BACKGROUND: Lower socioeconomic status (SES) is associated with worsened cancer survival. The authors evaluate the impact of SES on stage of cancer at diagnosis and survival in Ontario, Canada. METHODS: All incident cases of breast, colon, rectal, nonsmall cell lung, cervical, and laryngeal cancer diagnosed in Ontario during the years 2003‐2007 were identified by using the Ontario Cancer Registry. Stage information is captured routinely for patients seen at Ontario's 8 Regional Cancer Centers (RCCs). The Ontario population was divided into quintiles (Q1‐Q5) based on community median household income reported in the 2001 census; Q1 represents the poorest communities. Overall survival (OS) and cancer‐specific survival (CSS) were determined with Kaplan‐Meier methodology. A Cox model was used to evaluate the association between survival and SES, stage, and age. RESULTS: Stage at diagnosis was available for 38,431 of 44,802 (85%) of cases seen at RCCs. The authors observed only very small differences in stage distribution by SES. Across all cases in Ontario, the authors found substantial gradients in 5‐year OS and 3‐year CSS across Q1 and Q5 for breast (7% absolute difference in OS, P < .001; 4% CSS, P < .001), colon (8% OS, P < .001; 3% CSS, P = .002), rectal (9% OS, P < .001; 4% CSS, P = .096), nonsmall cell lung (3% OS, P = .002; 2% CSS, P = .317), cervical (16% OS, P < .001; 10% CSS, P = .118), and laryngeal cancers (1% OS, P = .045; 3% CSS, P = .011). Adjustments for stage and age slightly diminished the survival gradient only among patients with breast cancer. CONCLUSIONS: Despite universal healthcare, SES remains associated with survival among patients with cancer in Ontario, Canada. Disparities in outcome were not explained by differences in stage of cancer at time of diagnosis. Cancer 2010. © 2010 American Cancer Society.

BACKGROUND Practice guidelines recommend neoadjuvant chemotherapy (NACT) for bladder cancer. However, the evidence in support of adjuvant chemotherapy (ACT) is less robust. Here we describe whether the evidence of efficacy for NACT/ACT was sufficient to change clinical practice and whether the efficacy demonstrated in clinical trials was translated into effectiveness in the general population. METHODS Electronic records of treatment were linked to the population‐based Ontario Cancer Registry to identify all patients with bladder cancer treated with cystectomy in Ontario 1994‐2008. Utilization of NACT/ACT was compared across 1994‐1998, 1999‐2003, and 2004‐2008. Logistic regression was used to analyze factors associated with NACT/ACT. Cox model and propensity score analyses were used to explore the association between ACT and survival. RESULTS Two thousand forty‐four patients underwent cystectomy for muscle‐invasive bladder cancer (MIBC). Use of NACT remained stable (mean, 4%), whereas utilization of ACT increased over time (16%, 18%, 22%; P = .001). Advanced stage (T3/T4; OR, 1.83; 95% CI, 1.38‐2.46) and node‐positive disease (OR, 8.10; 95% CI, 6.20‐10.7) were associated with greater utilization of ACT. Five‐year overall survival (OS) and cancer‐specific survival (CSS) for all patients was 29% (95% CI, 28%‐31%) and 33% (95% CI, 31%‐35%), respectively. Utilization of ACT was associated with improved OS (HR, 0.71; 95% CI, 0.62‐0.81) and CSS (HR, 0.73; 95% CI, 0.64‐0.84). Results were consistent in propensity score analyses. CONCLUSIONS NACT remains substantially underutilized in routine clinical practice. Our results suggest that perioperative chemotherapy is associated with a substantial survival benefit in the general population. Patients who are planning to undergo cystectomy for bladder cancer should be reviewed by a multidisciplinary team. Cancer 2014;120:1630–1638. © 2013 American Cancer Society.

Uptake of adjuvant chemotherapy for NSCLC increased in patients age 70 years or older following reporting of pivotal adjuvant chemotherapy trials, but it remained below that for patients younger than age 70 years. Adoption of adjuvant chemotherapy appears to be associated with significant survival benefit in the elderly (age ≥ 70 years), with tolerability apparently similar to that of patients who are younger than age 70 years.

