Illustration of loss in expectation of life for DLBCL for 55-year-old women diagnosed with DLBCL. The figure shows general population and cancer cohort survival curves and shows that the LEL is the difference in area underneath the two survival curves.

Timeline of treatment advances for DLBCL showing treatments that received FDA approval between 1975 and 2018.

Timeline of treatment advances for CRC showing treatments that received FDA approval between 1975 and 2018.

Supplementary table containing sensitivity analysis results for females aged 55 at diagnosis.

Timeline of treatment advances for lung cancer showing treatments that received FDA approval between 1975 and 2018.

AbstractBackground:Cancer is becoming more of a chronic disease due to improvements in treatment and early detection for multiple cancer sites. To gain insight on increased life expectancy due to these improvements, we quantified trends in the loss in expectation of life (LEL) due to a cancer diagnosis for six cancer sites from 1975 through 2018.Methods:We focused on patients diagnosed with female breast cancer, chronic myeloid leukemia (CML), colon and rectum cancer, diffuse large B-cell lymphoma (DLBCL), lung cancer, or melanoma between 1975 and 2018 from nine Surveillance, Epidemiology, and End Results cancer registries. Life expectancies for patients with cancer ages 50+ were modeled using flexible parametric survival models. LEL was calculated as the difference between general population life expectancy and life expectancy for patients with cancer.Results:Over 2 million patients were diagnosed with one of the six cancers between 1975 and 2018. Large increases in life expectancy were observed between 1990 and 2010 for female breast, DLBCL, and CML. Patients with colon and rectum cancer and melanoma had more gradual improvements in life expectancy. Lung cancer LEL only began decreasing after 2005. Increases in life expectancy corresponded with decreases in LEL for patients with cancer.Conclusions:The reported gains in life expectancy largely correspond to progress in the screening, management, and treatment of these six cancers since 1975.Impact:LEL provides an important public health perspective on how improvements in treatment and early detection and their impacts on survival translate into changes in cancer patients’ life expectancy.

Timeline of treatment advances for CML showing treatments that received FDA approval between 1975 and 2018.

Supplementary table containing sensitivity analysis results for males aged 55 at diagnosis.

Proportion of loss in expectation of life by cancer site, shown over year at diagnosis by sex and age at diagnosis.

Timeline of treatment advances for melanoma showing treatments that received FDA approval between 1975 and 2018.

Timeline of treatment advances for breast cancer showing treatments that received FDA approval between 1975 and 2018.

BACKGROUND:Melanoma represents a significant public health challenge in Canada, contributing to the deaths of over 1000 individuals each year. Prince Edward Island and Nova Scotia were previously noted to have the highest incidence rates of melanoma in Canada. METHODS:Data from patients diagnosed with or dying from melanoma was extracted from the Nova Scotia Cancer Registry. TNM stage was available for cases diagnosed 2007 to 2017. Incidence (1992-2019) and mortality (1992-2021) rates were examined using Join Point Trend Analysis Software. RESULTS:Between 2007 and 2019, 2450 cases of in situ and 4063 cases of invasive melanoma were documented, of which 52.8% were male. The largest number of cases was from the 60- to 79-year age group. The most common site in females was upper limbs (in situ) and lower limbs (invasive), and for males, face, and neck (in situ), and trunk (invasive). The majority of invasive cases (71.5%) were diagnosed at stage I. Invasive melanoma incidence has been increasing by 2.7% per year since 1992, while in situ disease has increased at a greater rate (4.9% per year). The current estimate of 92% for 5 years of net survival has not changed appreciably over the same period. Survival for late-stage melanoma has shown a modest improvement for patients diagnosed over the period. CONCLUSION:With increasing rates of melanoma in Nova Scotia, there is a need for informed education, directed at the public and physicians, around pigmented skin lesions. This would allow the patient to detect atypical melanocytic lesions at an early stage. Sun safety practices in Nova Scotia should continue to be encouraged.

Supplementary table containing model fit criteria for final model for each cancer site.

Objectives To determine the long-term risk of mortality among children with inborn errors of metabolism. Study design We conducted a retrospective cohort study of 1750 children with inborn errors of metabolism (excluding mitochondrial disorders) and 1 036 668 children without errors of metabolism who were born in Quebec, Canada, between 2006 and 2019. Main outcome measures included all-cause and cause-specific mortality be-tween birth and 14 years of age. We used adjusted survival regression models to estimate HRs and 95% CIs for the association between inborn errors of metabolism and mortality over time. Results Mortality rates were greater for children with errors of metabolism than for unaffected children (69.1 vs 3.2 deaths per 10000 person-years). During 7 702 179 person-years of follow-up, inborn errors of metabolism were associated with 21.2 times the risk of mortality compared with no error of metabolism (95% CI 17.23-26.11). Dis-orders of mineral metabolism were associated with greater mortality the first 28 days of life (HR 60.62, 95% CI 10.04-365.98), and disorders of sphingolipid metabolism were associated with greater mortality by 1 year (HR 284.73, 95% CI 139.20-582.44) and 14 years (HR 1066.00, 95% CI 298.91-3801.63). Errors of metabolism were disproportionately associated with death from hepatic/digestive (HR 208.21, 95% CI 90.28-480.22), respiratory (HR 116.57, 95% CI 71.06-191.23), and infectious causes (HR 119.83, 95% CI 40.56-354.04). Conclusions Children with errors of metabolism have a considerably elevated risk of mortality before 14 years, including death from hepatic/digestive, respiratory, and infectious causes. Targeting these causes of death may help improve long-term survival. (J Pediatr 2023;252:16-21).

