Temporal and geographic changes in stage at diagnosis in England during 2008-2013: A population-based study of colorectal, lung and ovarian cancers.
Cancer
Case-mix adjustment
Early diagnosis of cancer
Geographic inequalities
Missing data
Multiple imputation
Population surveillance
Stage at diagnosis
Temporal changes
Time trends
Journal
Cancer epidemiology
ISSN: 1877-783X
Titre abrégé: Cancer Epidemiol
Pays: Netherlands
ID NLM: 101508793
Informations de publication
Date de publication:
08 2020
08 2020
Historique:
received:
14
11
2019
revised:
04
05
2020
accepted:
05
05
2020
pubmed:
15
6
2020
medline:
12
1
2021
entrez:
15
6
2020
Statut:
ppublish
Résumé
Increasing diagnosis of cancer when the disease is still at early stages is a priority of cancer policy internationally. In England, reducing geographical inequalities in early diagnosis is also a key objective. Stage at diagnosis is not recorded for many patients, which may bias assessments of progress. We evaluate temporal and geographical changes in stage at diagnosis during 2008-2013 for colorectal, non-small cell lung, and ovarian cancers, using multiple imputation to minimise bias from missing data. Population-based data from cancer registrations, routes to diagnosis, secondary care, and clinical audits were individually linked. Patient characteristics and recorded stage were summarised. Stage was imputed where missing using auxiliary information (including patient's survival time). Logistic regression was used to estimate temporal and geographical changes in early diagnosis adjusted for case mix using a multilevel model. We analysed 196,511 colorectal, 180,048 non-small cell lung, and 29,076 ovarian cancer patients. We estimate that there were very large increases in the percentage of patients diagnosed at stages I or II between 2008-09 and 2012-13: from 32% to 44% for colorectal cancer, 19% to 25% for non-small cell lung cancer, and 28% to 31% for ovarian cancer. Geographical inequalities reduced for colorectal and ovarian cancer. Multiple imputation is an optimal approach to reduce bias from missing data, but residual bias may be present in these estimates. Increases in early-stage diagnosis coincided with increased diagnosis through the "two week wait" pathway and colorectal screening. Epidemiological analyses from 2013 are needed to evaluate continued progress.
Sections du résumé
BACKGROUND
Increasing diagnosis of cancer when the disease is still at early stages is a priority of cancer policy internationally. In England, reducing geographical inequalities in early diagnosis is also a key objective. Stage at diagnosis is not recorded for many patients, which may bias assessments of progress. We evaluate temporal and geographical changes in stage at diagnosis during 2008-2013 for colorectal, non-small cell lung, and ovarian cancers, using multiple imputation to minimise bias from missing data.
METHODS
Population-based data from cancer registrations, routes to diagnosis, secondary care, and clinical audits were individually linked. Patient characteristics and recorded stage were summarised. Stage was imputed where missing using auxiliary information (including patient's survival time). Logistic regression was used to estimate temporal and geographical changes in early diagnosis adjusted for case mix using a multilevel model.
RESULTS
We analysed 196,511 colorectal, 180,048 non-small cell lung, and 29,076 ovarian cancer patients. We estimate that there were very large increases in the percentage of patients diagnosed at stages I or II between 2008-09 and 2012-13: from 32% to 44% for colorectal cancer, 19% to 25% for non-small cell lung cancer, and 28% to 31% for ovarian cancer. Geographical inequalities reduced for colorectal and ovarian cancer.
INTERPRETATION
Multiple imputation is an optimal approach to reduce bias from missing data, but residual bias may be present in these estimates. Increases in early-stage diagnosis coincided with increased diagnosis through the "two week wait" pathway and colorectal screening. Epidemiological analyses from 2013 are needed to evaluate continued progress.
Identifiants
pubmed: 32535409
pii: S1877-7821(20)30077-1
doi: 10.1016/j.canep.2020.101743
pii:
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
101743Subventions
Organisme : Cancer Research UK
ID : 11415
Pays : United Kingdom
Organisme : Cancer Research UK
ID : C23409/A11415
Pays : United Kingdom
Organisme : Cancer Research UK
ID : C7923/A18348
Pays : United Kingdom
Informations de copyright
Copyright © 2020 Elsevier Ltd. All rights reserved.
Déclaration de conflit d'intérêts
Declaration of Competing Interest None.