Cost-effectiveness of large-panel next-generation sequencing in guiding first-line treatment decisions for patients with nonsquamous advanced non-small cell lung cancer.

BACKGROUND: Clinical practice guidelines recommend broad-panel genomic profiling to identify actionable genomic alterations for patients with advanced non-small cell lung cancer (aNSCLC). OBJECTIVE: To assess the cost-effectiveness of large-panel next-generation sequencing (LP-NGS) compared with current empirical single-gene test (SGT) patterns to inform first-line treatment decisions for patients with aNSCLC from a US commercial payer perspective, accounting for the effect of testing turnaround time and time to treatment initiation. METHODS: We developed a discrete-event simulation model to estimate the impact of LP-NGS vs SGT for patients with nonsquamous aNSCLC. Discrete events and timing included testing patterns, receipt of the initial test result, treatment initiation (targeted vs nontargeted therapies), switching, retesting, rebiopsies, clinical trial participation, progression on therapy, and death. LP-NGS and SGT cohorts each comprised 100,000 adults with aNSCLC simulated over a 5-year postdiagnosis period, assumed to have the same distribution of genomic alterations. The model predicted the proportion of patients receiving appropriate first-line therapy according to clinical practice guidelines. Economic outcomes included expected life-years gained, quality-adjusted life-years, and the total costs of care over 5 years. Sensitivity and scenario analyses explored the robustness of the base-case model results. RESULTS: In the base-case model, LP-NGS was likely to identify more alterations than SGT. Total 5-year costs per patient were $539,658 for LP-NGS and $544,550 for SGT (net difference, $4,892 lower costs per patient for LP-NGS), which is likely to be cost-effective 95.1% of the time. The most influential model parameters on the 5-year total costs of care were preprogression nondrug medical costs on nontargeted therapy, NGS turnaround time, and clinical trial participation. CONCLUSIONS: This study suggests that LP-NGS to guide first-line treatment decisions is clinically more appropriate (more likely to identify alterations and subsequently allocate patients to clinically appropriate therapy) and provides a dominant cost-effectiveness treatment strategy over 5 years for patients with newly diagnosed aNSCLC in the United States.

Cancer-of-Unknown-Primary-Origin: A SEER-Medicare Study of Patterns of Care and Outcomes among Elderly Patients in Clinical Practice.

Knowledge of contemporary patterns of cancer-of-unknown-primary-origin (CUP) diagnostic work-up, treatment, and outcomes in routine healthcare is limited. Thus, we examined data from elderly patients diagnosed with CUP in real-world US clinical practice. From the Surveillance, Epidemiology, and End Results-Medicare-linked database, we included patients ≥ 66 years old with CUP diagnosed between 1 January 2013 and 31 December 2015. We analyzed baseline demographics, clinical characteristics, methods of diagnostic work-up (biopsy, immunohistochemistry, imaging), treatment-related factors, and survival. CUP diagnosis was histologically confirmed in 2813/4562 patients (61.7%). Overall, 621/4562 (13.6%) patients received anticancer pharmacotherapy; among these, 97.3% had a histologically confirmed tumor and 83.1% received all three procedures. Among those with a histologically confirmed tumor, increasing age, increasing comorbidity score, not receiving all three diagnostic measures, and having a not-further specified histologic finding of only 'malignant neoplasm' were all negatively associated with receipt of anticancer pharmacotherapy. Median overall survival was 1.2 months for all patients. Median time between CUP diagnosis and treatment initiation was 41 days. Limited diagnostic work-up was common and most patients did not receive anticancer pharmacotherapy. The poor outcomes highlight a substantial unmet need for further research into improving diagnostic work-up and treatment effectiveness in CUP.

Genomic testing among patients with newly diagnosed advanced non-small cell lung cancer in the United States: A contemporary clinical practice patterns study.

