déterminants sociodémographiques, socioéconomiques et cliniques de l’accès aux soins (stade de cancer, traitement) et du pronostic (déclin fonctionnel, survie) chez des PA atteintes d’un cancer. Les travaux ont été réalisés à partir de données issues de registres de cancers et de troiscohortes de PA en Gironde (486 patients de 65 ans et plus, période 2005-14). Les cohortes ont permis de disposer de données telles que le niveau d’éducation, le revenu, la prise demédicaments, la dépendance ou la démence. Selon l’objectif (accès/pronostic), nous avons utilisé différentes méthodes pour prendre en compte le type de données et de critères (régression logistique, modèles multiniveaux, modèles multi-état et de Cox). Notre population était composée pour plus de la moitié de PA de 80 ans et plus, de sexe masculin et ayant un niveau d’éducation supérieur au niveau primaire. Nous nous sommes d’abord intéressés aux déterminants de l’accès aux soins. Aucun déterminant d’un stade avancé de cancer au diagnostic n’a pu être mis en évidence, un niveau d’éducation faible était proche de la significativité pour les cancers avec un stade avancé (p=0,0671). Pour l’accès à un traitement du cancer, nous avons mis en évidence qu’un stade avancé (p=0,003) et la présence d’une démence (p=0,0109) étaient associés à un risque plus faible de recevoir un traitement. Nous avons ensuite étudié les déterminants du pronostic. Les sujets les plus âgés présentaient toujours un risque plus élevé de déclin fonctionnel (p<0,005), quel que soit le critère analysé. Les sujets ayant un faible niveau d’éducation (p=0,027), prenant plus de six médicaments par jour (p=0,047), présentant une démence (p<0,001) ou diagnostiqués à un stade avancé (p<0,001) avaient une probabilité de déclin fonctionnel plus importante, les résultats variant selon le critère. Enfin, à 12, 24 et 36 mois, la probabilité de survie globale était respectivement de 66, 57 et 48%. Le risque de décès était plus élevé chez les hommes (p=0,019), diagnostiqués à un stade avancé de cancer (p<0,001) et sans traitement du cancer (p<0,001), mais aussi chez les fumeurs (actuels et anciens) (p=0,019) et les PA dépendantes (p<0,001). En sus de déterminants classiques de l’accès aux soins ou du pronostic des cancers, nous avons mis en évidence pour les PA, le rôle des déficits cognitifs pour l’accès à un traitement ou sur le pronostic fonctionnel et celui de la dépendance sur la survie. Chez les PA avec un cancer, les facteurs spécifiques aux PA semblent donc essentiels à analyser. L’analyse des liens de causalité entre les déterminants de santé reste un sujet particulièrement intéressant dans cette population de PA comme pour les patients avec un cancerThe growing incidence of cancer associated to an aging population represents an epidemiologic reality that requires questioning access to care and prognosis in elderly with cancer, for which disparities have been highlighted. However, generally speaking, studies are limited in that they overlook geriatric-specific factors. The aim of this work was to study sociodemographic, socioeconomic and clinical determinants of access to care (cancer stage, cancer treatment) and prognosis (functional decline, survival) in elderly cancer patients. This research project has relied on data from cancer registries and three elderly cohort studies in the French department of Gironde (486 patients aged 65 and over from 2005 to 2014). The cohorts provided data such as education level, income, medication, dependency and dementia. Depending on the aim, we used different statistical methods to analyze different types of data and outcomes (logistic regression, multi-level model, multi-state model, Cox model). More than half of our population was aged 80 and over, male and had high education degrees. First, we studied determinants of access to care. No determinant of advance stage at diagnosis was found, but low education was close to significance for advanced stage (p=0.067). Concerning cancer treatment administration, advanced stage at diagnosis (p=0.003) and diagnosis of dementia (p=0.011) were associated with a lower risk of treatment administration. Second, we studied determinants of prognosis. Older old had higher risk of functional decline (p<0.001), regardless of the outcome. Subjects with low education (p=0.027), taking more than six daily drugs (0.047), presenting diagnosed dementia (p<0.001) or those with advanced cancer stage at diagnosis had higher risk of functional decline, results depending on outcome. At last, overall survival at 12, 24 and 36 months was 66, 55 and 48%, respectively. Risk of death was higher in men (p=0.019), in patients with advanced stage at diagnosis (p<0.001) or without treatment (p<0.001) in current and former smokers (p=0.019) and in dependent elderly patients (p<0.001). In addition to classical determinants of access to care and prognosis in cancer, we demonstrated the impact of cognitive impairment on treatment administration or functional prognosis, and that of dependency on survival. . It appears essential to consider geriatric specific factors in studies on the elderly with cancer population. The causality between health determinants is particularly interesting in the elderly as well as in the cancer populations
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Bailly, Laurent. "Validation et exploitation d’un registre histologique des cancers : Estimation par capture recapture de l’exhaustivité par modélisation log-linéaire et selon les modèles écologiques Mtbh en Bayesien". Thesis, Montpellier 1, 2011. http://www.theses.fr/2011MON1T036/document.
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Introduction: Les études populationnelles sur le cancer nécessitent un recensement de référence fiable et exhaustif, en théorie possible à partir d'un recueil histologique. Méthode: Depuis 2005, toutes les structures d'anatomopathologie des Alpes-Maritimes adressent les codes ADICAP des tumeurs malignes et invasives et identifiants patients. L'exhaustivité pour les cancers du sein et colorectaux des 50-75 ans a été évalué par méthode de capture recapture en modélisation log-linéaire et en Bayesien à partir des cas communs ou non dépistés et vus en Réunion de Concertation Pluridisciplinaire. RésultatUn programme d'assurance qualité a permis de s'assurer de la fiabilité des données recueillies.L'estimation de l'exhaustivité était de plus de 90 % pour les cancers du sein et colorectaux des 50-75 ans. Les taux observés sur le département des Alpes-Maritimes, comparés aux taux estimés en France, se sont révélés cohérents.Enfin, la base a été utilisée pour déterminer l'existant les lésions prénéoplasiques du col de l'utérus avant la vaccination anti-HPV. ConclusionCe travail conclut à l'intérêt d'un recueil histologique des cas de cancers incidentsIntroduction Cancer population studies require reliable and complete baseline data, which should theoretically be available by collecting histopathology records.Method Since 2005, all histopathology laboratories from Alpes-Maritimes address ADICAP codes for invasive cancer and patient identifiers. The completeness of such a collection was evaluated using capture-recapture analysis based on three data sources concerning breast and colorectal cancers with the number of cases which were common or not between sources recording screened, diagnosed and treated cancers in the French Alpes Maritimes districtResult Data quality for the ADICAP code database may be considered satisfactoryThe estimated completeness of cancer records collected from histopathology laboratories was higher than 90%.Rates observed in the Alpes-Maritimes, compared with estimated rates in France have proven consistent. Rates of CIN for the entire female population of the Alpes-Maritimes in 2006 has been established.Conclusion A verified and validated histopathology data collection may be useful for cancer population studies
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Faivre-Finn, Corinne. "Amélioration des pratiques de soin et du pronostic du cancer colo-rectal : études de population". Dijon, 2001. http://www.theses.fr/2001DIJOMU10.
