Introduction Multidisciplinary team meetings (MTMs) integrate expertise from different specialties to support individualized treatment planning. However, their association with short-term postoperative outcomes in high-risk patients with gastrointestinal malignancies remains unclear. This study evaluated the implementation of preoperative MTM discussion and its association with postoperative outcomes in patients with gastric cancer (GC) or colorectal cancer (CRC) complicated by diabetes mellitus and/or coronary heart disease. Methods This single-center retrospective cohort study included consecutive patients with histologically confirmed gastric or colorectal adenocarcinoma and concomitant diabetes mellitus and/or coronary heart disease who underwent radical resection between January 2020 and January 2024. Patients were divided into MTM and no-MTM groups according to whether they received preoperative MTM discussion. The primary outcome was the severity of postoperative complications during the hospitalization, categorized as no complication, Clavien-Dindo grade I-II, or grade III or higher. Multivariable ordinal logistic regression was used to estimate the association between the absence of preoperative MTM discussion and increasing complication severity. The secondary outcome was the occurrence of any postoperative complication and was analyzed using binary logistic regression. Firth penalized logistic regression for major postoperative complications was performed as a sensitivity analysis. Results A total of 477 patients were included, with 191 in the MTM group and 286 in the no-MTM group. The no-MTM group had a higher overall postoperative complication rate than the MTM group (19.2% vs. 12.0%, p=0.039), whereas ICU admission and hospitalization costs were higher in the MTM group. Multivariable ordinal logistic regression showed that absence of preoperative MTM discussion, longer operative time per 30-minute increase, and preoperative hypoalbuminemia were independently associated with increasing postoperative complication severity. Secondary analyses yielded generally consistent findings. Conclusions Preoperative MTM discussion was associated with a lower occurrence and lower severity of postoperative complications during the hospitalization among high-risk patients with GC or CRC.
Introduction Pancreatic cancer is associated with substantial symptom burden, but access to supportive care medications (SCMs) may vary by socioeconomic context. We examined associations between neighborhood socioeconomic status (SES) and the receipt and timing of SCMs among older adults with pancreatic cancer in the United States. Methods We conducted a retrospective cohort study using SEER-Medicare data (from 2005–2020). The cohort included beneficiaries aged 65 years or older with incident pancreatic cancer and Part D coverage. SCMs included psychotropics, pain medications, anti-nausea agents, appetite stimulants, and sleep aids. Neighborhood SES was measured using Yost Index quintiles (with Q5 representing the highest SES). Multivariable logistic regression estimated associations with medication receipt, and Fine-Gray competing risk models estimated associations with the cumulative incidence of medication initiation, treating death as a competing event. Results Among 81,535 beneficiaries, 69% received at least one SCM after diagnosis. Compared with beneficiaries in Q5, those in Q1 had lower adjusted odds of receiving antipsychotics (aOR 0.81; 95% CI 0.68–0.96), antidepressants (aOR 0.80; 95% CI 0.73–0.88), anxiolytics (aOR 0.87; 95% CI 0.78–0.97), anti-nausea agents (aOR 0.77; 95% CI 0.71–0.83), appetite stimulants (aOR 0.78; 95% CI 0.72–0.85), and sleep aids (aOR 0.67; 95% CI 0.60–0.76). Lower neighborhood SES was also associated with lower cumulative incidence of psychotropic, anti-nausea, appetite stimulant, and sleep aid initiation. Associations with pain medication receipt and initiation were smaller and less consistent. Conclusion Lower neighborhood SES was associated with lower receipt and cumulative incidence of several SCM classes among older adults with pancreatic cancer. Because SEER-Medicare does not capture symptom burden or clinical indication, these findings describe medications dispensed through Part D rather than the adequacy of supportive care received and identify targets for research on the mechanisms underlying these differences and on interventions to improve equitable symptom management.
