Cancer in Elderly in Denmark - Route to Diagnosis, Treatment and Prognosis Project proposal by: - Bolette Danckert (Danish Cancer Society) - Henry Jensen (Centre for Cancer Diagnosis in Primary Care, Aarhus) - Georgios Lyratzopoulos (UCL, London) - Sean McPhail (National Cancer Registration and Analysis Service in Public Health England) - Annette Fischer Pedersen (Department of Clinical Medicine at Aarhus University) - Niels Lyhne Christensen (Danish Cancer Society) - Alina Zounina Falborg (Centre for Cancer Diagnosis in Primary Care, Aarhus) - Henrik Frederiksen (AgeCare elite research centre at Odense University Hospital) - Henrik Møller (Danish Clinical Registries) - Linda Aagaard Thomsen (Danish Cancer Society) - Peter Vedsted (Centre for Cancer Diagnosis in Primary Care, Aarhus)
Presentation Agenda Status: Velux application submitted. Start Summer 2019. Project presentation Background Research Questions Data and Methods Perspectives ICBP Routine monitoring Potential Nordic projects
Motivation Increasing number of cancer incidences among the elderly Poorer survival among elderly patients Little evidence on the elderly exists Potential importance of comorbidities and potential undertreatment Unanswered questions: Is the poor survival due to inadequate healthcare seeking behaviour? Is it related to the choices made by healthcare professionals? Or could it be the result of undertreatment?
Existing studies Studies among general population Routes to diagnosis Standardized cancer patient pathways Treatment Patterns for the elderly population? - Distribution - Relation to prognosis - Depending on personal characteristics - Socio-economy, social network, comorbidities - Depending on structural factors - Urbanisation degree Route to diagnosis First Treatment Diagnosis Treatment starts
Research Questions RQ1 RQ2 RQ3 Where do elderly cancer patients present in the healthcare system prior to their cancer diagnosis? How is the route to diagnosis associated with the prognosis of cancer in elderly cancer patients? Which patient and structural parameters are associated with routes to diagnosis in elderly cancer patients? RQ4 RQ5 RQ6 Which treatment modalities are elderly cancer patients undergoing? How is the treatment modality associated with the prognosis of elderly cancer patients? Which patient and structural parameters are associated with the treatment of elderly cancer patients?
Data Population: Time period: 70+ at time of diagnosis 2014-2017 (diagnosis year) Data: Danish Cancer Registry National Patient Register Civil Registration System Statistics Denmark Danish Health Service Register (Diagnosis, date of diagnosis, tumour, node and metastasis (TNM) stage, municipality and region of residence, age and sex) (Admissions, procedures (e.g. surgery, radiotherapy, chemotherapy, imaging), CPPs, diagnosis codes, procedure codes and dates) (Vital status, marital status and home address) (Income, education and social network (marital status and children), degree of urbanisation (city size)) (List size (number of patients) of general practices)
Perspectives Facilitate better diagnostics and more efficient treatment Research perspectives: International Cancer Benchmarking Program (ICBP), module 9 Routine monitoring Nordic projects regarding standardized cancer patient pathways. 21 provinces: - England - Ireland - Northern Ireland - Wales - Scotland - Denmark - Norway - Canada - New Zealand