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Biomedical subjects

H Comber

Publications and source records attributed to H Comber.

16 recordsLinked to original sources
PubMed2006

Patterns of care and effects on mortality for cancers of the oesophagus and gastric cardia: a population-based study.

BACKGROUND: We investigated temporal trends in treatment, and factors influencing treatment receipt and survival, for upper gastrointestinal cancers in routine community-based clinical practice. PATIENTS AND METHODS: Oesophageal and gastric-cardia cancers, diagnosed during the period 1994-2001, were sourced from the National Cancer Registry (Ireland). Analysis was by Joinpoint regression and multivariate logistic and Cox models. RESULTS: Thirty-five percent of patients received surgery, 35% radiotherapy and 24% chemotherapy. Over time chemo- and radiotherapy receipt increased significantly, whilst surgery decreased. Treatment patterns varied by tumour site, histology and stage. Older and/or unmarried patients were significantly less likely to receive treatment. Among surgically treated patients, those aged 70+ had higher mortality. Among both surgical and non-surgical patients, those receiving chemotherapy or radiotherapy had a modest, short-term, survival benefit. CONCLUSIONS: The use of adjuvant therapies is increasing in routine practice. After adjusting for clinical factors, patient-related factors predicted treatment and mortality. Improving equity in gastrointestinal cancer treatment may help improve survival.

Adult↗
PubMed2006

A population-based study of skin cancer incidence and prevalence in renal transplant recipients.

BACKGROUND: Cancers occurring following solid organ transplantation are a rapidly growing public health concern. Defining the extent of the problem has been limited by surveillance systems with incomplete registration of cases and the paucity of reliable national incidence data. OBJECTIVES: To determine the incidence of all cancers following renal transplantation and to make a detailed examination of trends and patterns associated with postrenal transplant skin cancers. METHODS: Integration of data from the national renal transplant database and the national cancer registry in Ireland enabled accurate determination of the number of renal transplant recipients (RTRs) with skin cancers and other malignancies in the time period 1 January 1994 to 31 December 2001. RESULTS: We demonstrated a biphasic increase in skin cancer incidence following renal transplantation, determined by the age at transplantation. There was a steady increase in risk for older RTRs (age 50+ years) from year 2 post-transplant, whereas the increased risk in younger RTRs (age < 50 years) occurred later but much more significantly, reaching 200 times the risk for an age-matched nontransplanted population by year 6 post-transplant. The number of nonmelanoma skin cancers (NMSCs) registered in RTRs accounted for 1% of all NMSCs registered nationally over the study period. The standardized incidence rates for invasive NMSC (33-fold increase) and in situ carcinoma of the skin (65-fold increase) were significantly increased (P < 0.05). The risk for invasive squamous cell carcinoma (SCC) was increased 82-fold compared with the nontransplanted population. Male RTRs were at particular risk of invasive SCC at sun-exposed sites such as the scalp and the external ear. Risk of malignant melanoma and Kaposi sarcoma were also increased relative to the nontransplanted population. CONCLUSIONS: This comprehensive national study illustrates how rates of skin cancer in Irish RTRs have influenced the national incidence of skin cancer. The high incidence of SCC, basal cell carcinoma and Bowen's disease in the early post-transplant period for older patients and the cumulative risk in younger patients with increased duration of transplantation highlight the importance of implementing early and continued cancer surveillance regimens post-transplant.

Adult↗
PubMed2006

Mortality predictions for colon and anorectal cancer for Ireland, 2003-17.

OBJECTIVE: Colorectal cancer mortality predictions for Ireland are presented for all ages and for the age group 0-64 years. METHODS: Log and log-linear Poisson regression modelling was fitted to colorectal cancer mortality data for each year between 1950 and 2002 to predict average European age standardized mortality rates (EASMRs) per 100,000 person years (100,000 PY(-1)) and average numbers of deaths. RESULTS: EASMRs for colon cancer are predicted to fall to 17.3 100,000 PY(-1) (95%PI 14.4, 20.2) in men and to 8.4 100,000 PY(-1) (95%PI 6.9, 10.2) in women by 2013-17. EASMRs for anorectal cancer are also predicted to fall to 8.0 100,000 PY(-1) (95%PI 6.6, 9.5) in men and to 3.0 100,000 PY(-1) (95%PI 2.3, 3.8) in women by this time. Truncated EASMRs for colon cancer for those aged between 0 and 64 years are predicted over the next 15 years to fall from their current levels to 4.4 100,000 PY(-1) (95%PI 3.0, 5.8) in men and to 2.3 100,000 PY(-1) (95%PI 1.5, 3.2) in women. For anorectal cancer, truncated EASMRs for those aged between 0 and 64 years are also predicted over the next 15 years to fall from their current levels to 2.9 100,000 PY(-1) (95%PI 2.0, 3.8) in men and to 0.9 100,000 PY(-1) (95%PI 0.4, 1.3) in women. CONCLUSIONS: Ireland currently has one of the highest colorectal mortality rates in the developed world but recent downward trends, the advent of new screening tests and well targeted public health promotion programmes may lead to further reductions.

Adolescent↗
PubMed2005

Delays in treatment in the cancer services: impact on cancer stage and survival.