OBJECTIVES: According to 2018 United States and international lung cancer and pathology guidelines, testing of EGFR, ALK, ROS1 and BRAF genes is a minimum requirement to identify targeted therapy options in patients with advanced non-small cell lung cancer (aNSCLC). We describe real-world use and clinical features of next-generation sequencing (NGS) and other non-NGS testing technologies in these patients. MATERIALS AND METHODS: Patients were from the Flatiron Health electronic health record-derived de-identified database and were newly diagnosed with non-squamous aNSCLC between 1 January 2018 and 30 June 2019. We describe occurrence and patterns of NGS- (including comprehensive genomic profiling [CGP]) and non-NGS-based genomic testing before the start of first-line therapy, unsuccessful genotyping (<4 genes tested) and incidence of potentially missed targeted therapy options (<4 genes tested with no positive results). RESULTS: Among 3050 patients, 2356 received any type of genomic testing (NGS: 1406 [59.7%]). Unsuccessful genotyping occurred in 13.2% and 52.2% of NGS- and non-NGS-tested patients, respectively. Among NGS-tested patients, 10.0% had a potentially missed targeted therapy option (CGP: 2.9%), compared with 40.2% in the non-NGS tested group. While all four guideline-recommended genes were tested in ≥ 92% of patients who had NGS testing, when only non-NGS testing was used, although EGFR and ALK had similarly high testing proportions, BRAF and ROS1 (56.1% and 83.7%, respectively) were examined less often. CONCLUSIONS: Our findings suggest that in aNSCLC clinical practice, NGS testing may help to avoid potentially missed targeted therapy options and improve testing uptake for recently approved biomarkers. Results therefore support the use of guideline-recommended broad-panel NGS testing in clinical practice.

Application of clinical trial inclusion criteria to clinical practice patients to quantify the burden of CNS metastases on health-related quality of life and healthcare resource use in patients with NSCLC.

OBJECTIVES: Quantify the burden of central nervous system (CNS) metastases on health-related quality of life (HRQoL) and healthcare resource use (HRU) in patients with advanced non-small-cell lung cancer (NSCLC) from a prospective European study in clinical practice, utilising clinical trial inclusion criteria. MATERIALS AND METHODS: Patients ≥18 years, with metastatic NSCLC, Eastern Oncology C0operative Group (ECOG) performance status 0-2 and life expectancy ≥12 weeks were enrolled in two cohorts by baseline CNS metastases status. Demographics, clinical characteristics, NSCLC management data, HRQoL and HRU were collected at baseline and two follow-up visits (Visits 2 and 3, 6 weeks apart). HRQoL was assessed using validated questionnaires. RESULTS: 162 patients were enrolled (n = 80 CNS cohort, n = 82 non-CNS cohort). Baseline characteristics were balanced, but CNS patients were younger (mean ±â€¯standard deviation age: 62.1 ±â€¯9.6 vs 65.6 ±â€¯9.7 years, p =  0.021) with a lower body mass index (13.8 % underweight [<18.5kg/m2] vs 3.7 %, p =  0.049). Mean HRQoL scores were similar between cohorts at all visits. Cancer pharmacotherapy, procedures and concomitant treatment were comparable across cohorts, with some exceptions. More CNS patients were hospitalised at baseline (10.3 % vs 2.2 %) for longer (mean 7.2 vs 4.6 days; p <  0.001). By Visit 2, more CNS patients were hospitalised (50.0 % vs 29.3 %; p = 0.009) with emergency room visits (11.8 % vs 2.7 %; p =  0.032). At baseline, more CNS versus non-CNS patients had Magnetic Resonance Imaging (MRI) scans (80.0 % vs 31.7 %; p <  0.001), but fewer had fluorodeoxyglucose (FDG)-positron emission tomography (PET)-computed tomography (CT) scans (10.0 % vs 28.0 %; p = 0.004). CONCLUSION: These data from clinical practice show minor differences in HRQoL/HRU between patients with advanced NSCLC with/without CNS metastases when applying selected clinical trial criteria. Although follow-up was short, HRQoL scores were similar between cohorts at all visits, supporting the wider inclusion of selected patients with CNS disease into clinical trials.