Background The widespread success of tobacco control policy and smoking cessation campaigns has led to considerable reductions in lung cancer mortality. However, it is currently not known how many more deaths might have occurred if not for the substantial progress made in lung cancer control. Methods In this retrospective study, we used age-specific population counts and lung cancer mortality rates from 1950 to 2019 (from 48 countries) from the Global Cancer Observatory. We estimated age-standardized mortality rates (ASMR), standardized to the WHO (2000-2025) Standard Population. Peak mortality was defined as the year when the maximum ASMR was reached for each country and sex. For each year in the period following peak mortality, the expected number of lung cancer deaths was estimated using peak-year age-specific mortality rates and age-specific population counts for that year. The number of avoided deaths was estimated as the difference between expected and observed lung cancer deaths in that period. Results Lung cancer mortality peaked for males in all 48 countries but has yet to peak for females in 11 countries. There have been 3.08 million avoided lung cancer deaths since mortality rates peaked for many countries (2.93 million for males, 0.15 million for females). Across these countries, 21.4% and 4.3% of expected lung cancer mortality has been avoided since mortality peaked for males and females, respectively. Fourteen countries have reduced lung cancer mortality more than 25% for men, while only two countries have for women. There have been statistically significant reductions in lung cancer deaths for 46 out of 48 (96%) countries for men and 14 out of 48 (29%) countries for women. Conclusion There has been a substantial number of lung cancer deaths avoided since mortality rates peaked for many countries, though the reduction in mortality has not been observed in all countries or equally for males and females.
Introduction Immune checkpoint inhibitors (ICIs) were introduced at different times across cancer types, but whether early approvals coincided with cancer-specific changes in national mortality remains uncertain. Methods We conducted an ecological observational comparative time-series study using CDC WONDER United States Cancer Statistics mortality data from 1999–2019. We analyzed CDC-calculated age-adjusted mortality rates (AAMRs) for melanoma of the skin, lung and bronchus, kidney and renal pelvis, urinary bladder, and Hodgkin lymphoma. Cancer-specific synthetic-control models used each site’s first major ICI approval year, preperiod-centered log AAMR trajectories, mutually exclusive solid or hematologic comparison sites, and a common 0–3-year postapproval estimand. Placebo analyses and staggered-adoption difference-in-differences (DiD) were robustness checks. Results Observed AAMRs averaged 3.44%, 13.05%, 4.73%, 3.60%, and 3.68% below synthetic estimates for melanoma, lung, kidney, bladder, and Hodgkin lymphoma, respectively. Conditional placebo-rank pseudo-P values were .40, .23, .25, .20, and 1.00. Temporal-placebo models showed earlier divergence for several sites. The balanced 0–3-year DiD estimate was −0.96 deaths per 100,000 (95% pointwise CI, −2.99 to 1.06). Conclusion Cancer-specific mortality patterns were directionally compatible with lower mortality during early ICI approval eras, but placebo benchmarking, heterogeneous temporal specificity, and an imprecise DiD estimate precluded firm causal attribution. These ecological findings do not estimate individual treatment effectiveness or current ICI practice.
Introduction Approximately 1,000 children are diagnosed with cancer in Canada each year. Treatment places significant financial and psychosocial burdens on families through direct medical costs and indirect costs such as travel and lost income. These burdens can negatively affect parental quality of life. In the Maritimes (Nova Scotia, New Brunswick, and Prince Edward Island), all pediatric cancer care is centralized in Nova Scotia, requiring many families to travel long distances for treatment. However, the impact of this travel burden on Maritime families has not yet been studied. Methods A prospective, longitudinal, observational mixed-methods cohort design was used for this study. This study examined the indirect and psychosocial costs of families treated at the IWK Health Centre through capturing expenses and interviews respectively. The study period was 2016-2020 and included families who had a child being treated for cancer. Thirty families participated in the study, with 28 providing financial information and 29 participating in interviews. Financial information was collected during the first year of treatment. Semi-structured interviews were used to capture the psychosocial impact. Interviews were transcribed and thematically analyzed using NVivo by two independent researchers. Results Families spent a median of $9668 (IQR $7944-12958) on indirect costs and had a median of 55 (IQR 0-125) days of income lost. Most families (79%) in our study experienced a psychosocial burden using terms like stress, worry, or frustration directly as a result of the financial burdens from cancer treatment, in addition to the already significant anxiety around having a child with cancer. Conclusion The financial hardships of cancer treatment have lasting negative implications on families. Current programs and infrastructure are not sufficient to support most families in Canada. There is a need to expand caregiver support programs so families can focus on caring for their child with cancer without suffering financial toxicity.
