A survey of disclosure of diagnosis to patients with glioma in Japan

Background

There have been few studies investigating neuro-oncologists?? attitudes toward the disclosure of the diagnosis. This study aimed to determine the current status of disclosure to glioma patients in Japan and to analyze the factors associated with disclosure.

Methods

A set of questionnaires about disclosure to patients with malignant glioma was distributed by e-mail to 191 physicians participating in the 27th Annual Meeting of the Japan Society for Neuro-Oncology.

Results

The response rate was 73.8% (141/191). Of these, 44.3% disclosed the correct diagnosis to glioblastoma patients aged <60?years and 41.4% disclosed the correct diagnosis to those aged ??70?years; for anaplastic astrocytoma patients, these proportions were 61.5 and 51.9%, respectively. Physicians working at facilities performing surgery on more than 50 cases of glioma per year, those in metropolitan areas, and those with other patient psychosocial support systems available disclosed the diagnosis and prognosis more frequently. The physicians?? gender and postgraduate period of practice did not influence disclosure. When the family opposed disclosing the diagnosis to the patient, more than half of the physicians respected the family??s wishes.

Conclusions

This survey revealed that most of the physicians told at least the malignant nature of the disease to patients with malignant glioma, but they did not always tell the exact diagnosis. Physicians tended to modify their attitudes toward disclosing a diagnosis or prognosis of glioma depending on the histopathological grading, the hospital volume of cases, the location, the availability of patient psychological support systems, and the patient??s family??s wishes.     

Use of radiation treatment units in breast cancer. Changes in the last 15 years

Introduction Advances in diagnosis and treatment in oncology combined with technical advances in radiotherapy have resulted in qualitative and quantitative changes in the use of radiation to treat breast cancer. Objective The objective was to analyse changes in radiation indications from 1990 to the present time and their consequences in the use of treatments units. Methods and material From January 1990 to December 2005, 4545 radiation treatments for breast cancer were performed, classified as radical after conservative surgery, radical after mastectomy or palliative. Data are presented as relative frequencies and as 3-year period groups. Results An increase in the proportion of treatments for breast cancer and in treatment unit use distribution is observed. Radical treatments have increased over time, ranging from 55% in the first 3-year period group to 82% in the last one. Unit treatment distribution analysis is similar, but with a less important increase, rising from 85% to 95%. A rise in conservative treatment is also observed, from 43% to 75%. Conclusions An increase in breast cancer incidence is observed and there was also an increase in irradiation after conservative treatment. On the contrary, probably due to the rise in the use of systemic treatments, a decrease in post-mastectomy irradiation and palliative treatments is shown.     

Improved survival for patients with de novo metastatic prostate cancer in the last 20 years

IntroductionDuring recent years, several new life-prolonging therapeutic options have been introduced for patients with metastatic prostate cancer (mPCa). The aim of the present study was to evaluate the changes in the survival of patients diagnosed with mPCa prior to and in the early period of the implementation of these new agents.Patients and methodsThe study population consisted of 207 men diagnosed in 1997 and 316 men diagnosed in the period 2007–2013 with de novo mPCa and managed with initial endocrine therapy. Men were followed for overall survival and PCa-specific survival.ResultsAt the time of diagnosis, men diagnosed in the period 2007–2013 had less co-morbidity, lower prostrate-specific antigen levels and lower clinical tumour categories than men diagnosed in 1997. A significantly higher proportion of men diagnosed in 1997 were managed with surgical castration (57% versus 9%). Only one patient diagnosed in 1997 received second-line therapy compared with 81 men (26%) diagnosed in the period 2007–2013. The median overall survival was significantly longer for men diagnosed between 2007 and 2013 compared with men diagnosed in 1997 (39.4 months versus 24.2 months, p < 0.0001). Likewise, the cumulative incidence of PCa-specific death was higher among men diagnosed in 1997 compared with men diagnosed between 2007 and 2013, with 5-year cumulative incidences of 72% and 47%, respectively (p < 0.0001).ConclusionSurvival in men diagnosed with metastatic PCa has improved significantly over time. The improved survival can in part be explained by lead-time bias, but also by the introduction of new life-prolonging treatments.     

北京城区女性乳腺癌发病死亡和生存情况20年监测分析

目的 探讨北京城区乳腺癌发病率、死亡率及生存率的变化特点,为乳腺癌的预防与控制提供依据。方法 利用1982-2001年北京城区肿瘤登记报告资料,并结合1982年1月1日至1983年12月30日和1987年1月1日至1988年12月30日两个时期新发病例的随访资料,对北京城区女性乳腺癌的发病率、死亡率、生存率进行比较分析。结果 1982-2001年北京城区女性乳腺癌发病率及世界标准人口标化率呈逐年上升趋势,平均每年递增4．6％和4．9％。其流行特征：（1）年龄别发病率呈现一条由低到高的双峰曲线;（2）20年间各年龄组发病率均呈增高趋势;（3）35～64岁截缩发病率高达95．3／10万;（4）1982-1983年和1987-1988年两个时期相比,5年观察生存率（OSR）从62．0％上升到68．7％,相对生存率（RSR）由66．3％增长到74．2％;（5）20年间,死亡率一直在8／10万～10／10万的水平上波动。结论 北京城区女性乳腺癌发病率呈逐年上升的流行趋势,死亡率呈平稳状态,5年生存率在不断提高。北京市乳腺癌的二级预防是有效果的。     