A Real-World Data Study to Evaluate Treatment Patterns, Clinical Characteristics and Survival Outcomes for First- and Second-Line Treatment in Locally Advanced and Metastatic Urothelial Cancer Patients in Germany.

Background: Worldwide, urothelial carcinoma (UC) is a common cause of morbidity and mortality. In particular, the incidence of bladder cancer varies widely across Europe; Germany has the ninth highest international age-standardized incidence. For advanced UC or metastatic UC (mUC), platinum-based combination chemotherapy is the standard first-line (1L) treatment; however, there is wide heterogeneity of second-line (2L) treatments, ranging from vinflunine in parts of Europe to taxanes and other agents elsewhere in Europe, in the United States and globally. Limited data exist on treatment patterns and outcomes in patients with advanced UC or mUC in the routine clinical setting in Germany. The objective of this study was to describe clinical characteristics, treatment patterns and subsequent outcomes in this setting. Methods: This retrospective observational cohort analysis evaluated 1L and 2L treatment patterns and overall survival (OS) in patients aged ≥18 years with advanced UC or mUC (T4b, N2-3 and/or M1) at office-based urology and academic as well as nonacademic urology clinics throughout Germany between 1 November 2009 and 2 June 2016. Data were obtained through the GermanOncology database and additional treatment centers using similar electronic case report forms. Results: Among the 435 patients included in the analysis, 435 received 1L treatment and 125 received 2L treatment. Median age at start of 1L treatment was 69 years, 75% of patients were male, 75% were current or ex-smokers, 15% had hemoglobin <10 g/dL and 44% had creatinine clearance<60 mL/min/1.73; proportions were similar with 2L treatment. Cardiovascular disease was the most frequently reported comorbidity (65%), followed by diabetes (19%). Most patients (77%) received 1L platinum-based combination treatment (most commonly gemcitabine + cisplatin, 83%). Of those treated with 2L treatment, 66% received a single agent (most commonly vinflunine, 71%). Median OS (95% CI) with 1L treatment was 16.1 months (13.7-19.2) overall and 17.7 months (14.4-24.2) with 1L cisplatin + gemcitabine. In the 1L setting, 12-month OS was 61%, 24-month OS was 39% and 36-month OS was 26%. Median (95% CI) OS with 2L treatment was 9.2 months (5.5-11.6) overall and 5.9 months (4.1-12.6) with 2L vinflunine. In the 2L setting, OS rates for the same time periods were 40%, 22% and 8%, respectively. Median (95% CI) progression-free survival was 7 months (6.4-8.1) and 4 months (3.0-4.8), respectively, in the 1L and 2L settings. Objective response rates were 34% in the 1L setting and 14% in the 2L setting. No difference in OS by sex or smoking status was noted. Patients with or without renal impairment had a 12-month OS of 54% or 69%, respectively. OS at 12 months was 63% among patients with an Eastern Cooperative Oncology Group performance status (ECOG PS) of 0 to 1 vs 53% among patients with an ECOG PS of ≥2. Cox regression analysis found no difference in OS between vinflunine and other 2L treatments (P = 0.69). Conclusions: This study provides a contemporary multicenter assessment of real-world treatment patterns and outcomes among palliatively treated patients with UC in Germany. The findings were generally consistent with the poor treatment outcomes observed globally, underscoring the need for effective 1L and 2L treatment for advanced UC or mUC.

Prognosis of breast cancer molecular subtypes in routine clinical care: A large prospective cohort study.