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LA PRISE EN CHARGE DU CANCER COLO-RECTAL A BEAUCOUP EVOLUE AU COURS DES 25 DERNIERES ANNEES. TRES PEU DE DONNEES SONT DISPONIBLES CONCERNANT LES AMELIORATIONS THERAPEUTIQUES, L'IMPACT DES ESSAIS THERAPEUTIQUES SUR LES PRATIQUES DE SOIN ET L'EVOLUTION DU PRONOSTIC DE CETTE MALADIE A L'ECHELLE D'UNE POPULATION. CE TRAVAIL EST BASE SUR LES REGISTRES DES TUMEURS DIGESTIVES DE LA COTE-D'OR, DE LA SAONE ET LOIRE ET DU CALVADOS. LE TAUX D'EXERESE EST PASSE DE 66. O % A 80. 1 % ENTRE 1978 A 1993 POUR LE CANCER DU RECTUM ET DE 69. 3 % A 91. 9 % ENTRE 1976 ET 1991 (TAUX STABLE APRES 1991) POUR LE CANCER DU COLON. POUR LES CANCERS DU COLON ET DU RECTUM, LE TAUX DE PATIENTS DIAGNOSTIQUES AUX STADES I ET II A GLOBALEMENT AUGMENTE, CORRESPONDANT A UNE DIMINUTION DU TAUX DE PATIENTS DIAGNOSTIQUE A DES STADES AVANCES. LES AUTRES PROGRES MAJEURS CONCERNANT LE CANCER DU RECTUM SONT L'AUGMENTATION DU TAUX DE CONSERVATION SPHINCTERIENNE ET DU TAUX DE PATIENTS TRAITES AVEC UNE RADIOTHERAPIE ADJUVANTE. CONCERNAT LES CANCERS DU COLON, LE TAUX DE PATIENTS TRAITES AVEC UNE CHIMIOTHERAPIE ADJUVANTE A NETTEMENT AUGMENTE POUR LES STADES III MAIS AUSSI POUR LES STADES II. ENFIN LE TAUX DE MORTALITE POSTOPERATOIRE A DIMINUE SIGNIFICATIVEMENT POUR CES DEUX LOCALISATIONS. L'ENSEMBLE DE CES AMELIORATIONS A CONDUIT A UNE AMELIORATION DES TAUX DE SURVIE RELATIVE A 5 ANS PASSANT DE 35. 4 % (PERIODE 1978-1981) A57. 0 % (PERIODE 1985-1989) POUR LE CANCER DU RECTUM ET DE 33. 0 % A 55. 3 % (PERIODE 1976-1979) A 55. 3 %(sic) (PERIODE 1992-1995) POUR LE CANCER DU COLON. L'ENSEMBLE DE CE TRAVAIL MONTRE QUE MALGRE LES AMELIORATIONS IMPORTANTES QUI ONT EU LIEU LA PRISE EN CHARGE DU CANCER COLORECTAL (sic) DES PROGRES SONT TOUJOURS POSSIBLES, PARTICULIEREMENT CHEZ LES SUJETS AGES DE PLUS DE 75 ANS.
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Tedardi, Marcello Vannucci. "Estudo da viabilidade da implantação de um registro de câncer animal na cidade de São Paulo, SP, Brasil". Universidade de São Paulo, 2015. http://www.teses.usp.br/teses/disponiveis/10/10133/tde-14082015-140756/.
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Registros de Câncer são sistemas padronizados, flexíveis e multicêntricos para coleta de dados de pacientes com neoplasias, permitindo a obtenção de dados epidemiológicos de alta qualidade a um baixo custo. Eles podem ser de base populacional, abrangendo todos os casos de uma área geográfica delimitada, possibilitando calcular sua incidência e sobrevida, quanto de base hospitalar, coletando dados sobre o paciente para uso em pesquisa, educação continuada e melhoria dos atendimentos. Essas abordagens, na Medicina Veterinária, tiveram início na década de 60 com o Kansas Animal Tumor Registry (1961) e com o California Animal Tumor Registry (1963). Desde então, outras iniciativas similares surgiram nos Estados Unidos, Canadá, Noruega, Dinamarca, Suécia e Reino Unido. Esses registros, concentrados no Hemisfério Norte, não existem ainda na América Latina. Este trabalho teve como objetivo avaliar a viabilidade de implantação de um Registro de Câncer Animal na cidade de São Paulo, SP, Brasil. Elaborou-se um registro piloto para permitir entender a sua viabilidade em larga escala quanto Sistema de Informação em Saúde. Foram desenvolvidos identidade, logotipo, formulários de admissão e seguimento, e um software especializado, o SIRCA-SP, para o funcionamento do Registro de Câncer Animal de São Paulo (RCA-SP). O fluxo de informação foi planejado para que a coleta pudesse ser realizada de forma multicêntrica, padronizada e sigilosa. A análise preliminar dos dados permite entender as características da distribuição local do câncer e o potencial do RCA-SP. O estudo de viabilidade foi realizado através de parâmetros definidos pelo Center for Diseases Control, Atlanta, EUA. O RCA-SP foi criado, em 2013, como um registro de base hospitalar que coleta informações sobre cães e gatos diagnosticados com câncer a partir de janeiro de 2012 em hospitais, clínicas e serviços autônomos veterinários sediados na cidade de São Paulo. O software SIRCA-SP foi desenvolvido para otimizar e garantir a qualidade dos dados coletados, consolidados e armazenados pelo RCA-SP. O sistema possui interface amigável e pode ser acessado via internet. Os formulários foram padronizados e geram dados comparáveis aos outros Registros de Câncer em animais e humanos. Avaliação preliminar dos dados demonstra predomínio, nos 645 casos registrados de cães (96,58%) e de fêmeas (80,15%). As localizações de câncer mais comuns foram em glândula mamária (63,88%), pele (17,98%) e em órgãos genitais (5,43%). O sistema demonstrou ser simples, flexível, bem aceito, oportuno e útil. A sua representatividade, por ser projeto piloto, é pequena, mas tenderá a aumentar com adesão de novas fontes notificadoras. O sistema não possui mecanismos de garantia de sua exaustividade. Algumas soluções como o sistema de pré-verificação de inclusão, projetado para evitar entrada duplicada de dados, e a integração entre prontuário eletrônico e os campos de interesse epidemiológico auxiliam na distribuição de responsabilidades do registro aos usuários e, consequente, diminuição de custos operacionais. A implantação de um Registro de Câncer Animal na cidade de São Paulo mostrou-se viável e a coleta multicêntrica é realizada de forma contínua e ininterruptaCancer Registries are flexible, multicentric and standardized systems to collect data from patients with neoplasia, allowing the epidemiological registry of high quality data, at low cost. They can be classified as population-based, covering all cases in a defined geographical area, allowing incidence and survival calculation, or, hospital-based, collecting data about the patient for research, continuing education and improvement of care. Those approaches started in Veterinary Medicine in the 60’s, with the Kansas Animal Tumor Registry (1961) and the California Animal Tumor Registry (1963). Since then, other similar initiatives have emerged in United States, Canada, Norway, Denmark, Sweden, Italy and United Kingdom. Those registries, concentrated in North Hemisphere, were absent in Latin America up to now. This study aimed to assess the feasibility of implementing an Animal Cancer Registry in Sao Paulo, SP, Brazil. A pilot cancer registry system was developed to allow understanding its feasibility, in large scale, as a Health Information System. An identity, logo, admission and follow-up forms were developed, and a specialized software, the SIRCA-SP, for Sao Paulo Animal Cancer Registry (RCA-SP) operation was standardized. An information flow was planned, so that the collection could be performed in a multicentric, standardized and confidential way. Preliminary analysis of the data allowed the understanding of local cancer distribution characteristics and the RCA-SP potential. The feasibility study was perform using parameters defined by the Centers for Disease Control, Atlanta, USA. The RCA-SP, created in 2013, is a hospital-based cancer registry, which collects information about dogs and cats diagnosed with cancer since January 2012 in hospitals, clinics and veterinary autonomous services in Sao Paulo, SP, Brazil. The SIRCA-SP was designed to optimize and ensure the quality of data collection, consolidation and storing by RCA-SP. The system has a friendly interface and can be access via Internet. The forms were standardized and generate data comparable to other cancer registries in animals and humans. Preliminary survey data shows predominance, in the 645 cases, of dogs (96.58%) and females (80.15%). The most common cancer location were mammary gland (63.88%), skin (17.98%) and genitals (5.43%). The system proved to be simple, flexible, well accepted, timely and useful. As a pilot study, its representativeness is still small, but tends to increase with the accession of new reporting sources. The system has no assurance mechanisms of their completeness. Some solutions such, as the pre-verification tool, designed to avoid duplicated entries, and the electronic medical records integration with the standard epidemiological fields, share the fields to assist in the distribution of registry responsibilities to users and, consequently, decrease operating costs. The implementation of an Animal Cancer Registry in São Paulo proved to be feasible, and the multicentric collection is ready to be carried out continuously and uninterruptedly
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Corner, Jessica Lois. "The newly registered nurse and the cancer patient". Thesis, King's College London (University of London), 1990. https://kclpure.kcl.ac.uk/portal/en/theses/the-newly-registered-nurse-and-the-cancer-patient(be199839-8d7b-4657-930a-ebdce68565a6).html.
