PurposeThe purpose of this study was to examine why Norway has the highest rate of mortality due to cutaneous melanoma (CM) in Europe. The Norwegian Malignant Melanoma Registry (NMMR) enables the study of clinical and histopathological characteristics of patients who die due to CM.ResultsThe NMMR and the Norwegian Cause of Death Registry provided data on the clinical and histopathological factors as well as the date and cause of death, through June 2015 for all first invasive CMs diagnosed in 2008–2012 (n=8087). Cox regression was used to estimate associations between clinical and pathological factors and CM-specific death. Multiple imputation was used to handle missing data.ResultsThe CMs were equally distributed between men (49.9%) and women (50.1%), and the median follow-up was 4.0 years (range: 0.08–7.5 years). Trunk was the most common anatomic site (48%), superficial spreading melanoma was the dominant melanoma subtype (68.2%), median Breslow thickness was 1.0 mm, ulceration was present in 23% of CMs, and 91.8% of cases were in a local clinical stage at diagnosis. Compared to women, men were diagnosed at a higher age, with thicker and more-often-ulcerated tumor, and more often were in advanced clinical stages. During follow-up, 1015 patients died due to CM, representing 52.8% of all deaths. The nodular subtype made up the dominant proportion of fatal CM cases (55.3% in women, 64.6% in men). Sex, age, anatomic site (trunk), T-stage, ulceration, clinical stage, and having a second primary CM were associated with increased risk of CM-specific death.ConclusionOur data suggest that the high rate of mortality due to CM observed in Norway is attributable to the more advanced stage of the disease at diagnosis. Most high-risk cases occurred in male patients ≥70 years of age. Efforts to improve awareness and secondary prevention of CM, including warning signs of all melanoma subtypes, are required urgently and should be targeted toward men in particular.

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There have been notable changes in incidence patterns and a remarkable improvement in survival for lung cancer over the last 17 years, most markedly for patients without distant metastases at the time of diagnosis. Hopefully, survival will improve even more when immunotherapy is implemented.

Selection of lung cancer treatment should be based on tumour characteristics, physiological reserves and preferences of the patient. Our aims were to identify and quantify other factors associated with treatment received. Lung cancer patient data from 2002 to 2011 were obtained from the national population-based Cancer Registry of Norway, Statistics Norway and the Norwegian Patient Register. Multivariable logistic regression examined whether year of diagnosis, age, sex, education, income, health trust, smoking status, extent of disease, histology and comorbidities were associated with choice of treatment; surgery or radical or palliative radiotherapy, within 1 year of diagnosis. Among the 24,324 lung cancer patients identified, the resection rate remained constant while the proportion of radical radiotherapy administered increased from 8.6 to 14.1%. Older patients, those with lower household incomes and certain health trusts were less likely to receive any treatment. Lower education and the male gender were identified as negative predictors for receiving surgery. Smoking history was positively associated with both radical and palliative radiotherapy, while comorbidity and symptoms were independently associated with receiving surgery and palliative radiotherapy. Although Norway is a highly egalitarian country with a free, universal healthcare system, this study indicates that surgery and radical and palliative radiotherapy were under-used among the elderly, those with a lower socioeconomic status and those living in certain health trusts.According to Norwegian guidelines, lung cancer treatment should be based on extent of disease (EOD), tumor histology, comorbidities, performance status and preferences of the patient.1 Surgical resection is considered a prerequisite for the cure of lung cancer, but a benefit has only been shown for patients with localized disease, that is, disease that does not extend beyond the intrapulmonary or hilar lymph nodes.Stereotactic radiotherapy has recently become an alternative for selected patients. 2,3 If a patient is deemed ineligible for surgical treatment due to EOD or significant comorbidities, radiotherapy and/or chemotherapy can be offered. For patients with mediastinal lymph node metastasis, this combination is offered with curative intent, while for patients whose tumours have spread beyond the lung and mediastinum, in the majority of patients, palliative radiotherapy and/ or chemotherapy are offered for symptom relief, to slow disease progression and improve medium term survival. Likelihood of both receiving surgical treatment and radiotherapy as treatment for lung cancer has previously been shown to be affected by factors not mentioned in guidelines. A number of studies have found that socioeconomic status (SES) and/or place of residence may influence the likelihood of receiving surgical treatment. [4][5][6][7][8] However, the influence of SES on radiotherapy remains inconclusive. 4,[9][10][11] Previous studies have been unable to examine the association between lung canc...