BACKGROUND: In Germany, most breast cancer patients are treated in specialized breast cancer units (BCU), which are certified, and routinely monitored. Herein, we evaluate up-to-date oncological outcome of breast cancer (BC) molecular subtypes in routine clinical care of a specialized BCU. METHODS: The study was a prospectively single-center cohort study of 4102 female cases with primary, unilateral, non-metastatic breast cancer treated between 01 January 2003 and 31 December 2012. The five routinely used molecular subtypes (Luminal A-like, Luminal B/HER2 negative-like, Luminal B/HER2 positive-like, HER2-type, Triple negative) were analyzed. The median follow-up time of the whole cohort was 55 months. We calculated estimates for local control rate (LCR), disease-free survival (DFS), distant disease-free survival (DDFS), overall survival (OS), and relative overall survival (ROS). RESULTS: Luminal A-like tumors were the most frequent (44.7 %) and showed the best outcome with LCR of 99.1 % (95 % CI 98.5; 99.7), OS of 95.1 % (95 % CI 93.7; 96.5), and ROS of 100.0 % (95 % CI 98.5; 101.5). Triple negative tumors (12.3 %) presented the poorest outcome with LCR of 89.6 % (95 % CI 85.8; 93.4), OS of 78.5 % (95 % CI 73.8; 83.3), and ROS of 80.1 % (95 % CI 73.8; 83.2). CONCLUSIONS: Patients with a favorable subtype can expect an OS above 95 % and an LCR of almost 100 % over 5 years. On the other hand the outcome of patients with HER2 and Triple negative subtypes remains poor, thus necessitating more intensified research and care.

Minimally Invasive Colorectal Cancer Surgery in Europe: Implementation and Outcomes.

Minimally invasive surgery (MIS) of colorectal cancer (CRC) was first introduced over 20 years ago and recently has gained increasing acceptance and usage beyond clinical trials. However, data on dissemination of the method across countries and on long-term outcomes are still sparse.In the context of a European collaborative study, a total of 112,023 CRC cases from 3 population-based (N = 109,695) and 4 institute-based clinical cancer registries (N = 2328) were studied and compared on the utilization of MIS versus open surgery. Cox regression models were applied to study associations between surgery type and survival of patients from the population-based registries. The study considered adjustment for potential confounders.The percentage of CRC patients undergoing MIS differed substantially between centers and generally increased over time. MIS was significantly less often used in stage II to IV colon cancer compared with stage I in most centers. MIS tended to be less often used in older (70+) than in younger colon cancer patients. MIS tended to be more often used in women than in men with rectal cancer. MIS was associated with significantly reduced mortality among colon cancer patients in the Netherlands (hazard ratio [HR] 0.66, 95% confidence interval [CI] (0.63-0.69), Sweden (HR 0.68, 95% CI 0.60-0.76), and Norway (HR 0.73, 95% CI 0.67-0.79). Likewise, MIS was associated with reduced mortality of rectal cancer patients in the Netherlands (HR 0.74, 95% CI 0.68-0.80) and Sweden (HR 0.77, 95% CI 0.66-0.90).Utilization of MIS in CRC resection is increasing, but large variation between European countries and clinical centers prevails. Our results support association of MIS with substantially enhanced survival among colon cancer patients. Further studies controlling for selection bias and residual confounding are needed to establish role of MIS in survival of patients.

Time trends in axilla management among early breast cancer patients: Persisting major variation in clinical practice across European centers.

Background We examined time trends in axilla management among patients with early breast cancer in European clinical settings. Material and methods EUROCANPlatform partners, including population-based and cancer center-specific registries, provided routinely available clinical cancer registry data for a comparative study of axillary management trends among patients with first non-metastatic breast cancer who were not selected for neoadjuvant therapy during the last decade. We used an additional short questionnaire to compare clinical care patterns in 2014. Results Patients treated in cancer centers were younger than population-based registry populations. Tumor size and lymph node status distributions varied little between settings or over time. In 2003, sentinel lymph node biopsy (SLNB) use varied between 26% and 81% for pT1 tumors, and between 2% and 68% for pT2 tumors. By 2010, SLNB use increased to 79-96% and 49-92% for pT1 and pT2 tumors, respectively. Axillary lymph node dissection (ALND) use for pT1 tumors decreased from between 75% and 27% in 2003 to 47% and 12% in 2010, and from between 90% and 55% to 79% and 19% for pT2 tumors, respectively. In 2014, important differences in axillary management existed for patients with micrometastases only, and for patients fulfilling the ACOSOG Z0011 criteria for omitting ALND. Conclusion This study demonstrates persisting differences in important aspects of axillary management throughout the recent decade. The results highlight the need for international comparative patterns of care studies in oncology, which may help to identify areas where further studies and consensus building may be necessary.