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Yu, Xue Qin. "Comparing survival from cancer using population-based cancer registry data - methods and applications". Thesis, The University of Sydney, 2007. http://hdl.handle.net/2123/1774.
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Over the past decade, population-based cancer registry data have been used increasingly worldwide to evaluate and improve the quality of cancer care. The utility of the conclusions from such studies relies heavily on the data quality and the methods used to analyse the data. Interpretation of comparative survival from such data, examining either temporal trends or geographical differences, is generally not easy. The observed differences could be due to methodological and statistical approaches or to real effects. For example, geographical differences in cancer survival could be due to a number of real factors, including access to primary health care, the availability of diagnostic and treatment facilities and the treatment actually given, or to artefact, such as lead-time bias, stage migration, sampling error or measurement error. Likewise, a temporal increase in survival could be the result of earlier diagnosis and improved treatment of cancer; it could also be due to artefact after the introduction of screening programs (adding lead time), changes in the definition of cancer, stage migration or several of these factors, producing both real and artefactual trends. In this thesis, I report methods that I modified and applied, some technical issues in the use of such data, and an analysis of data from the State of New South Wales (NSW), Australia, illustrating their use in evaluating and potentially improving the quality of cancer care, showing how data quality might affect the conclusions of such analyses. This thesis describes studies of comparative survival based on population-based cancer registry data, with three published papers and one accepted manuscript (subject to minor revision). In the first paper, I describe a modified method for estimating spatial variation in cancer survival using empirical Bayes methods (which was published in Cancer Causes and Control 2004). I demonstrate in this paper that the empirical Bayes method is preferable to standard approaches and show how it can be used to identify cancer types where a focus on reducing area differentials in survival might lead to important gains in survival. In the second paper (published in the European Journal of Cancer 2005), I apply this method to a more complete analysis of spatial variation in survival from colorectal cancer in NSW and show that estimates of spatial variation in colorectal cancer can help to identify subgroups of patients for whom better application of treatment guidelines could improve outcome. I also show how estimates of the numbers of lives that could be extended might assist in setting priorities for treatment improvement. In the third paper, I examine time trends in survival from 28 cancers in NSW between 1980 and 1996 (published in the International Journal of Cancer 2006) and conclude that for many cancers, falls in excess deaths in NSW from 1980 to 1996 are unlikely to be attributable to earlier diagnosis or stage migration; thus, advances in cancer treatment have probably contributed to them. In the accepted manuscript, I described an extension of the work reported in the second paper, investigating the accuracy of staging information recorded in the registry database and assessing the impact of error in its measurement on estimates of spatial variation in survival from colorectal cancer. The results indicate that misclassified registry stage can have an important impact on estimates of spatial variation in stage-specific survival from colorectal cancer. Thus, if cancer registry data are to be used effectively in evaluating and improving cancer care, the quality of stage data might have to be improved. Taken together, the four papers show that creative, informed use of population-based cancer registry data, with appropriate statistical methods and acknowledgement of the limitations of the data, can be a valuable tool for evaluating and possibly improving cancer care. Use of these findings to stimulate evaluation of the quality of cancer care should enhance the value of the investment in cancer registries. They should also stimulate improvement in the quality of cancer registry data, particularly that on stage at diagnosis. The methods developed in this thesis may also be used to improve estimation of geographical variation in other count-based health measures when the available data are sparse.
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Yu, Xue Qin. "Comparing survival from cancer using population-based cancer registry data - methods and applications". University of Sydney, 2007. http://hdl.handle.net/2123/1774.
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Doctor of PhilosophyOver the past decade, population-based cancer registry data have been used increasingly worldwide to evaluate and improve the quality of cancer care. The utility of the conclusions from such studies relies heavily on the data quality and the methods used to analyse the data. Interpretation of comparative survival from such data, examining either temporal trends or geographical differences, is generally not easy. The observed differences could be due to methodological and statistical approaches or to real effects. For example, geographical differences in cancer survival could be due to a number of real factors, including access to primary health care, the availability of diagnostic and treatment facilities and the treatment actually given, or to artefact, such as lead-time bias, stage migration, sampling error or measurement error. Likewise, a temporal increase in survival could be the result of earlier diagnosis and improved treatment of cancer; it could also be due to artefact after the introduction of screening programs (adding lead time), changes in the definition of cancer, stage migration or several of these factors, producing both real and artefactual trends. In this thesis, I report methods that I modified and applied, some technical issues in the use of such data, and an analysis of data from the State of New South Wales (NSW), Australia, illustrating their use in evaluating and potentially improving the quality of cancer care, showing how data quality might affect the conclusions of such analyses. This thesis describes studies of comparative survival based on population-based cancer registry data, with three published papers and one accepted manuscript (subject to minor revision). In the first paper, I describe a modified method for estimating spatial variation in cancer survival using empirical Bayes methods (which was published in Cancer Causes and Control 2004). I demonstrate in this paper that the empirical Bayes method is preferable to standard approaches and show how it can be used to identify cancer types where a focus on reducing area differentials in survival might lead to important gains in survival. In the second paper (published in the European Journal of Cancer 2005), I apply this method to a more complete analysis of spatial variation in survival from colorectal cancer in NSW and show that estimates of spatial variation in colorectal cancer can help to identify subgroups of patients for whom better application of treatment guidelines could improve outcome. I also show how estimates of the numbers of lives that could be extended might assist in setting priorities for treatment improvement. In the third paper, I examine time trends in survival from 28 cancers in NSW between 1980 and 1996 (published in the International Journal of Cancer 2006) and conclude that for many cancers, falls in excess deaths in NSW from 1980 to 1996 are unlikely to be attributable to earlier diagnosis or stage migration; thus, advances in cancer treatment have probably contributed to them. In the accepted manuscript, I described an extension of the work reported in the second paper, investigating the accuracy of staging information recorded in the registry database and assessing the impact of error in its measurement on estimates of spatial variation in survival from colorectal cancer. The results indicate that misclassified registry stage can have an important impact on estimates of spatial variation in stage-specific survival from colorectal cancer. Thus, if cancer registry data are to be used effectively in evaluating and improving cancer care, the quality of stage data might have to be improved. Taken together, the four papers show that creative, informed use of population-based cancer registry data, with appropriate statistical methods and acknowledgement of the limitations of the data, can be a valuable tool for evaluating and possibly improving cancer care. Use of these findings to stimulate evaluation of the quality of cancer care should enhance the value of the investment in cancer registries. They should also stimulate improvement in the quality of cancer registry data, particularly that on stage at diagnosis. The methods developed in this thesis may also be used to improve estimation of geographical variation in other count-based health measures when the available data are sparse.