ObjectiveTo construct an updated comorbidity index (Patient Register Index [PRI]) using national data collections from Norway and compare its predictive ability of 1-year mortality with the Charlson Comorbidity Index (CCI).Materials and methodsData regarding over 1.11 million patients registered in the Norwegian Patient Register in 2010 and 2011 were used to construct the PRI. The PRI was evaluated by comparing its model fit and discrimination with the CCI.ResultsCompared with the CCI, the PRI weights decreased for six, increased for four, and were unchanged for seven diseases. When the PRI was added to the model including age and sex, the age effects were reduced by up to 38% for patients older than 50 years. All measures of model fit improved for the PRI model.ConclusionAdjustment for comorbidity is especially important for patients 50 years of age or older, and its effect on 1-year mortality is almost comparable to the age effect. The PRI is based on more recent data than the CCI, and is more representative of the general population due to its construction.

Cancer survival varies by place of residence, but it remains uncertain whether this reflects differences in tumour, patient and treatment characteristics (including tumour stage, indicators of socioeconomic status (SES), comorbidity and information on received surgery and radiotherapy) or possibly regional differences in the quality of delivered health care. National population-based data from the Cancer Registry of Norway were used to identify cancer patients diagnosed in 2002-2011 (n 5 258,675). We investigated survival from any type of cancer (all cancer sites combined), as well as for the six most common cancers. The effect of adjusting for prognostic factors on regional variations in cancer survival was examined by calculating the mean deviation, defined by the mean absolute deviation of the relative excess risks across health services regions. For prostate cancer, the mean deviation across regions was 1.78 when adjusting for age and sex only, but decreased to 1.27 after further adjustment for tumour stage. For breast cancer, the corresponding mean deviations were 1.34 and 1.27. Additional adjustment for other prognostic factors did not materially change the regional variation in any of the other sites. Adjustment for tumour stage explained most of the regional variations in prostate cancer survival, but had little impact for other sites. Unexplained regional variations after adjusting for tumour stage, SES indicators, comorbidity and type of treatment in Norway may be related to regional inequalities in the quality of cancer care.

We examine changes in survival and patient-, tumour-and treatment-related factors among resected and nonresected lung cancer patients, and identify subgroups with the largest and smallest survival improvements.National population-based data from the Cancer Registry of Norway, Statistics Norway and the Norwegian Patient Register were linked for lung cancer patients diagnosed during 1997-2011. The 1-and 5-year relative survival were estimated, and Cox proportional hazard regression, adjusted for selected patient characteristics, was used to assess prognostic factors for survival in lung cancer patients overall and stratified by resection status.We identified 34 157 patients with lung cancer. The proportion of histological diagnoses accompanied by molecular genetics testing increased from 0% to 26%, while those accompanied by immunohistochemistry increased from 8% to 26%. The 1-year relative survival among nonresected and resected patients increased from 21.7% to 34.2% and 75.4% to 91.5%, respectively. The improved survival remained significant after adjustment for age, sex, stage and histology. The largest improvements in survival occurred among resected and adenocarcinoma patients, while patients ⩾80 years experienced the smallest increase.Lung cancer survival has increased considerably in Norway. The explanation is probably multifactorial, including improved attitude towards diagnostic work-up and treatment, and more accurate diagnostic testing that allows for improved selection for resection and improved treatment options. @ERSpublications Lung cancer survival in Norway has improved due to improved attention towards diagnostic work-up and treatment http://ow.ly/S5L4j

Background: In 2015, Norway implemented cancer patient pathways to reduce waiting times for treatment. The aims of this paper were to describe patterns in waiting time and their association with patient characteristics for colorectal, lung, breast and prostate cancers. Methods: National, population-based data from 2007-2016 were used. A multivariable quantile regression examined the association between treatment period, age, stage, sex, place of residence, and median waiting times. Results: Reduction in median waiting times for radiotherapy among colorectal, lung and prostate cancer patients ranged from 14-50 days. Median waiting time for surgery remained approximately 21 days for both colorectal and breast cancers, while it decreased by 7 and 36 days for lung and prostate cancers, respectively. The proportion of lung and prostate cancer patients with metastatic disease at the time of diagnosis decreased, while the proportion of colorectal patients with localised disease and patients with stage I breast cancer increased (p<0.001). After adjusting for case-mix, a patient's place of residence was significantly associated with waiting time for treatment (p<0.001), however, differences in waiting time to treatment decreased over the study period. Conclusions: Between 2007 and 2016, Norway experienced improved stage distributions and consistently decreasing waiting times for treatment. While these improvements occurred gradually, no significant change was observed from the time of cancer patient pathway implementation.