Recent Trends in Survival of Patients With Pancreatic Cancer in Germany and the United States.

OBJECTIVES: Survival improvement for pancreatic cancer has not been observed in the last 4 decades. We report the most up-to-date population-based relative survival (RS) estimates and recent trends in Germany and the United States. METHODS: Data for patients diagnosed in 1997 to 2010 and followed up to 2010 were drawn from 12 population-based German cancer registries and the US SEER (Surveillance, Epidemiology and End Results) 13 registries database. Using period analysis, 5-year RS for 2007 to 2010 was derived. Model-based period analysis was used to assess 5-year RS time trends, 2002-2010. RESULTS: In total 28,977 (Germany) and 34,793 (United States) patients aged 15 to 74 years were analyzed. Five-year RS was 10.7% and 10.3% in Germany and the United States, respectively, and strongly decreased with age and tumor spread. Prognosis slightly improved from the period 2002-2004 to 2008-2010 (overall age-adjusted RS: +2.5% units in Germany and +3.4% units in the United States); improvement was particularly strong for regional stage and head and body subsites in Germany and for localized and regional stages and tail subsite in the United States. CONCLUSIONS: Although pancreatic cancer survival continues to be poor for advanced-stage patients, our study disclosed encouraging indications of first improvements in 5-year RS after decades of stagnation.

T-DM1 as a New Treatment Option for Patients with Metastatic HER2-positive Breast Cancer in Clinical Practice.

AIM: To compare results of trastuzumab-emtansine (T-DM1) treatment in our clinical practice with data from phase III clinical trials. PATIENTS AND METHODS: A retrospective chart review of all 23 patients with metastatic human epidermal growth factor receptor 2 (HER2)-positive breast cancer who were started on T-DM1 until April 2014 was performed. RESULTS: Four patients (17.4%) received T-DM1 as first-line, three (13.0%) as second-line, six (26.0%) as third-line, and 10 (43.5%) as fifth- or further-line therapy. Overall, the response rate (ORR) was 26.0%, disease control rate 78.3% and median progression-free survival (PFS) 8.4 months. The only toxicities of grade 3 or more were fatigue (21.7%), thrombocytopenia (4.3%) and elevation of liver enzymes (8.7%). ORR and PFS were similar to the TH3RESA and EMILIA trials. Compared to the EMILIA study, we recorded higher rates of newly-diagnosed cerebral metastasis and cerebral progression in patients with stable peripheral metastases. CONCLUSION: T-DM1 is effective and well-tolerated even in intensively pre-treated patients.

Cancer surveillance using registry data: Results and recommendations for the Lithuanian national prostate cancer early detection programme.

INTRODUCTION: We describe long term trends in prostate cancer epidemiology in Lithuania, where a national prostate specific antigen (PSA) test based early detection programme has been running since 2006. METHODS: We used population-based cancer registry data, supplemented by information on PSA testing, life expectancy and mortality from Lithuania to examine age-specific prostate cancer incidence, mortality and survival trends among men aged 40+ between 1978 and 2009, as well as life expectancy of screening-eligible men, and the proportion of men with a first PSA test per year since the programme started. RESULTS: The number of prostate cancer patients rose from 2.237 in 1990-1994 to 15.294 in 2005-2009. By 2010, around 70% of the eligible population was tested, on average around two times. The early detection programme brought about the highest prostate cancer incidence peaks ever seen in a country to date. Recent incidence and survival rises in the age groups 75-84 suggest PSA testing in the elderly non-eligible population. Life expectancy of men aged 70-74 indicates that less than 30% of patients will live for 15 years and may have a chance to benefit from early detection. CONCLUSIONS: Early detection among men aged 70-74, and particularly among the elderly (75+) may have to be reconsidered. Life expectancy assessment before testing, avoiding a second test among men with low PSA values and increasing the threshold for further evaluation and the screening interval may help reducing harm. Publishing information on treatment modalities, side-effects and patient reported quality of life is recommended.

