Patterns of care and survival after a cancer of unknown primary (CUP) diagnosis: a population-based nested cohort study in Australian Government Department of Veterans' Affairs clients

Schaffer, Andrea L., Pearson, Sallie-Anne, Dobbins, Timothy A., Er, Chuang C., Ward, Robyn L. and Vajdic, Claire M. (2015) Patterns of care and survival after a cancer of unknown primary (CUP) diagnosis: a population-based nested cohort study in Australian Government Department of Veterans' Affairs clients. Cancer Epidemiology, 39 4: 578-584. doi:10.1016/j.canep.2015.02.007


Author Schaffer, Andrea L.
Pearson, Sallie-Anne
Dobbins, Timothy A.
Er, Chuang C.
Ward, Robyn L.
Vajdic, Claire M.
Title Patterns of care and survival after a cancer of unknown primary (CUP) diagnosis: a population-based nested cohort study in Australian Government Department of Veterans' Affairs clients
Journal name Cancer Epidemiology   Check publisher's open access policy
ISSN 1877-783X
1877-7821
Publication date 2015-08
Year available 2015
Sub-type Article (original research)
DOI 10.1016/j.canep.2015.02.007
Open Access Status Not Open Access
Volume 39
Issue 4
Start page 578
End page 584
Total pages 7
Place of publication New York, NY, United States
Publisher Elsevier
Language eng
Formatted abstract
Background: Little is known about patterns of care after a cancer of unknown primary (CUP) diagnosis.

Methods: We performed a retrospective cohort study to describe and compare the treatment, health service use and survival of patients with CUP and metastatic cancer of known primary among 143,956 Australian Government Department of Veterans' Affairs clients, 2004-2007. We randomly matched clients with CUP (C809; = 252) with clients with a first diagnosis of metastatic solid cancer of known primary (= 980). We ascertained health services from the month of diagnosis up to 2 months post-diagnosis for consultations, hospitalizations and emergency department visits, and up to 1 year for treatment. We compared cancer treatments using conditional logistic regression; consultation rates using negative binomial regression; and survival using stratified Cox regression.

Results: 30% of CUP patients and 70% of patients with known primary received cancer treatment and the median survival was 37 days and 310 days respectively. CUP patients received fewer cancer medicines (odds ratio (OR). =. 0.54, 95% confidence interval (CI) 0.33-0.89) and less cancer-related surgery (OR. =. 0.25, 95% CI 0.15-0.41); males with CUP received more radiation therapy (OR=2.88, 95% CI 1.69-4.91). CUP patients had more primary care consultations (incidence rate ratio (IRR). =. 1.25, 95% CI 1.11-1.41), emergency department visits (IRR=1.86, 95% CI 1.50-2.31) and hospitalizations (IRR=1.18, 95% CI 1.03-1.35), and a higher risk of death within 30 days (hazard ratio=3.30, 95% CI 1.69-6.44).

Conclusions: Patients with CUP receive less treatment but use more health services, which may reflect underlying patient and disease characteristics.
Keyword Cancer of unknown primary
Cohort
Epidemiology
Treatment
Health services
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Office of the Vice-Chancellor
School of Medicine Publications
 
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Created: Wed, 27 Jul 2016, 16:07:53 EST by Amelie Casgrain on behalf of School of Medicine