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Jégu, Jérémie. "Cancer ultérieur chez les survivants d'un premier cancer : incidence et impact sur la survie". Thesis, Strasbourg, 2014. http://www.theses.fr/2014STRAJ006/document.
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Les objectifs de cette thèse étaient d’étudier les tendances du risque de second cancer primitif (SPC) selon l’année de diagnostic d’un premier cancer des voies aéro-digestives supérieures (VADS) dans le Bas-Rhin, de produire les premières estimations de l’incidence des SPC à l’échelle nationale en France et d’estimer la survie des patients atteints d’un cancer des VADS selon la présence d’antécédents de cancer. Ce travail a montré que : 1) L’excès de risque de SPC des VADS et de l’œsophage a diminué de 53% entre 1975 et 2006 dans le Bas-Rhin, mais que le risque de SPC du poumon est resté stable ; 2) Le risque de SPC en France est augmenté de 36% chez les patients atteints de cancer par rapport à la population générale ; 3) La survie des hommes atteints d’un cancer des VADS était fortement associée à la présence d’antécédents de cancer. Des perspectives se dégagent de ce travail en termes de recherche épidémiologique, de recherche clinique et de politiques de santé publiqueThe objectives of this PhD thesis were: to study the trends of the risk of second primary cancer (SPC) among patients with a head and neck (HNSCC) cancer in Bas-Rhin, to provide first nationwide estimates of the risk of SPC in France and to assess the survival of patients with a HNSCC depending on their history of cancer. This work showed that : 1) The excess risk of SPC of head and neck and esophagus sites decreased by 53% over three decades among patients with a HNSCC, and that the excess risk of SPC of the lung did not change significantly. 2) The risk of SPC among cancer survivors in France was increased by 36% compared to the general population. 3) History of cancer was strongly associated with survival among HNSCC patients. Several epidemiological and clinical research perspectives can be established based on this work. These results also present an interest in a public health perspective in the framework of the third cancer plan
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Vaittinen, Pauli. "Risk characterization of familial cancer using the Swedish Family-Cancer database with a special reference to breast cancer /". Stockholm, 2003. http://diss.kib.ki.se/2003/91-7349-723-1/.
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BAY, JACQUES-OLIVIER. "Formes familiales de cancers : methodes d'etude et de recherche ; role d'un registre des tumeurs". Besançon, 1992. http://www.theses.fr/1992BESA3025.
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VICTORIA, JOELLE. "Registre du rhone des cancers du sein : resultats des annees 1988-1990". Lyon 1, 1991. http://www.theses.fr/1991LYO1M394.
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De, Camargo Cancela Marianna. "Les cancers de la cavité buccale et de l'oropharynx dans le monde : incidence internationale et classification TNM dans les registres du cancer". Phd thesis, Université Claude Bernard - Lyon I, 2010. http://tel.archives-ouvertes.fr/tel-00599275.
Texto completoResumen
L'objectif de ces travaux est de connaître et évaluer les caractéristiques épidémiologiques des cancers de la cavité orale et de l'oropharynx. Ces deux localisations partagent des facteurs de risque en commun, et sont de fait souvent regroupées dans les études épidémiologiques. Cependant, la découverte de facteurs de risque spécifiques, telle l'infection par le virus du papillome humain pour les cancers de l'oropharynx, nous conduit à fournir des taux d'incidence spécifiques avec la classification anatomique de ces cancers. En réorganisant les données disponibles dans la base des données du Centre International de Recherche sur le Cancer, nous avons recherché les cas incidents au niveau mondial et recalculé les taux d'incidence dans les registres de 60 pays, pendant la période 1998-2002. La classification TNM n'est pas disponible dans les bases de données du CIRC. Nous avons identifié et contacté les registres du cancer qui ont déclaré son recueil. Cela nous a permis de créer et structurer une base des données innovante et inédite, dont les informations ont été analysées par rapport à la qualité. Finalement nous avons comparé la distribution de stades précoces et avancés dans 8 pays. Les résultats montrent que l'incidence des cancers de la cavité buccale et de l'oropharynx est très hétérogène au niveau mondial par rapport à la sous localisation des tumeurs, à l'âge d'incidence, au ratio homme/femme et au stade clinique.
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Abulkasim, Muna Abdussalam Owen. "The prevalence of breast cancer in Africa and establishment of The Libyan Breast Cancer Registry". Master's thesis, Faculty of Health Sciences, 2020. http://hdl.handle.net/11427/32180.
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Breast cancer is well-known globally and remains one of the principal health concerns affecting women, and a rare malignancy in men. Although, there has been significant progress made in prevention strategies such as early detection and better treatment in most developed countries, incidence and mortality rates of breast cancer continued to rise. The rise is significant in Africa, a continent low in resources with a growing and ageing population exposed to risk factors leading to developing the disease. Although the incidence of breast cancer is lower in Africa than in high-income countries, mortality rates are high, mainly in women less than fifty years of age. Like most African countries, Libya is least prepared to cope with breast cancer and cancer in general. Additionally, many Libyans are adopting unhealthy lifestyles together which, together with environmental changes and high life expectancy, is perhaps the cause of rising cancer rates. However, no systematic collection of breast cancer incidence is currently undertaken, which in turn, impacts the implementation of detection and treatment measures. This thesis sought to evaluate the situation of breast cancer in Africa and specifically, for Libyan patients, through a systematic review of prevalence studies in Africa and by designing a registry for Libyan breast cancer patients. Objectives : • To conduct a systematic review and literature-based meta-analysis to provide an evidence-based estimate of the prevalence rate of breast cancer in Africa. This systematic review provides epidemiological data to guide health practitioners, educators and researchers for further studies needed in the field of breast cancer, specific for African patients. • To design a breast cancer registry for Libyan breast cancer patients. Developing a Libyan breast cancer registry provides an opportunity to learn more about disease development, and the changes through the course of the patient's life. Secondly, we will be able to track the incidence, mortality, and survival of patients diagnosed with breast cancer and their distribution in Libya. Finally, the information will be translated into numbers to aid policymakers in measuring the extent of the problem and help researchers in taking action needed to reduce the breast cancer load in Libya. Methods: • A systematic literature search was performed to identify studies retrieved from electronic databases, grey literature and reference lists, with no time and language limits. We have reviewed the available studies addressing the prevalence rate of breast cancer for African patients living in Africa who developed the disease. • Secondly, the Libyan Breast Cancer Registry (LBCR) is a prospective, hospital-based registry planned to document clinical and imaging characteristics of patients at presentation. Through follow-up, we will document disease progression and treatment practices to reliably determine the incidence of all-cause mortality and worsening disease requiring hospitalization. Results: • The overall prevalence rate of breast cancer in Africa was 0.30 [ 95% CI, 0.26 to 0.34] (22 studies, n=10,795). The prevalence rate of breast cancer for African females was 0.49 [95% CI, 0.38 to 0.62]. South African region had the highest breast cancer prevalence rate, 0.65 [95% CI, 0.24 to 1.26], while the lowest rates of breast cancer were from Central African regions. The use of mammography yielded higher rates of detection, (0.63 [95% CI, 0.46 to 0.82]), in comparison with clinical breast examination (0.31 [95% CI, 0.22 to 0.42]). • The proposed LBCR comprises parts I, II, AND III. Part I consists of demographic data and cancer information detailing personal data such as medical history, general examination, breast examination, methods and results of the diagnosis, and the treatment offered. Part II comprises the forms used for continuous follow-up – a new form is completed at each visit. All new information regarding patients' details, new complaints, and investigation findings and any changes or treatment offered at the visit, are recorded in this section. Part III documents mortality information. Details are recorded accompanied with a copy of the death certificate, and an autopsy report in case it was required. The LBCR pack includes consent forms in both English and Arabic languages. Also, it is accompanied by a manual of operation with given answered examples. Furthermore, the form is provided with contact details in case of any required information or explanation needed in the future. Conclusion: The clinical picture of breast cancer in Africa differs from Western countries due to the high proportion of patients developing the disease at a younger age and seeking management care at an advanced stage. Currently, there exists no specific breast cancer registry designed specifically for any African patients living in Africa. The LBCR will provide comprehensive, contemporary data on patients with breast cancer through establishing a baseline figure of the current situation for future local and national comparisons. The LBCR includes ready and accessible information for the temporary and future use of medical elements and researchers in this field and will help in the development of strategies to prevent and manage breast cancer and its complications.