BACKGROUND:The time interval between surgery and initiation of adjuvant chemotherapy (ACT) may impact survival in colorectal and breast cancers. This is the first report describing the association between time to adjuvant chemotherapy (TTAC) and survival in non-small cell lung cancer (NSCLC). METHODS: All cases of NSCLC diagnosed in Ontario, Canada, from 2004 to 2006 who underwent surgical resection (n ¼ 3354) were identified using the Ontario Cancer Registry. TTAC was defined as the interval between dates of surgery and initiation of ACT. Factors associated with TTAC greater than 10 weeks were evaluated by logistic regression. The Cox proportional hazards model was used to describe the effect of delayed TTAC (analyzed as a continuous variable) on overall survival. RESULTS: Among the 1032 cases treated with ACT, the median TTAC was 8 weeks (range, 1-16 weeks); 35% of cases initiated ACT more than 10 weeks after surgery. Rates of TTAC greater than 10 weeks varied widely across regions (11%-50%, P ¼ .001). There was no significant association between increased comorbidity and delayed TTAC; there was a trend toward greater delay in TTAC with longer postoperative hospital stay (P ¼ .054) and postoperative readmission to hospital (P ¼ .056). Male sex, higher stage of disease, greater comorbidity, and more extensive surgery were independently associated with inferior survival. TTAC was not associated with overall survival (odds ratio ¼ 1.00, 95% confidence interval ¼ 0.99-1.00). CONCLUSIONS: One-third of NSCLC patients treated with ACT in the general population start ACT beyond 10 weeks after surgery. Delayed TTAC does not appear to be associated with inferior survival in NSCLC. Cancer 2013;119:1243-50. V C 2012 American Cancer Society.KEYWORDS: chemotherapy, lung cancer, health services, outcomes, access to care. INTRODUCTIONOn the basis of results of several large randomized controlled trials (RCTs), adjuvant cisplatin-based chemotherapy has become standard for eligible patients who undergo resection of non-small cell lung cancer (NSCLC). Recently, we reported uptake, practice patterns, and outcomes of adjuvant chemotherapy (ACT) for NSCLC in the general population of Ontario, Canada.1,2 Adjuvant chemotherapy was adopted widely from 2004 onward and was not associated with any increase in hospitalization rates. Moreover, survival at the population level improved after 2004, consistent with the results of clinical trials. We also found that the drugs and regimens being used in the general population were consistent with those evaluated in the relevant RCTs.Several studies in colorectal and breast cancer have found an association between the interval from surgery to initiation of ACT and survival. Meta-analyses in colorectal and breast cancer [3][4][5] have recently reported that delayed time to adjuvant chemotherapy (TTAC) is associated with inferior cancer-specific survival and overall survival. The optimal time of initiating ACT for NSCLC is unknown. In the contemporary NSCLC adjuvant trials, patients initiated ACT ...

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Transient activation of YAP with a modified mRNA after ischemia-reperfusion stress reduces cardiac inflammation, attenuates cardiac hypertrophic remodeling and helps to salvage the myocardium.

Purpose Since 2004, several clinical trials have demonstrated that adjuvant chemotherapy (ACT) improves survival in patients with early-stage non–small-cell lung cancer (NSCLC). Here, we evaluate the uptake of ACT and its impact on outcomes in the general population of Ontario, Canada. Methods All patients diagnosed with NSCLC in Ontario from 2001 to 2006 who underwent surgical resection (n = 6,304) were identified using the Ontario Cancer Registry. We linked electronic records of treatment to the registry. We described uptake of ACT and compared survival of all patients with surgically resected NSCLC diagnosed from 2001 to 2003 with patients diagnosed from 2004 to 2006. As a proxy measure of ACT-related toxicity, we evaluated hospitalizations within 6 months of surgery. Results Demographic, disease, and treatment-related characteristics did not differ between the 2001 to 2003 and 2004 to 2006 study cohorts. Over the study period, the proportion of patients receiving ACT increased from 7% (192 of 2,950 patients) to 31% (1,032 of 3,354 patients; P < .001). The proportion of patients admitted to hospital within 6 months of surgery remained stable and (36% in the 2001 to 2003 cohort and 37% in the 2004 to 2006 cohort). However, within 2 years of surgery, there was a 33% reduction in the proportion of patients admitted to hospital with metastatic disease (P < .001). During the study period, there was a substantial improvement in 4-year survival among surgically resected patients, from 52.5% (2001 to 2003) to 56.1% (2004 to 2006; P = .001). Conclusion There has been a rapid uptake of ACT for NSCLC, which was not associated with an increased rate of hospitalization. The adoption of ACT was associated with a substantial improvement in overall survival, suggesting that the benefits seen in clinical trials are generalizable to the general population.

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