Moderate progress for ovarian cancer in the last 20 years: prolongation of survival,but no improvement in the cure rate

Although ovarian cancer treatment has advanced in the last 20 years, long-term survival remains stable. The purpose of this study was to determine whether survival has improved in line with treatment advances in a population-based prospective cohort of ovarian cancer patients (1978–1997, with a follow-up through to 2000). The 10-year overall survival rate for cancer patients was similar before and after 1988: 32.2% (n=1661) and 34.4% (n=2089). For patients after 1988, a 12-month prolongation of median survival was observed. In terms of stage according to the International Federation of Gynecology and Obstetrics (FIGO), only FIGO I and FIGO II patients showed, in addition to a prolongation in survival, an absolute improvement of 12.9 and 12.6% after 5 years and of 13.2 and 8.6% after 10 years. This hardly affected the survival of the total sample. For the most frequent stage FIGO III patients and for FIGO IV patients, a prolongation in survival time, but no improvement in survival rate, was seen after five or 10 years. The progress in FIGO I and II patients may be due to more accurate staging. More effective chemotherapy may also explain some of the improvement. The prolongation in FIGO-stages III-IV may be due to more radical surgery. Patient selection criteria, not only the treatment modalities, may be responsible for the superior results reported in clinical trials. Cancer registries are important for evaluating the quality of healthcare delivery.     

中国近30年间结直肠癌死亡趋势分析

背景与目的：随着我国人民生活水平的提高及饮食习惯的改变,结直肠癌死亡率有升高趋势,该研究旨在分析中国近30年结直肠癌死亡的时间变化趋势。方法：分层汇总中国大陆居民1987—2015年结肠、直肠和肛门癌死亡率数据,利用Joinpoint模型估算各人群及各年龄组死亡率的时间变化趋势,利用负二项回归模型分析其死亡在人群水平上的危险因素。结果：男性结肠、直肠和肛门癌死亡率呈上升趋势［城市死亡率平均年度变化百分比（average annual percent change,AAPC）=0.50%,农村AAPC=0.57%］,女性死亡率小幅度下降［城市AAPC=-0.59%,农村AAPC=-0.45%］;65岁以下男性和75岁以下女性居民死亡率基本呈下降趋势,65岁以上男性和75岁以上女性居民基本呈上升趋势。结直肠癌的死亡风险,城市居民是农村居民的1.46倍（95%CI：1.40~1.52）,男性是女性的1.38倍（95%CI：1.32~1.42）,每增加5岁,死亡风险平均增大51%（OR=1.50,95%CI：1.49~1.51）,每过1年,死亡风险平均增加0.08%,但差异无统计学意义（OR=1.00,P=0.47）。结论：中国结直肠癌死亡率的变化趋势有地区、性别及年龄差异,男性居民呈上升趋势,女性居民呈小幅度下降趋势;高年龄组居民结直肠癌死亡率呈上升趋势。     

Excess mortality from breast cancer 20 years after diagnosis when life expectancy is normal

In a population-based study, causes of death were traced of 418 deceased breast cancer patients diagnosed in 1960-1979 who survived at least 10 years after diagnosis. The pattern of causes of death in these patients was compared with the general female population using standardized mortality ratios (SMRs). Of 418 patients surviving at least 10 years, 196 (47%) died from breast cancer and 50 (12%) died from another cancer. The SMR for breast cancer was 15.8 (95% CI: 13.1-18.8) 10-14 years after diagnosis; it was still 4.7 (95% CI: 2.6-7.8) after 20 years. Overall mortality was higher than expected 10-14 years after diagnosis (SMR: 1.3; 95% CI: 1.1-1.5), but lower after more than 20 years (SMR: 0.6; 95% CI: 0.4-0.7). Despite a normal (or even improved) life expectancy for breast cancer patients 20 years after diagnosis the risk of dying from this disease remained elevated.     

Changes in multiple myeloma epidemiology in the last thirty years: a single centre experience

In this study we have evaluated 772 multiple myeloma (MM) patients for clinical presentation, response to treatment, relapse modality, and survival in the last 30 years. Patients were divided, according to the date of diagnosis in group I or group II (before and after 1994, respectively) and therapy (high or conventional dose). Bone pain and early deaths were statistically reduced in group II, whereas MM that evolved from monoclonal gammopathy of undetermined significance (MGUS) had increased. The efficacy of high dose therapy (HDT) over conventional dose therapy (CDT) was confirmed through analysis of response rate, progression free, and overall survival. Relapse modality was similar after HDT or CDT. Among older patients, those diagnosed after 1994 lived longer than those diagnosed before 1994. In the last 30 years, the clinical presentation of multiple myeloma remained substantially unchanged. The new therapeutic approaches, chemotherapy and supportive therapy, allowed better control of the disease with an improvement of survival.     