OBJECTIVE:To determine the association between adolescent hospitalization for suicide attempts and the subsequent risk of eating disorder hospitalization. METHOD:This was a cohort study of 162,398 adolescent girls in Quebec, Canada, including 7741 with suicide attempts before 20 years of age, matched to 154,657 adolescents with no attempt between 1989 and 2019. The main exposure measure was suicide attempt hospitalization. The main outcome measure was hospitalization for an eating disorder up to 31 years later, including anorexia nervosa, bulimia nervosa, and other eating disorders. We used adjusted Cox regression models to estimate hazard ratios (HR) and 95% confidence intervals (CI) for the association between adolescent suicide attempts and eating disorder hospitalization. RESULTS:Adolescent girls admitted for a suicide attempt had 5.55 times the risk of eating disorder hospitalization over time (95% CI 3.74-8.23), compared with matched controls. Suicide attempt was associated with anorexia nervosa (HR 3.57, 95% CI 1.78-7.17) and bulimia nervosa and other eating disorders (HR 8.55, 95% CI 5.48-13.32). Associations were pronounced in girls with repeated suicide attempts. Girls who attempted suicide through self-poisoning had an elevated risk of anorexia nervosa, whereas girls who used violent methods such as cutting or piercing had a greater risk of bulimia nervosa and other eating disorders. Suicide attempt was strongly associated with eating disorder hospitalization in the year following the attempt, but associations persisted throughout follow-up. DISCUSSION:Suicide attempt admission is associated with the long-term risk of eating disorder hospitalization in adolescent girls. PUBLIC SIGNIFICANCE:This study of adolescent girls suggests that suicide attempt admission is associated with the long-term risk of hospitalization for eating disorders. The risk is greatest in the year after the attempt, but persists over time. Adolescents who present with a suicide attempt may benefit from screening for eating disorders and long-term follow-up to help prevent the exacerbation or development of eating disorders.

Survival analysis is often performed using the Cox proportional hazards model. Parametric models are useful in several applications, including health economic evaluation, cancer surveillance and event prediction. Flexible parametric models extend standard parametric models (e.g., Weibull) to increase the flexibility of the shape of the hazard function. We present a new SAS® macro for implementing flexible parametric models with a similar functionality to that of Stata®, with examples using data from cancer surveillance and clinical trials. Results from SAS were identical with similar computational time to Stata. The flexible parametric approach to modeling survival data is shown to be superior to standard parametric methods. This SAS macro will facilitate an increase in the use of flexible parametric models.

Introduction: Inequalities in health attributable to inequalities in society have long been recognized. Typically, those most privileged experience better health, regardless of universal access to health care. Associations between social and material deprivation and mortality from all causes of death-a measure of population health, have been described for some regions of Canada. This study further examines the link between deprivation and health, focusing on major causes of mortality for both rural and urban populations. In addition, it quantifies the burden of premature mortality attributable to social and material deprivation in a Canadian setting where health care is accessible to all.Methods: The study included 35,266 premature deaths (1995-2005), grouped into five causes and aggregated over census dissemination areas. Two indices of deprivation (social and material) were derived from six socioeconomic census variables. Premature mortality was modeled as a function of these deprivation indices using Poisson regression.Results: Premature mortality increased significantly with increasing levels of social and material deprivation. The impact of material deprivation on premature mortality was similar in urban and rural populations, whereas the impact of social deprivation was generally greater in rural populations. There were a doubling in premature mortality for those experiencing a combination of the most extreme levels of material and social deprivation.Conclusions: Socioeconomic deprivation is an important determinant of health equity and affects every segment of the population. Deprivation accounted for 40% of premature deaths. The 4.3% of the study population living in extreme levels of socioeconomic deprivation experienced a twofold increased risk of dying prematurely. Nationally, this inequitable risk could translate into a significant public health burden.

BACKGROUND:Colorectal cancer (CRC) is the third most commonly diagnosed cancer in Canada and accounts for 11.9% of all cancer-related mortality. Fortunately, previous studies have provided evidence of improved outcomes from access to timely and appropriate health services along the disease trajectory in CRC. As a result, the CIHR/CCNS Team in Access to Colorectal Cancer Services in Nova Scotia (Team ACCESS) was created to build colorectal cancer (CRC) research capacity in Nova Scotia (NS) and to study access to and quality of CRC services along the entire continuum of cancer care.OBJECTIVES:The objectives of this paper are to: 1) provide a detailed description of the methodologies employed across the various studies being conducted by Team ACCESS; 2) demonstrate how administrative health data can be used to evaluate access and quality in CRC services; and 3) provide an example of an interdisciplinary team approach to addressing health service delivery issues.METHODS:All patients diagnosed with CRC in NS between 2001 and 2005 were identified through the Nova Scotia Cancer Registry (NSCR) and staged using the Collaborative Stage Data Collection System. Using administrative databases that were linked at the patient level, Team ACCESS created a retrospective longitudinal cohort with comprehensive demographic, clinical, and healthcare utilization data. These data were used to examine access to and quality of CRC services in NS, as well as factors affecting access to and quality of care, at various transition points along the continuum of care. Team ACCESS has also implemented integrated knowledge translation strategies targeting policy- and decision- makers.DISCUSSION:The development of Team ACCESS represents a unique approach to CRC research. We anticipate that the skills, tools, and knowledge generated from our work will also advance the study of other cancer disease sites in NS. Given the increasing prevalence of cancer, and with national and provincial funding agencies promoting collaborative research through increased funding for research team development, the work carried out by Team ACCESS is important in the Canadian context and exemplifies how a team approach is essential to comprehensively addressing issues surrounding not only cancer, but other chronic diseases in Canada.