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Smith, Sarah Jane. "Cancer in Trent region : incidence, mortality and survival". Thesis, University of Nottingham, 1999. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.312199.
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Garrett, Amy. "Characteristics of Death Certificate Only Cases in the Cancer Registry". The Ohio State University, 2014. http://rave.ohiolink.edu/etdc/view?acc_num=osu1405704511.
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Thomas, Akesh, zainab Fatima y Girendra resident Hoskere. "Lung Cancer in Tennessee". Digital Commons @ East Tennessee State University, 2021. https://dc.etsu.edu/asrf/2021/presentations/69.
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Introduction
Lung cancer is the most common cause of cancer-related death in the United States (US). Tobacco smoking is a well-recognized cause of lung cancer. About 2% of the United States (US) population lives in Tennessee (TN). Nearly 21 % of TN adults are current smokers as per 2019 data, compared to 14% across the US. The percentage of smokers has historically been high in TN and its surroundings. This can be attributed to the area's socio-economic and cultural characteristics, along with large areas of tobacco farming in the region. This increases the risk of lung cancer in the TN population. Surveillance Epidemiology and End Results Program (SEER) is a collection of cancer registries across the US, covering about 35% of the US population (TN cancer registry is not a part of SEER). Our study compares lung cancer incidence and characteristics in the TN cancer registry with the SEER 18 registry.
Materials and Methods
Data were collected from the TN cancer registry and SEER separately for lung and bronchial cancer. Data was analyzed for different histological subtypes, age groups, gender, stage at diagnosis, and rural/urban residence. Stata and Microsoft Excel were used in data analysis. A Chi-square test was used to calculate the statistical significance.
Results
From 2008 to 2017, 58644 cases of lung cancer were reported in the Tennessee cancer registry. During the same period, 519112 cases were reported in the SEER registry. The most frequent histological subtype of lung cancer in TN and SEER was adenocarcinoma (frequency of 17,503 Vs. 182346), followed by squamous cell carcinoma and small cell carcinoma. Most cancers in TN and SEER were diagnosed at stage of distant metastasis (46% vs. 52% ), followed by regional metastasis, localized, and in situ (Image1). The frequency of lung cancer diagnosis was high among those older than 65 in TN and SEER (64% vs. 69%). Males had a higher incidence of lung cancer in both registries. Most lung cancers were reported in the urban area in both registries. Chronic obstructive pulmonary disease was the most commonly reported secondary diagnosis (3,099), followed by pleural effusion in the TN database; the comparable data were not available in SEER. Relative survival at 12 months and five years for lung cancer in TN were 46.6 % and 19.5 % (Vs. 46.4% and 19.9% in SEER)
Discussion and Conclusion
If both registries were perfect, then lung and bronchial cancer incidence will be 9241 and 6048 per million in ten years in TN and SEER, respectively. But after careful analysis, we conclude that such analysis will be erroneous. The proportion of different histological types, stage at diagnosis, age groups, and gender were in the same order in both groups. Although chi-square test values are significant for all the variables, we infer no conclusion considering the data's inherent bias. Further in-depth analysis of the data is required.
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Imbert, Guesdon Bérengère. "Épidémiologie des mélanomes de 1983 à 2003 d'après le registre des cancers du Tarn". Toulouse 3, 2007. http://www.theses.fr/2007TOU31075.
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Le but de notre étude est de faire une analyse épidémiologique des mélanomes de 1983 à 2003 d'après les données du registre des cancers du Tarn, et d'en étudier les comptes-rendus anatomopathologiques(CRAP). Les résultats montrent que l'incidence a quasiment doublé en 10 ans. Les éléments pronostiques (ceux nécessaires à la démarche thérapeutique) des mélanomes sont fréquemment absents des CRAP. Cette tendance est similaire dans le reste du monde et est due à l'évolution des habitudes d'exposition au soleil au cours de ces quarantes dernières années. Une standardisation des CRAP en cancérologie est nécessaire pour améliorer la prise en charge de ces malades de plus en plus nombreux.
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Edwards, Dympna Mary Catherine. "Head and neck cancer services in the UK : a study of current management, patient views and factors affecting survival". Thesis, King's College London (University of London), 1999. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.322068.
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De, Camargo Cancela Marianna. "Les cancers de la cavité buccale et de l’oropharynx dans le monde : incidence internationale et classification TNM dans les registres du cancer". Thesis, Lyon 1, 2010. http://www.theses.fr/2010LYO10311/document.
Texto completoResumen
L’objectif de ces travaux est de connaître et évaluer les caractéristiques épidémiologiques des cancers de la cavité orale et de l’oropharynx. Ces deux localisations partagent des facteurs de risque en commun, et sont de fait souvent regroupées dans les études épidémiologiques. Cependant, la découverte de facteurs de risque spécifiques, telle l’infection par le virus du papillome humain pour les cancers de l’oropharynx, nous conduit à fournir des taux d’incidence spécifiques avec la classification anatomique de ces cancers. En réorganisant les données disponibles dans la base des données du Centre International de Recherche sur le Cancer, nous avons recherché les cas incidents au niveau mondial et recalculé les taux d’incidence dans les registres de 60 pays, pendant la période 1998-2002. La classification TNM n’est pas disponible dans les bases de données du CIRC. Nous avons identifié et contacté les registres du cancer qui ont déclaré son recueil. Cela nous a permis de créer et structurer une base des données innovante et inédite, dont les informations ont été analysées par rapport à la qualité. Finalement nous avons comparé la distribution de stades précoces et avancés dans 8 pays. Les résultats montrent que l’incidence des cancers de la cavité buccale et de l’oropharynx est très hétérogène au niveau mondial par rapport à la sous localisation des tumeurs, à l’âge d’incidence, au ratio homme/femme et au stade cliniqueOral cavity and oropharynx cancers : International incidence and TNM classification in population-based cancer registries The aim of this work was to know and to evaluate the epidemiological patterns of oral cavity and ororpharynx cancers. These topographies share some common risk factors and they are often grouped in epidemiological studies. However, the implication of the human papilloma virus in oropharyngeal tumors lead us to provide incidence rates according to the anatomical classification of these tumors. We reorganized the incidence data available at the International Agency for Research on Cancer, for the period 1998-2002. Incidence rates were calculated for oral cavity and oropharynx cancers separately for 60 countries. As the TNM classification is not available on the IARC database we contacted the cancer registries that declared to abstract and collect it. Based on their data we created and structure a new, innovative and quality controlled. Finally, we compared the TNM stage distribution among 8 countries. The results show that the oral cavity and oropharynx cancers have a very heterogeneous distribution in the studied registries concerning tumor sub-sites, age of incidence, male to female ratio and clinical stage
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VACCAREZZA, ARGAGNON FRANCOISE. "Diagnostic et prise en charge des cancers colo-rectaux : etude a partir d'un registre de population". Toulouse 3, 1993. http://www.theses.fr/1993TOU31122.
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Nguyen, Hoang Minh Dung. "Information Extraction from Radiology Reports for a Population Based Cancer Registry". Thesis, The University of Sydney, 2013. http://hdl.handle.net/2123/9466.