This study describes waiting times for cancer treatment in Ireland, tests for differences between health board areas and investigates if delay affected cancer stage or prognosis. We measured the times between referral, outpatient attendance and treatment for all patients diagnosed with five common cancers in Ireland in 1999. There was a four-fold spread of waiting time between the 25th and 75th centile. The time from referral to treatment was shortest for breast cancer (median 4 weeks), twice this for colorectal cancer, lung cancer and lymphoma, and 15 weeks for prostate cancer. Delays varied significantly, but not consistently, between health boards. Patients with longer waiting times generally had less advanced disease and better survival, suggesting that typical delays are not of clinical significance, but that patients with advanced disease are probably being "fast-tracked" by GPs and hospitals.

Aged↗
PubMed2004

Recent trends in cervical cancer mortality in Britain and Ireland: the case for population-based cervical cancer screening.

This study used published mortality data and regression techniques to look at time trends in cervical cancer mortality between 1970 and 2000 in the UK and the Republic of Ireland. Mortality from cancer of the cervix has been declining in the UK for at least the past 30 years. The rate of decrease has been greatest in England, Wales and Scotland and has accelerated in these countries since the reorganisation of screening services in the late 1980s. Mortality in Northern Ireland is also decreasing, but at a lesser rate and without significant change over the same period. In contrast, cervical cancer mortality in the Irish Republic, which, unlike the UK, does not have comprehensive population-based screening, has been increasing by an average of 1.5% per year since 1978. The mortality rate, which was half of that in the UK in the late 1970s, now exceeds that in any of the region of the UK. The absence of population-based screening for cervical cancer in the Republic of Ireland is the most plausible explanation for these differences in trend.

Adult↗
PubMed1993

A randomized, double-blind, multi-centre, parallel-group study comparing the tolerability and efficacy of moclobemide and dothiepin hydrochloride in depressed patients in general practice.

A randomized, double-blind, multi-centre, parallel-group study compared the tolerability and efficacy of 450 mg of moclobemide and 75-150 mg of dothiepin in the management of depressed patients in general practice. Patients who fulfilled the DSM-III-R criteria for major depressive disorder and who scored 13 or more on the Hamilton Depression Rating Scale were admitted. The trial lasted six weeks. The dose of moclobemide was 150 mg three times daily and that of dothiepin was 75 mg daily for the first two weeks and 150 mg thereafter. Assessments were made at baseline and after one, three and six weeks using the HDRS, the Zung SRS and the CGI. Adverse events and vital signs were monitored at each visit, and laboratory screening tests performed at the beginning and end of the study. Sixty-four general practitioners from four centres recruited 345 patients: 175 received dothiepin and 170 moclobemide; 265 completed six weeks of treatment. Thirty-eight dothiepin-treated patients (22%) and 42 who received moclobemide (25%) dropped out, most commonly because they experienced adverse events. More patients on dothiepin (24) than on moclobemide (16) dropped out for this reason; the incidence of adverse events was 10% higher in the dothiepin-treated group and of "side effects" more than 10% higher, the latter difference being statistically significant. Both treatments resulted in significant improvement; this was greater in the dothiepin-treated group and the difference was statistically significant, although clinically small.

Adolescent↗
PubMedDate not supplied

Mortality from breast cancer in Ireland prior to the introduction of population-based mammographic screening.

Mammographic screening has been shown in international randomised controlled trials and case-control studies to be effective in reducing mortality from breast cancer. Ireland has a high mortality rate from breast cancer when compared with rates from other countries. Organised population-based mammographic screening for breast cancer is about to begin in Ireland. The purpose of this study was to examine current mortality from breast cancer, as well as trends in breast cancer mortality in Ireland since 1975, as a baseline against which future evaluations of the impact of screening can be carried out. Over the 23-yr period of review, mortality from breast cancer appears to have remained quite stable. Within the period, however, there is some variation in adjusted rates, most notably an increase to a peak in 1989, followed by a decrease between 1989 and 1997. Continued monitoring of recent trends is required, with in-depth analysis of possible explanations, such as changing breast cancer incidence rates, biological characteristics, therapeutic regimes and coding practices.

Adolescent↗
PubMedDate not supplied

Mortality predictions for Ireland, 2001-2015: cancers of the breast, ovary, and cervix and Corpus uteri.

Linear and log-linear Poisson regression models of Irish breast, ovarian, and cervical and corpus uterine cancer mortality data for the years 1953-2000 were used to predict European age standardized mortality rates (EASMRs) per 100,000 person years and numbers of deaths for the period 2001-2015. Rates for the whole population and for those under 65 are expected to fall from their current levels for breast and corpus uterine cancers but not for ovarian and cervical uterine cancers. EASMRs for postmenopausal women aged between 55 and 69 years are predicted to fall for breast, ovarian, and cervical and corpus uterine cancers. The continuing expansion of the Irish female population is the primary reason why the numbers of deaths arising from breast, ovarian, and cervical uterine cancer are predicted to increase in all of the above age groups. It is not exactly clear why the numbers of corpus uterine cancer deaths are expected to continue to decline, but it may be a matter of improvement in overall death-certificate coding or their diagnoses as cervical cancer deaths.

Adolescent↗