Recent cancer survival in Germany: an analysis of common and less common cancers.

The monitoring of cancer survival by population-based cancer registries is a prerequisite to evaluate the current quality of cancer care. Our study provides 1-, 5- and 10-year relative survival as well as 5-year relative survival conditional on 1-year survival estimates and recent survival trends for Germany using data from 11 population-based cancer registries, covering around one-third of the German population. Period analysis was used to estimate relative survival for 24 common and 11 less common cancer sites for the period 2007-2010. The German and the United States survival estimates were compared using the Surveillance, Epidemiology and End Results 13 database. Trends in cancer survival in Germany between 2002-2004 and 2008-2010 were described. Five-year relative survival increased in Germany from 2002-2004 to 2008-2010 for most cancer sites. Among the 24 most common cancers, largest improvements were seen for multiple myeloma (8.0% units), non-Hodgkin lymphoma (6.2% units), prostate cancer (5.2% units) and colorectal cancer (4.6% units). In 2007-2010, the survival disadvantage in Germany compared to the United States was largest for cancers of the mouth/pharynx (-11.0% units), thyroid (-6.8% units) and prostate (-7.5% units). Although survival estimates were much lower for elderly patients in both countries, differences in age patterns were observed for some cancer sites. The reported improvements in cancer survival might reflect advances in the quality of cancer care on the population level as well as increased use of screening in Germany. The survival differences across countries and the survival disadvantage in the elderly require further investigation.

Survival of cancer patients in urban and rural areas of Germany--a comparison.

BACKGROUND: Cancer care services including cancer prevention activities are predominantly localised in central cities, potentially causing a heterogeneous geographic access to cancer care. The question of an association between residence in either urban or rural areas and cancer survival has been analysed in other parts of the world with inconsistent results. This study aims at a comparison of age-standardised 5-year survival of cancer patients resident in German urban and rural regions using data from 11 population-based cancer registries covering a population of 33 million people. MATERIAL AND METHODS: Patients diagnosed with cancers of the most frequent and of some rare sites in 1997-2006 were included in the analyses. Places of residence were assigned to rural and urban areas according to administrative district types of settlement structure. Period analysis and district type specific population life tables were used to calculate overall age-standardised 5-year relative survival estimates for the period 2002-2006. Poisson regression models for excess mortality (relative survival) were used to test for statistical significance. RESULTS: The 5-year relative survival estimates varied little among district types for most of the common sites with no consistent trend. Significant differences were found for female breast cancer patients and male malignant melanoma patients resident in city core regions with slightly better survival compared to all other district types, particularly for patients aged 65 years and older. CONCLUSION: With regard to residence in urban or rural areas, the results of our study indicate that there are no severe differences concerning quality and accessibility of oncological care in Germany among different district types of settlement.

Cancer survival in Lithuania after the restoration of independence: rapid improvements, but persisting major gaps.

BACKGROUND: Following restoration of political independence in 1990, Lithuania underwent rapid societal and economic changes. We aimed to assess trends in cancer survival in the first two decades following these changes. MATERIAL AND METHODS: We used population-based data from the Lithuanian Cancer Registry and period analysis techniques to examine trends in one-, 2-5- and five-year relative survival between 1995-1999 and 2005-2009 for 24 common cancers in Lithuania. RESULTS: Between 1995-1999 and 2005-2009, five-year relative survival increased significantly for 20 of 24 cancers, and for 10 cancers the increase exceeded 10% units. Five-year relative survival estimates reached 46%, 69% and 91% for colorectal, breast and prostate cancer in 2005-2009, respectively, while patients with testicular cancer, Hodgkin's or non-Hodgkin's lymphoma had a five-year relative survival of 77%, 75% and 50%, respectively. CONCLUSION: We found a rapid increase in survival for most forms of common cancers in Lithuania between 1995 and 2009. Nevertheless, several cancers with effective therapies exhibit considerable gaps compared with Northern and Western European countries. Despite ongoing rises in survival, mortality declines are not yet manifesting for important common cancers such as breast and colorectal cancer. Rapid incidence rises suggest that increases in survival for prostate and thyroid cancers are massively influenced by early detection-related effects. Improving the availability of effective therapies, and carefully planned early detection programs may help to increase cancer survival in Lithuania in the future.