Improving outcomes in gastric cancer over 20 years

Background Gastric cancer has in the past proven to be a difficult disease to cure. Surgery is the most effective treatment, although the extent of lymphadenectomy undertaken is controversial. This paper examines trends in the detection and treatment of gastric cancer, the move toward targeted surgery, and their impact on survival.Methods From 1982 to 2001, 430 patients with gastric cancer were under the care of a single surgeon at the same institution. Copies of the operation records, discharge summaries, and histology reports were retained and subsequently reviewed.Results Thirty-six patients were excluded from the analysis. Two hundred and five patients (52%) had potentially curative surgery for adenocarcinoma and 189 had incurable disease. During the 20-year period, overall 5-year survival increased significantly, from 15% to 41% (P < 0.01). The number of curative procedures also increased significantly, from 33% to 73% (P1 < 0.001) as disease was detected earlier, and 5-year survival in these patients increased from 26% to 46%. Eighty-seven D1, 92 D2, and 26 targeted procedures were performed, with 30-day mortalities of 5%, 9%, and 5%, respectively. The 5-year survival was 47% for D1, 42% for D2, and 66% for targeted surgery.Conclusion This paper demonstrates an improvement in the stage at which disease was detected and improvement in long-term survival for patients with gastric cancer. The development of targeted surgery has shown promising early results.     

Ras oncogenes in oral cancer: the past 20 years

Oral squamous cell carcinoma (OSCC) of head and neck is associated with high morbidity and mortality in both Western and Asian countries. Several risk factors for the development of oral cancer are very well established, including tobacco chewing, betel quid, smoking, alcohol drinking and human papilloma virus (HPV) infection. Apart from these risk factors, many genetic factors such as oncogenes, tumor suppressor genes and regulatory genes are identified to involve in oral carcinogenesis with these risk factors dependent and independent manner. Ras is one of the most frequently genetically deregulated oncogene in oral cancer. In this review, we analyze the past 22years of literature on genetic alterations such as mutations and amplifications of the isoforms of the ras oncogene in oral cancer. Further, we addressed the isoform-specific role of the ras in oral carcinogenesis. We also discussed how targeting the Akt and MEK, downstream effectors of the PI3K/Akt and MAPK pathways, respectively, would probably pave the possible molecular therapeutic target for the ras driven tumorigenesis in oral cancer. Analysis of these ras isoforms may critically enlighten specific role of a particular ras isoform in oral carcinogenesis, enhance prognosis and pave the way for isoform-specific molecular targeted therapy in OSCC.     

Radical treatment of non-small cell lung cancer during the last 5 years

The management of non-small cell lung cancer (NSCLC) has continued to improve over the last 5 years due to advances in surgery, radiological staging, combined modality therapies and advances in radiation technology.We have an updated staging classification (7th Edition American Joint Committee on Cancer staging) and now in 2011, a new histology classification introducing the concepts of adenocarcinoma in situ and minimally invasive adenocarcinoma. This classification has profound surgical implications as the role of limited resection is reconsidered for early stage lesions. Surgery is curative in early stage disease. The role of surgery in locally advanced NSCLC remains controversial. The principal aim is a complete resection as this will determine long-term prognosis. Intraoperative staging of lung cancer is extremely important to determine the extent of resection according to the tumour and nodal status. Systematic nodal dissection is generally advocated to obtain accurate intraoperative staging and to help decide on adjuvant therapy.Radiotherapy currently plays a major role in the management of lung cancer as most patients are not surgical candidates due to disease stage, fitness and co-morbidities. In the last 5 years we have seen continuing optimisation of chemo-radiotherapy combinations and technological advances including the development of image guided radiotherapy (IGRT), stereotactic ablative body radiotherapy (SABR) and intensity modulated radiotherapy (IMRT).Quality of life evaluation is becoming increasingly important and should be considered when deciding on a specific treatment, especially in a multimodality setting.     

From radiotherapy to Targeted therapy: 20 years in the management of non-small-cell lung cancer

Non-small-cell lung cancer (NSCLC) is the leading cause of cancer death worldwide. Before 1980, radiotherapy was considered the only real recourse in advanced disease. In 1995, a landmark meta-analysis of trials conducted in the 1980s and early 1990s demonstrated a survival benefit with platinum-based chemotherapy. Newer chemotherapy agents and improved supportive care measures have allowed more patients to benefit from chemotherapy with reduced toxicity. Concurrent platinum-based chemotherapy and radiotherapy has improved the survival in stage III disease, and recently chemotherapy has also demonstrated improved survival in resected early-stage disease. The majority of patients still present with advanced unresectable disease for whom the prognosis remains poor, but for key subpopulations the outlook has improved markedly since the emergence of targeted therapies directed against the epidermal growth factor receptor and vascular endothelial growth factor receptor pathways. Patient selection and the incorporation of targeted therapies with cytotoxic chemotherapy are the focus of many ongoing studies, and there is an abundance of new agents undergoing clinical trials. Together, these developments have moved us away from the nihilism of 20 years ago into an era of unprecedented optimism in taking on the many remaining challenges of managing NSCLC in the 21st century.