Cancer in in Eld lderly in in Denmark - Route to Diagnosis, - PowerPoint PPT Presentation

Cancer in in Eld lderly in 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 Patterns for the elderly population? • Routes to diagnosis - Distribution • Standardized cancer patient pathways - Relation to prognosis • Treatment - Depending on personal characteristics - Socio-economy, social network, comorbidities - Depending on structural factors - Urbanisation degree First Treatment Route to diagnosis Diagnosis Treatment starts

Research Questions RQ1 Where do elderly cancer patients present in the healthcare system prior to their cancer diagnosis? RQ2 How is the route to diagnosis associated with the prognosis of cancer in elderly cancer patients? RQ3 Which patient and structural parameters are associated with routes to diagnosis in elderly cancer patients? RQ4 Which treatment modalities are elderly cancer patients undergoing? RQ5 How is the treatment modality associated with the prognosis of elderly cancer patients? RQ6 Which patient and structural parameters are associated with the treatment of elderly cancer patients?

Data • Population: 70+ at time of diagnosis • Time period: 2014-2017 (diagnosis year) • Data: Danish Cancer Registry (Diagnosis, date of diagnosis, tumour, node and metastasis (TNM) stage, municipality and region of residence, age and sex) National Patient Register (Admissions, procedures (e.g. surgery, radiotherapy, chemotherapy, imaging), CPPs, diagnosis codes, procedure codes and dates) Civil Registration System (Vital status, marital status and home address) Statistics Denmark (Income, education and social network (marital status and children), degree of urbanisation (city size)) Danish Health Service Register (List size (number of patients) of general practices)

Perspectives 21 provinces: • Facilitate better diagnostics and more efficient - England - Ireland treatment - Northern Ireland • Research perspectives: - Wales • International Cancer Benchmarking Program (ICBP), - Scotland module 9 - Denmark • Routine monitoring - Norway • Nordic projects regarding standardized cancer patient - Canada pathways. - New Zealand