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In a noisy corpus such as in clinical data, the text usually contains a large number of misspell words, abbreviations and acronyms that can be an obstacle to high quality information extraction and classification. Furthermore, the gold-standard training data needed for supervised learning usually contains many errors and inconsistencies due to differences in human annotators. In this research, a specialised proof-reading process for the clinical domain to resolve unknown tokens and convert scores and measures into a standard layout is introduced. The automatic coding of the texts increased the coded content significantly after the automatic correction process. Accuracy of the automatic coding and annotation of the notes which have not been coded by the clinical staff is suggested by the system output. To deal with the problem of noisy training data, this thesis proposes an algorithm for a method named “reverse active learning” which means applying active learning in reverse order to improve performance of supervised machine learning on clinical corpora. The effects of automatic proof-reading and reverse active learning are shown to produce results on the i2b2 2010 clinical corpus that are a state-of-the-art of supervised learning method and offer a means of improving all processing strategies in clinical language processing. Finally, a Cancer Staging Information Extraction System based on the combination of proposed methods of proof-reading, supervised learning, active learning and reverse active learning is presented. In this research, free-text reports are annotated for examples of the information to be extracted and then algorithms are developed that use the examples to compute a more general model of the desired content. Besides traditional supervised learning methods such as Conditional Random Fields and Support Vector Machines, active learning approaches are investigated to bring further improvement to information extraction system performance.
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SILVA, Diego Rodrigues Mendonça e. "Câncer de esôfago no centro-oeste do Brasil: incidência, mortalidade e tendências". Universidade Federal de Goiás, 2012. http://repositorio.bc.ufg.br/tede/handle/tde/1755.
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Previous issue date: 2012-10-02Introduction: Esophageal cancer is a malignancy of high mortality worldwide. Studies on Population-based of this neoplasm in Brazil are scarce. In the central-western of Brazil there are population-based cancer registries to monitor the impact of cancer. However there are no studies describing the profile of this tumor in the central-western of Brasil. Another reason for this study is the large-scale of internal migration happened in the 70's from Porto Alegre to the central-western. Such migration may have influenced the incidence and mortality rates of esophageal cancer in the region. Objective: To evaluate the performance of the Population-Based Cancer Registry of Goiânia (PBCR of Goiânia) in the collecting of basic variables and recommended variable (clinical staging) of incident cases of esophageal cancer. To describe the epidemiological profile of the incidence, mortality and trends esophageal cancer in central-western Brazil. Methods: From the PBCR of Goiânia it was analyzed the completeness of variables related to the patient, tumor and clinical staging of esophageal cancer cases for incidence analysis the period were: Cuiabá (2000-2005), Brasília (1999-2002) and Goiânia (1995-2008). Mortality data were obtained from DATASUS (2010) for the period 1980-2008 for all capitals of central western region. For statistical analysis we used version 15.0 of SPSS for Windows ®, the X2 test and odds ratios were calculated by applying significance at p<0.05 and Joinpoint Regression Program for trend analysis. Results: In the period from 1988 to 2008 were reported 827 cases of esophageal cancer in Goiania in a 3:1 ratio (men/women). Most cases were diagnosed in advanced stages. The analysis of variables collected by RCBP Goiânia identified indices of good completeness of the basic variables related to the patient and tumor, whereas for clinical staging was low (5%). The highest incidence of esophageal cancer in the center-western of Brazil was observed in Cuiabá and lowest in Goiania, while rates in women were similar in Brasilia and Cuiaba. The mortality rates have a heterogeneous increase trend among men in Cuiaba and Campo Grande and among women in Goiania. Conclusions: The RCPB Goiânia had a good performance in collecting of basic variables of esophageal cancer, and low for clinical staging. The profile of incidence of esophageal cancer in the central-western of Brazil was higher in Brasilia and Cuiaba, with incidence rates for men similar to those of Porto Alleger in some periods. There was an increased in mortality in men in Cuiaba and Campo Grande and among women in Goiania. Long-term studies may confirm the influence of migration on the incidence rates of esophageal cancer in this region.
Introdução: O câncer de esôfago é uma neoplasia de alta mortalidade em todo mundo. Estudos de base populacional no Brasil sobre essa neoplasia são escassos. No centro-oeste do Brasil existem registros de câncer de base populacional que monitoram o impacto do câncer, entretanto, não existem estudos avaliando o perfil epidemiológico desse tumor na região. Outra razão para esse estudo é a migração interna em grande escala que houve na década de 70 da população do sul (Porto Alegre) para o centro-oeste. Tal migração pode ter influenciado nas taxas de incidência do câncer de esôfago na região.Objetivo: Avaliar o desempenho do Registro de Câncer de Base Populacional de Goiânia (RCBP de Goiânia) na coleta de variáveis básicas e uma variável recomendada (estadiamento clínico) nos casos incidentes de câncer de esôfago. Determinar a incidência, a mortalidade e as tendências do câncer de esôfago nas capitais do centro-oeste brasileiro (Goiânia, Brasília, Cuiabá e Campo Grande). Metodologia: Para o desempenho do RCBP de Goiânia no período de 1988-2008 avaliou-se os casos de câncer de esôfago quanto à exaustividade das variáveis referentes ao paciente, tumor e o estadiamento clínico. A análise do perfil epidemiológico de incidência e mortalidade abrangeu os seguintes períodos: Cuiabá (2000-2005), Brasília (1999-2002) e Goiânia (1995-2008). Dados da mortalidade foram obtidos do DATASUS (2010) no período 1980-2008. Na análise estatística utilizou-se o software SPSS versão 15.0 para Windows®, o teste X2 e Odds Ratio foram calculados, com nível de p<0,05; utilizou-se o Joinpoint Regression Program para análise de tendência. Resultados: No período de 1988 a 2008 foram notificados 827 casos do câncer de esôfago em Goiânia na proporção de 3:1 (homem/mulher). A maioria dos casos foram diagnosticado em estádio avançado. Na análise do RCBP de Goiânia identificaram-se índices bons de exaustividade das variáveis básicas referentes ao paciente e tumor, para o estadiamento clínico o índice foi ruim (5%). Em relação ao impacto da incidência do câncer de esôfago no centro-oeste do Brasil foi maior em Cuiabá e menor em Goiânia, sendo que as taxas em mulheres foram semelhantes em Brasília e Cuiabá. A mortalidade apresentou padrões heterogêneos com tendência crescente entre os homens em Cuiabá e Campo Grande e entre mulheres em Goiânia. Conclusões: O RCPB de Goiânia apresentou bom desempenho na coleta das variáveis básicas do câncer de esôfago, e ruim para o estadiamento clínico. O perfil da incidência do câncer de esôfago no centro-oeste do Brasil mostrou taxas elevadas em Cuiabá e Brasília, sendo estas taxas de incidência em homens semelhantes às taxas de Porto Alegre em alguns períodos. A mortalidade aumentou em homens em Cuiabá e Campo Grande, e em mulheres em Goiânia. Estudos a longo prazo poderão confirmar a influência da migração nas taxas de incidência do câncer de esôfago nessa região.
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Aa, Maaike Anne van der. "Variation in incidence and outcome of cervical cancer in the Netherlands studies based on cancer registry data /". [S.l.] : Rotterdam : [The Author] ; Erasmus University [Host], 2008. http://hdl.handle.net/1765/11129.
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CHABANE, CHRISTINE. "Cancer des voies aero-digestives superieures : tumeurs multiples metachrones : registre des tumeurs du doubs 1979-1988". Besançon, 1994. http://www.theses.fr/1994BESA3066.
