Health-related predictors of cancer registry-notified cancer of unknown primary site (CUP) |
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| Institution: | 1. Centre for Big Data Research in Health, University of New South Wales Sydney, NSW, Australia;2. Centre for Primary Health Care and Equity, University of New South Wales Sydney, NSW, Australia;3. School of Medicine, University of Wollongong, NSW, Australia;4. National Drug and Alcohol Research Centre, University of New South Wales Sydney, NSW, Australia;5. Faculty of Medicine and Health, University of Sydney, NSW, Australia;6. Cancer Voices NSW, NSW, Australia;1. Moffitt Cancer Center, Department of Health Outcomes and Behavior, 4115 E. Fowler Ave., Tampa, FL 33617, United States;2. Moffitt Cancer Center, Center for Immunization and Infection Research in Cancer, 12902 USF Magnolia Drive, Tampa, FL 33612, United States;3. Moffitt Cancer Center, Department of Cancer Epidemiology, 12902 USF Magnolia Drive, Tampa, FL 33612, United States;4. Moffitt Cancer Center, Department of Biostatistics and Bioinformatics, 12902 USF Magnolia Drive, Tampa, FL 33612, United States;5. University of South Florida, Department of Family Medicine, 13330 USF Laurel Drive, Tampa, FL 33612, United States;6. University of South Florida, Department of Epidemiology & Biostatistics, 13201 Bruce B Downs Blvd, Tampa, FL 33612, United States;8. University of Florida, Department of Medicine, 1600 SW Archer Rd., Gainesville, FL 32608, United States;9. University of Florida Health, Department of Health Outcomes and Biomedical Informatics, 2004 Mowry Road, Ste 2245, Gainesville, FL 32610, United States;10. University of Florida Health, Cancer Population Sciences, 2004 Mowry Road, Ste 2245, Gainesville, FL 32610, United States;1. Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, United States;2. Biostatistics and Computational Biology Branch, National Institute of Environmental Health Sciences Durham, NC, United States;3. Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, United States;4. Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, United States;5. Biospecimen Processing Center, University of North Carolina, Chapel Hill, NC, United States;6. Division of Oncology and Center for Childhood Cancer Research, Children’s Hospital of Philadelphia, Philadelphia, PA, United States;7. Department of Biomedical and Health Informatics, Children’s Hospital of Philadelphia, Philadelphia, PA, United States;8. Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States;9. Showers Center for Childhood Cancer and Blood Disorder, Akron Children’s Hospital, Akron, OH, United States;10. Department of Biostatistics, Colleges of Medicine and Public Health & Health Professions, University of Florida, Children’s Oncology Group Statistics & Data Center, Gainesville, FL, United States;11. Department of Otolaryngology, Washington University School of Medicine, St Louis, MO, 63110;1. Institute of Medical Epidemiology, Biostatistics and Informatics, Medical Faculty, Martin-Luther-University Halle-Wittenberg, Germany;2. Section of Cancer Information, International Agency for Research on Cancer, 150 cours Albert Thomas, 69372 Lyon Cedex 08, France;3. Department of Medicine, University of Zimbabwe School of Medicine, Harare, Zimbabwe;4. Department of Pathology, Maputo Central Hospital, Maputo, Mozambique;5. CTSU, Nuffield Department of Population Health, University of Oxford, Oxford OX3 7FL, United Kingdom;6. African Cancer Registry Network, 267 Banbury Road, Oxford OX2 7HT, United Kingdom;1. Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA;2. Department of Health and Human Performance, University of Houston, TX, USA;3. Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA;1. Department of Medicine, University of Kentucky, Lexington, KY, United States;2. Department of Neurology, University of Kentucky, Lexington, KY, United States;3. Departments of Neurosurgery, University of Kentucky, Lexington, KY, United States;4. Departments of Pathology, Division of Neuropathology, University of Kentucky, Lexington, KY, United States;5. Markey Cancer Center, University of Kentucky, Lexington, KY, United States;1. Department of Oncology, Lund University, and Skane University Hospital, Lund, Sweden;2. Research Unit of Clinical Epidemiology, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark;3. Center for Clinical Epidemiology, Odense University Hospital, Odense, Denmark;4. Institute of Pathology, Aalborg Hospital, Aalborg, Denmark;5. Medical Oncology Department, Instituto Português de Oncologia (IPO-Porto), Porto, Portugal;6. Department of Epidemiological Methods and Etiologic Research, Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany;7. Department of Health Information and Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal;8. Centre de recherche en Épidémiologie et Santé des Populations (CESP), Inserm U1018, France;9. Cancer and Environment Team, Université Paris-Sud, Villejuif, France;10. Institute for Medical Informatics, Biometry and Epidemiology, University Clinic Essen, Germany;11. Unit of Public Health and Environmental Care, Department of Preventive Medicine, University of Valencia, Valencia, Spain;12. CIBER Epidemiologia y Salud Pública (CIBERESP), Madrid, Spain;13. Unit of Cancer Epidemiology, Centre for Oncologic Prevention, University of Turin, Italy;14. Registre des Tumeurs de l´Hérault, Montpellier, France;15. Division of Occupational and Environmental Medicine, Department of Clinical and Experimental Medicine, Linköping University, Sweden;p. Department of Oncology, University of Padua, Italy;q. Department of Public Health, University of Aarhus, Denmark |
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| Abstract: | BackgroundThe relationship between comorbid disease and health service use and risk of cancer of unknown primary site (CUP) is uncertain.MethodsA prospective cohort of 266,724 people aged 45 years and over in New South Wales, Australia. Baseline questionnaire data were linked to cancer registration, health service records 4–27 months prior to diagnosis, and mortality data. We compared individuals with incident registry-notified CUP (n = 327; 90% C80) to two sets of randomly selected controls (3:1): (i) incident metastatic cancer of known primary site (n = 977) and (ii) general cohort population (n = 981). We used conditional logistic regression to estimate adjusted odds ratios (ORs) and 95% confidence intervals (CIs).ResultsIn fully adjusted models incorporating sociodemographic and lifestyle factors, people with cancer registry-notified CUP were more likely to have fair compared with excellent self-rated overall health (OR 1.78, 95% CI 1.01–3.14) and less likely to self-report anxiety (OR 0.48, 95% CI 0.24−0.97) than those registered with metastatic cancer of known primary. Compared to general cohort population controls, people registered with CUP were more likely to have poor rather than excellent self-rated overall health (OR 6.22, 95% CI 1.35–28.6), less likely to self-report anxiety (OR 0.28, 95% CI 0.12−0.63), and more likely to have a history of diabetes (OR 1.89, 95% CI 1.15–3.10) or cancer (OR 1.62, 95% CI 1.03–2.57). Neither tertiary nor community-based health service use independently predicted CUP risk.ConclusionLow self-rated health may be a flag for undiagnosed cancer, and an investigation of its clinical utility in primary care appears warranted. |
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| Keywords: | Cancer of unknown primary Cohort Epidemiology Health services Consultations Comorbidity |
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