Survival of adults with acute lymphoblastic leukemia in Germany and the United States.

BACKGROUND: Adulthood acute lymphoblastic leukemia (ALL) is a rare disease. In contrast to childhood ALL, survival for adults with ALL is poor. Recently, new protocols, including use of pediatric protocols in young adults, have improved survival in clinical trials. Here, we examine population level survival in Germany and the United States (US) to gain insight into the extent to which changes in clinical trials have translated into better survival on the population level. METHODS: Data were extracted from the Surveillance, Epidemiology, and End Results database in the US and 11 cancer registries in Germany. Patients age 15-69 diagnosed with ALL were included. Period analysis was used to estimate 5-year relative survival (RS). RESULTS: Overall 5-year RS was estimated at 43.4% for Germany and 35.5% for the US (p = 0.004), with a decrease in survival with increasing age. Survival was higher in Germany than the US for men (43.6% versus 37.7%, p = 0.002) but not for women (42.4% versus 40.3%, p>0.1). Five-year RS estimates increased in Germany and the US between 2002 and 2006 by 11.8 and 7.3 percent units, respectively (p = 0.02 and 0.04, respectively). CONCLUSIONS: Survival for adults with ALL continues to be low compared with that for children, but a substantial increase in 5-year survival estimates was seen from 2002 to 2006 in both Germany and the US. The reasons for the survival differences between both countries require clarification.

Improved population level survival in younger Hodgkin lymphoma patients in Germany in the early 21st century.

Treatment for Hodgkin lymphoma (HL) is more aggressive in Germany than in the United States (US) and differences in treatment may lead to differences in population level survival. Patients diagnosed with HL in 11 German states in 1997-2006 were included in the analyses and were compared to similar analyses from patients in the Surveillance, Epidemiology, and End Results database in the US. Period analysis was used to calculate 5-year relative survival for the time period of 2002-2006 overall and by gender, age and histology. Overall 5-year relative survival for patients with HL in Germany was 84·3%, compared to 80·6% for the US. Survival was highest in patients aged 15-29 years at 97·9% and decreased with age to 57·5% at age 60 + Survival for men and women, respectively, was 84·7% and 84·1% in Germany and 78·2% and 83·6% in the US. 5-year relative survival for patients diagnosed with HL in Germany was close to 100% for younger patients. Survival of HL patients in the US was lower than in Germany overall, but was comparable in older patients and in women. Population-based studies with longer follow-up are still needed to examine effects of late toxicity on long term survival.

Socioeconomic deprivation and cancer survival in Germany: an ecological analysis in 200 districts in Germany.

Although socioeconomic inequalities in cancer survival have been demonstrated both within and between countries, evidence on the variation of the inequalities over time past diagnosis is sparse. Furthermore, no comprehensive analysis of socioeconomic differences in cancer survival in Germany has been conducted. Therefore, we analyzed variations in cancer survival for patients diagnosed with one of the 25 most common cancer sites in 1997-2006 in ten population-based cancer registries in Germany (covering 32 million inhabitants). Patients were assigned a socioeconomic status according to the district of residence at diagnosis. Period analysis was used to derive 3-month, 5-year and conditional 1-year and 5-year age-standardized relative survival for 2002-2006 for each deprivation quintile in Germany. Relative survival of patients living in the most deprived district was compared to survival of patients living in all other districts by model-based period analysis. For 21 of 25 cancer sites, 5-year relative survival was lower in the most deprived districts than in all other districts combined. The median relative excess risk of death over the 25 cancer sites decreased from 1.24 in the first 3 months to 1.16 in the following 9 months to 1.08 in the following 4 years. Inequalities persisted after adjustment for stage. These major regional socioeconomic inequalities indicate a potential for improving cancer care and survival in Germany. Studies on individual-level patient data with access to treatment information should be conducted to examine the reasons for these socioeconomic inequalities in cancer survival in more detail.