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Lemmens, Valery Eduard Petronius Paulus. "Clinical epidemiology of colorectal cancer in the Netherlands studies of variation and trends with the Eindhoven Cancer Registry /". [S.l.] : Rotterdam : [The Author] ; Erasmus University [Host], 2007. http://hdl.handle.net/1765/10735.
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Bin, Ishaq Saeed A. "Epidemiology of cancer as a tool to develop a population based cancer registry in the United Arab Emirates". Thesis, University of Glasgow, 2004. http://theses.gla.ac.uk/6197/.
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The purpose of this study was to assess the possibility of developing a population based cancer registry in the United Arab Emirates. As this was retrospective and explorative in nature, the study was performed in two stages, the initial stage where the researcher examined critically routinely collected data that is needed to support a cancer registry as well as assessed data on cancer that were obtained from Al Mafraq Hospital records. The final stage took place in Al Ain Medical District where detailed study of the existing practice with respect to cancer registration were undertaken in respond to a request form Ministry of Health, data on cancer were obtained from health care services and cancer registry records. Other information was obtained from key officials and health professionals in the district using qualitative methods. The initial stage showed that this was the first study of this kind in the United Arab Emirates and that cancer data production and recording is a complex intervention, where health and health related professionals and patients are involved. It also revealed that the key professionals were supportive to the study and showed positive attitude. The initial study indicated that there was deficiency in the data collected routinely as well as there was no cancer registry in Al-Mafraq Hospital. Furthermore, the data collected from medical record witnessed deficiency in their completeness and quality. Lack of education and training related to cancer data handling were observed during the fieldwork. The assessment of the population data sources indicated that there was no single data source that might provide a comprehensive and accurate data regarding Al Ain population. This condition was mainly created due to unique demographic pattern of a highly mobile population dominated by expatriates. The final stage showed that health facilities in Al Ain Medical District are capable of producing cancer data especially clinical data. However deficiencies in item definition, complete recording and storing of data by health professionals within the health facilities were identified.
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Maurel, Jean. "Apport des registres de cancer à l'évaluation des pratiques de soins en cancérologie : à propos du cancer colorectal". Caen, 1997. http://www.theses.fr/1997CAEN3097.
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Sengoku, Tami. "Diagnostic accuracy of FDG-PET cancer screening in asymptomatic individuals: use of record linkage from the Osaka Cancer Registry". 京都大学 (Kyoto University), 2015. http://hdl.handle.net/2433/199216.
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Sandberg, Linnea. "Quality assurance of a radiotherapy registry". Thesis, Umeå universitet, Institutionen för fysik, 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-176779.
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The radiotherapy clinics in Sweden have been without a functioning national platform consisting of dose data from patients undergoing radiotherapy. A national collaboration between clinics will improve the quality of radiotherapy since clinics will be able to compare dose data from treatment plans between clinics. It will also help and improve future researches in radiotherapy. A new national quality registry for radiotherapy in Sweden is under development and is located on the INCA platform. The aim of this study is to do a quality assurance of the INCA registry. The data stored in the registry are calculated from the treatment plans stored locally at the clinics. The quality assurance of the registry is done by creating a program run by Python code and by using Streamlit as the graphical user interface. The program takes dose and volume data from the dose volume histograms located in treatment plans from the INCA database and compares it with the dose and volume data from the local clinics' treatment planning system. The different treatment planning systems considered in the program are Oncentra(Elekta, Sweden), Eclipse(Varian, U.S.), RayStation(RaySearch Laboratories, Sweden) and Monaco(Electa, Sweden). The compared absorbed doses are the dose to 99% of the structure volume(D99%), D98%, D50%, D2% and D1%. The program generates how much the INCA data differs from the TPS data in percent and is named QARS(Quality Assurance of the Radiotherapy Database in Sweden). A verification of the created program and a preliminary evaluation is done on a limited dataset containing three patient groups(prostate patients, lung patients and head and neck patients) with five patients in each group. The dataset is run through the program with patient data from both Oncentra and Eclipse. The result indicates that all the near-maximum doses, D2% and D1% in INCA are very close to their corresponding TPS dose. There is a more noticeable difference in the near-minimum doses, D99% and D98% but also for some D50% where the difference seems to increase in larger structure volumes with very low doses and in very small structure volumes, smaller than 0.01 cm3. It is compared how well INCA agrees with Oncentra and Eclipse respectively and it is clear that Eclipse has a smaller difference to INCA than Oncentra for structures with very small volumes and larger structures with low doses. To summarise the study, it generates a program for quality assurance of the national quality registry for radiotherapy in Sweden which hopefully can help improve the quality of radiotherapy and help future researches in the field.
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Bolton, Damien Michael. "Whole-of-population based studies In urologic cancer". Thesis, The University of Sydney, 2017. http://hdl.handle.net/2123/17066.
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Since Prostate Specific Antigen testing became commercially available prostate cancer has transformed from a clinically diagnosed often advanced disease usually in elderly men, to a biochemically detected usually organ confined condition which more often affects younger males. This resulted in a major shift in the patterns of care of prostate cancer from an observant, pharmaceutical therapy dominated algorithm, to surgically directed management via radical prostatectomy. This transition initially was undertaken on the basis of logic but with little conclusive evidence to support this change. It was this major adjustment in practice that was the impetus for this thesis. Few prospectively established whole-of–population registries of patients undergoing radical prostatectomy had been established at the time this project was conceived. The aim of this project was to follow sequentially for a 10 year period the progress of all men treated by radical prostatectomy in the state of Victoria, with a view to determining the likelihood of progression to objective biochemical and clinical benchmarks in the future. Multiple publications were derived from this registry, and from projects that have arisen as a consequence of the existence of the central database. Outcomes identified include the very low risk of prostate cancer specific mortality (PCSM) even after biochemical recurrence, especially in men with lower risk prostate cancer at diagnosis, and that predictors of PCSM independent of tumour stage and grade included rural residency of patients (p=.003), involvement of a trainee surgeon in the operation (p=.014), presentation with voiding symptoms rather than on the basis of an elevated PSA level, and the primary surgeon contributing less than 40 cases (low volume) to the VRPR (p=.024). As a consequence of the existence of our whole of population based registry of radical prostatectomy for prostate cancer the implications became apparent for patients of having a strong family history of breast cancer and of being a carrier of one or more variants of the BRCA gene. Extension of this concept resulted in a series of all men treated by High Intensity Focused Ultrasound (HIFU) upon its introduction in the state of Victoria, and a patterns of practice study of all patients in this state undergoing surgery for renal cell carcinoma.
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Gromb, Sophie. "Le registre des cancers digestifs a la martinique de 1981 a 1985 : comparaison a d'autres chiffres recueillis en france". Bordeaux 2, 1988. http://www.theses.fr/1988BOR25037.
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Frasca, Matthieu. "Probabilité et précocité du recours aux soins palliatifs hospitaliers chez les patients avec cancer en France à partir de données issues des registres des cancers de Gironde et de la cohorte nationale ESME de patients avec cancer du sein métastatique". Thesis, Bordeaux, 2020. http://www.theses.fr/2020BORD0311.
