Patient Characteristics, Treatment Patterns, and Outcomes for Patients With Renal Cell Carcinoma in England: A Retrospective Cohort Study.

BACKGROUND AND OBJECTIVE: Considering the rapidly evolving treatment landscape of renal cell carcinoma (RCC), recent descriptions of the RCC population in the UK are lacking, as are real-world data on treatment and patient outcomes. To analyse the demographic and clinical characteristics, treatment patterns, and overall survival of patients with RCC using national data sets in England. PATIENTS AND METHODS: This was a retrospective cohort study of patients diagnosed with RCC (all stages) between 2014-2018 using demographic, clinical, cancer registration, and treatment data. Patients were followed until death or study end (December 31, 2020). Treatments administered in each line were described to understand treatment sequencing. Kaplan-Meier methods were used for time-to-event analyses. Factors associated with discontinuation and survival were identified using Cox proportional hazard models. RESULTS AND LIMITATIONS: Among 32,577 included patients, the median age at diagnosis was 66 years, 63.4% were male, and 6,786 (20.8%) had metastatic RCC at diagnosis. Tyrosine kinase inhibitor (TKI) monotherapy was the most common treatment class across lines. Over three quarters of patients (78.5% [95% CI: 78.0-78.9]) were alive one year after diagnosis (93.2% in the non-metastatic at diagnosis subgroup and 37.1% among patients with metastases at diagnosis). At three years post initial diagnosis, 18.0% patients were alive in the metastatic at diagnosis subgroup. Rapid evolution of the treatment landscape limits the results regarding lines of therapy. CONCLUSION: This large-scale study provides insight on characteristics of patients with RCC, and it highlights the need for better treatment options to improve survival.

A systematic literature review of real-world treatment outcomes of small cell lung cancer.

BACKGROUND: Robust evidence from real-world studies is needed to aid decision-makers and other stakeholders in choosing the best treatment options for patients. The objective of this work was to assess real-world outcomes of treatment strategies for limited- and extensive-stage small cell lung cancer (SCLC) prior to the global introduction of immunotherapies for this disease. METHODS: Searches were conducted in MEDLINE and Embase to identify articles published in English from October 1, 2015, through May 20, 2020. Searches were designed using a combination of Medical Subject Heading (Medline), Emtree (Embase subject headings), and free-text terms such as SCLC. Observational studies reporting data on outcomes of initial treatment strategies in patients with limited- and extensive-stage SCLC were included. Studies with limited sample sizes (<100 patients), enrolled all patients prior to 2010, or did not report outcomes for limited- and extensive-stage SCLC separately were excluded. Data were extracted into a predesigned template by a single researcher. All extractions were validated by a second researcher, with disagreements resolved via consensus. RESULTS: Forty articles were included in this review. Most enrolled patients from the United States (n = 18 articles) or China (n = 12 articles). Most examined limited-stage (n = 27 articles) SCLC. All studies examined overall survival as the primary outcome. Articles investigating limited-stage SCLC reported outcomes for surgery, chemotherapy and/or radiotherapy, and adjuvant prophylactic cranial irradiation. In studies examining multiple treatment strategies, chemoradiotherapy was the most commonly utilized therapy (56%-82%), with chemotherapy used in 18% to 44% of patients. Across studies, median overall survival was generally higher for chemoradiotherapy (15-45 months) compared with chemotherapy alone (6.0-15.6 months). Studies of extensive-stage SCLC primarily reported on chemotherapy alone, consolidative thoracic radiotherapy, and radiotherapy for patients presenting with brain metastases. Overall survival was generally lower for patients receiving chemotherapy alone (median: 6.4-16.5 months; 3 years, 5%-14.9%) compared with chemotherapy in combination with consolidative thoracic radiotherapy (median: 12.1-18.0 months; 3 years, 15.0%-18.1%). Studies examining whole-brain radiotherapy for brain metastases reported lower median overall survival (5.6-8.7 months) compared with stereotactic radiosurgery (10.0-14.5 months). CONCLUSIONS: Under current standard of care, which has remained relatively unchanged over the past few decades, prognosis remains poor for patients with SCLC.

Universal interventions for suicide prevention in high-income Organisation for Economic Co-operation and Development (OECD) member countries: a systematic review.

INTRODUCTION: To examine the effectiveness of universal suicide prevention interventions on reducing suicide mortality in high-income Organisation for Economic Co-operation and Development (OECD) member countries. METHODS: We implemented a comprehensive search strategy across three electronic databases: MEDLINE (Ovid), PsycINFO (Ovid) and Embase (Ovid). All studies using time-series, retrospective, prospective, pre-post or cross-sectional study designs were included. Studies were required to examine suicide mortality as the outcome of interest. To help organise the results, studies were grouped into six broad categories of universal interventions consistent with the World Health Organization (WHO) Comprehensive Mental Health Action Plan. A narrative synthesis of results was used to describe the findings. RESULTS: Of the 15 641 studies identified through the search strategy, 100 studies were eligible in the following categories: law and regulation reforms (n=66), physical barriers (n=13), community-based interventions (n=9), communication strategies (n=4), mental health policies and strategies (n=7), and access to healthcare (n=1). Overall, 100% (13/13) of the included physical barrier interventions resulted in a significant reduction in suicide mortality. Although only 70% (46/66) of the law and regulation reform interventions had a significant impact on reducing suicide, they hold promise due to their extended reach. Universal suicide prevention interventions seem to be more effective at reducing suicide among males than females, identifying a need to stratify results by sex in future studies. CONCLUSIONS: These findings suggest that universal suicide prevention interventions hold promise in effectively reducing suicide mortality in high-income OECD countries.

Food and beverage marketing in primary and secondary schools in Canada.

BACKGROUND: Unhealthy food marketing is considered a contributor to childhood obesity. In Canada, food marketing in schools is mostly self-regulated by industry though it is sometimes restricted through provincial school policies. The purpose of this study was to document the type of food marketing activities occurring in Canadian schools and examine differences by school characteristics. METHODS: An online survey was sent to public primary and secondary schools from 27 school boards in Ontario, British Columbia, and Nova Scotia and was completed by 154 Principals in spring 2016. This survey queried the type of food marketing occurring in schools including advertisements, food product displays, fundraising, exclusive marketing agreements, and incentive programs, among others. The occurrence of food marketing was described using frequencies, medians, and ranges. Chi-square and Fisher Exact tests were conducted to assess school-level differences in the frequency of marketing activities by school type (primary versus secondary), province (Ontario versus British Columbia), and the socio-economic status of most students (low versus middle/high income). The significance level was set at α < 0.05 for all tests. RESULTS: Overall, 84% of schools reported at least one type of food marketing and the median number of distinct types of marketing per school was 1 (range 0-6). The most frequently reported forms of marketing were the sale of branded food, particularly chocolate, pizza, and other fast food, for fundraising (64% of schools); food advertisements on school property (26%), and participation in incentive programs (18%). Primary schools (n = 108) were more likely to report participating in incentive programs (25%) and selling branded food items (72%) compared to secondary schools (n = 46; 2 and 43% respectively; p < 0.01). Conversely, secondary schools were more likely to report food advertising on school property (56%), exclusive marketing arrangements with food companies (43%), and food product displays (19%) than primary schools (13, 5 and 2%, respectively; p < 0.01). CONCLUSION: The presence of food marketing in most participating schools suggests that the current patchwork of policies that restrict food marketing in Canadian schools is inadequate. Comprehensive restrictions should be mandated by government in both primary and secondary schools to protect children and youth from this marketing.