Sex differences in colorectal cancer survival: population-based analysis of 164,996 colorectal cancer patients in Germany.

Risk of colorectal cancer (CRC) is considerably higher in men compared to women; however, there is inconclusive evidence of sex differences in CRC prognosis. We aimed to assess and explain sex differences in 5-year relative survival using standard and model-based period analysis among 164,996 patients diagnosed with CRC from 1997 to 2006 and reported to 11 German cancer registries covering a population of 33 million inhabitants. Age-adjusted 5-year relative survival was higher in women (64.5% vs. 61.9%, P<0.0001). A substantial survival advantage of women was confirmed in multivariate analysis after adjusting for CRC stage and subsite in subjects under 65 years of age (relative excess risk, RER 0.86, 95% CI 0.82-0.90), but not in older subjects (RER 1.01, 95% CI 0.98-1.04); this pattern was similar in the 1st and in the 2nd to 5th year after diagnosis. The survival advantage of women varied by CRC stage and age and was most pronounced for localized disease (RERs 0.59-0.88 in various age subgroups) and in patients under 45 years of age (RERs 0.59, 0.72 and 0.76 in patients with localized, regional or advanced disease, respectively). On the contrary, sex differences in survival did not vary by location of CRC. In conclusion, our large population-based study confirmed a survival advantage of female compared to male CRC patients, most notably in young and middle aged patients and patients with localized disease. The effect of sex hormones, either endogenous or through hormonal replacement therapy, might be the most plausible explanation for the observed patterns.

Survival among adolescents and young adults with cancer in Germany and the United States: an international comparison.

Serious concern arose in the scientific literature about the state of and progress in cancer survival among adolescent and young adult (AYA) patients in the recent years. We provide an up-to-date international comparison of survival among AYA patients. Using population-based cancer data from 11 German cancer registries and the SEER Program of the United States (covering populations of 39 and 33 million people, respectively), standardized tumor group classifications, period analysis and modeling, we compared the 5-year relative survival of AYA patients in the age groups 15-29 and 30-39 to survival seen among adults aged 40-49 for the 2002-2006 period. Additionally, we also provide an age-specific survival comparison between the two countries. In 2002-2006, for the overwhelming majority of the more than 30 types of cancer examined, AYA patients aged both 15-29 and 30-39 years had higher or similar survival than patients in the age group 40-49 in both countries. A numerically large and statistically significant survival deficit among AYA patients was only found for breast carcinomas in both populations, and colorectal and stomach carcinoma in the United States for the age group 15-29. Overall, results of the country-specific comparisons did not indicate systematic differences. With very few exceptions, no survival deficit between AYA patients and adults aged 40-49 years was found in either of the examined countries in the first decade of the 21st century.

Survival of patients with oral cavity cancer in Germany.

The purpose of the present study was to describe the survival of patients diagnosed with oral cavity cancer in Germany. The analyses relied on data from eleven population-based cancer registries in Germany covering a population of 33 million inhabitants. Patients with a diagnosis of oral cavity cancer (ICD-10: C00-06) between 1997 and 2006 are included. Period analysis for 2002-2006 was applied to estimate five-year age-standardized relative survival, taking into account patients' sex as well as grade and tumor stage. Overall five-year relative survival for oral cavity cancer patients was 54.6%. According to tumor localization, five-year survival was 86.5% for lip cancer, 48.1% for tongue cancer and 51.7% for other regions of the oral cavity. Differences in survival were identified with respect to age, sex, tumor grade and stage. The present study is the first to provide a comprehensive overview on survival of oral cavity cancer patients in Germany.