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Le vieillissement de la population et le nombre croissant de cancer interrogent l’accès aux soins palliatifs. L’intégration de ces soins en cancérologie et la diversification des structures spécialisées (unité, équipe mobile, lits identifiés, hôpital de jour) modifient les modalités de recours aux soins palliatifs hospitaliers (SPH). L’objectif de ce travail est d’étudier les facteurs prédictifs sociodémographiques, socioéconomiques, tumoraux et liés aux soins de la probabilité et de la précocité du recours aux SPH chez les patients avec cancer. Une revue systématique de la littérature a identifié les facteurs d’accès aux soins palliatifs dans le monde. L’incidence cumulée à 2 ans et en fin de suivi (probabilité) et le temps moyen de suivi après SPH (précocité) ont ensuite été étudiés dans deux analyses : l’une à partir de patients des registres des cancers de Gironde (n = 8 424, période 2014), l’autre à partir des patients avec cancer du sein métastatique (CSM) de la cohorte nationale ESME-CSM (n = 12 375, période 2008-2016). Selon l’analyse, les facteurs explicatifs étaient l’âge, le genre, le niveau socioéconomique, le lieu de résidence, la localisation ou sous-type tumoral, les caractéristiques des métastases et le type de centre. Plusieurs méthodes ont tenu compte du risque compétitif de décès (estimateur d’Aalen-Johansen, modèle multi-état, pseudo-valeurs). Dans les deux populations, les SPH étaient majoritairement initiés en phase terminale. Dans l’échantillon issu des registres (75+ ans : 2695, 32% ; Hommes : 4317, 51,3% ; Sein : 1247, 14,8%), les facteurs de l’incidence cumulée à 2 et 4 ans différaient selon le pronostic tumoral. En cas de pronostic défavorable, les patients ruraux, avec hémopathie maligne ou âgés traités hors des centres universitaires recevaient moins de SPH. En cas de pronostic favorable, les patients âgés, favorisés, avec cancer du poumon ou traités dans les centres universitaires recevaient plus de SPH. Les femmes et les patients avec tumeurs du système nerveux central de haut grade avaient un recours plus précoce. Dans l’échantillon des patients ESME-CSM (75+ ans : 2380, 19,2% ; CSM triple négatif : 1545, 12,6%), les facteurs de l’incidence cumulée dépendaient du temps de suivi. A 2 ans, les SPH concernaient surtout les plus jeunes avec CSM triple négatif, les plus âgés avec un autre sous-type, les patients en rechute ou avec plusieurs sites métastatiques. A 8 ans, ils étaient moins fréquents hors des centres à forte activité, en particulier pour les plus âgés. Le recours aux SPH était aussi moins précoce dans ces centres. En sus des disparités classiques d’accès aux soins, nous avons mis en évidence que le rôle des facteurs sociodémographiques dans le recours aux SPH dépendait du pronostic du cancer. Celui de l’âge dépendait en plus des caractéristiques du centre de prise en charge. Des études analytiques sur les mécanismes impliqués seraient utilesPopulation aging and growing incidence of cancer question access to palliative care. Integration of this care and specialized structures’ diversification (unit, mobile team, identified beds, outpatient clinics) are changing the referral’s modalities of hospital-based palliative care (HPC). This work aims to study the socio-demographic, socio-economic, tumour- and care-related predictive factors of the probability and the precocity of HPC in cancer patients. A systematic review of the literature identified factors of access around the world. Two analyses then studied the cumulative incidence at 2 years and at the end of follow-up (probability) and the mean follow-up time after HPC (precocity). First analysis was based on patients from the French cancer registers of Gironde (n = 8,424; 2014 period). The second was based on metastatic breast cancer (MBC) patients from the national ESME-CSM cohort (n = 12,375; 2008-2016 period). Regarding the analyses, the explanatory factors were age, gender, socioeconomic level, place of residency, tumour location or subtype, metastases’ characteristics and type of centre. Several methods have taken into account the competitive risk of death (Aalen-Johansen estimator, multi-state model, pseudo-values). In both populations, HPC were mostly initiated during the terminal disease. In registries’ sample (75+ years: 2,695, 32%; Males: 4,317, 51.3%; Breast: 1,247, 14.8%), the 4-year and 2-year cumulative incidence’s factors differed according to the tumour prognosis. In unfavourable prognosis subgroup, rural patients, those with haematological malignancy and older patients treated outside tertiary centres received less HPC. In favourable prognosis subgroup, older people, non-deprived patients and those with lung cancer or treated in tertiary centres received more HPC. Women and patients with high-grade central nervous system tumours had earlier referral. In the sample of ESME-CSM patients (75+ years: 2,380, 19.2%; triple negative MBC: 1,545, 12.6%), the cumulative incidence’s factors depended on follow-up period. At 2 years, HPC mainly concerned the youngest with triple negative MBC, the oldest with another subtype, relapsed patients or those with several metastatic sites. At 8 years, HPC were less frequent outside of highly-recruiting centres, in particular for older patients. HPC referral was also less early in these centres. In addition to classic disparities in care access, we have highlighted that the role of socio-demographic factors depends on cancer prognosis. The one of age also depends on care centre characteristics. Analytical studies on the mechanisms involved would be of value
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Luo, Qingwei. "“Unknown” prostate cancer stage at diagnosis in a population-based cancer registry: impact on epidemiological studies and use of multiple imputation". Thesis, The University of Sydney, 2018. http://hdl.handle.net/2123/19948.
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Routinely collected population-based cancer registry stage data are crucial to inform health service planning and to monitor variations in cancer outcomes. However, incomplete stage information is a major concern due to potential biases this introduces. This thesis examined the reasons why a large proportion of prostate cancer cases are recorded as “unknown” stage in the New South Wales (NSW) Cancer Registry (NSWCR) and validated the multiple imputation (MI) method for dealing with “unknown” stage data. NSW is the most populous state in Australia, with almost one third of the total national population. The NSWCR is the only population-based cancer registry in Australia that has collected stage information since its inception in 1972. The usefulness of long-term historical cancer registry stage data when examining cancer outcomes is illustrated in Chapter 2, with an investigation of geographical variation in long-term survival over time. The research reported in Chapter 3 shows that prostate cancer cases with “unknown” stage differ from those with a known stage, as survival and risk of disease progression for cases with “unknown” stage was intermediate between those for cases with localised and regional disease. Several possible reasons that could contribute to why “unknown” stage is recorded in the NSWCR are identified in Chapter 4. The publication included in Chapter 5 shows that MI appears to be valid for “unknown” stage when the MI is implemented according to the practical guidelines recommended in the literature. The application of MI to the NSWCR “unknown” stage data reported in Chapter 6 shows that the imputed stage data appear to be reliable. These findings provide important insights into prostate cancer cases with “unknown” stage recorded in the NSWCR, and an understanding of the potential biases in epidemiological studies that use these data. The validated MI method to handle “unknown” stage will help to increase the utility of the cancer registry data.
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Bordini, L. "LA RICERCA SISTEMATICA DEI TUMORI PROFESSIONALI: ATTIVAZIONE E PRIMI RISULTATI DEL REGISTRO TUMORI DEI SENI NASALI E PARANASALI DELLA LOMBARDIA". Doctoral thesis, Università degli Studi di Milano, 2011. http://hdl.handle.net/2434/152896.
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We present the findings of the first years of activity of the Lombardy registry of sinonasal cancers (SNC), which was started at the end of 2007. The registry collects all potential cases of primary malignant epithelial neoplasm of the nasal cavity and accessory sinuses, verifies clinical records, and interviews the patients or their next-of-kin to investigate exposures to known SNC carcinogens. Case ascertainment is complete for the year 2008: we recorded 31 verified cases among men and 24 among women. The age-standardized regional incidence rates were 0.8 and 0.5 100,000 in men and women, respectively. For 87 cases diagnosed in 2008-2010 period we obtained an interview. In 34 cases (32 M and 2 F), we documented occupational exposure to wood dust (61.8%), leather dust (29.4%), bitumen fumes (5.9%), and hexavalent chromium compounds (2.9%). For these subjects compensation claims were undertaken. In 4 cases we found leisure-time exposures. In 49 cases (56.3%) no evidence of exposure to known SNC carcinogens was found.
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Le, Hen Jean-Marc. "Validation de comptes-rendus standardisés pour la création d'un registre Aquitaine des carcinomes thyroi͏̈diens différenciés". Bordeaux 2, 1998. http://www.theses.fr/1998BOR2M017.
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