Report of Incidence and Mortality in China Cancer Registries,2008

Objective： Annual cancer incidence and mortality in 2008 were provided by National Central Cancer Registry in China, which data were collected from population‐based cancer registries in 2011. Methods： There were 56 registries submitted their data in 2008. After checking and evaluating the data quality, total 41 registries＇ data were accepted and pooled for analysis. Incidence and mortality rates by area （urban or rural areas） were assessed, as well as the age‐ and sex‐specific rates, age‐standardized rates, proportions and cumulative rate. Results： The coverage population of the 41 registries was 66,138,784 with 52,158,495 in urban areas and 13,980,289 in rural areas. There were 197,833 new cancer cases and 122,136 deaths in cancer with mortality to incidence ratio of 0.62. The morphological verified rate was 69.33%, and 2.23% of cases were identified by death certificate only. The crude cancer incidence rate in all areas was 299.12/100,000 （330.16/100,000 in male and 267.56/100,000 in female） and the age‐standardized incidence rates by Chinese standard population （ASIRC） and world standard population （ASIRW） were 148.75/100,000 and 194.99/100,000, respectively. The cumulative incidence rate （0-74 years old） was of 22.27%. The crude incidence rate in urban areas was higher than that in rural areas. However, after adjusted by age, the incidence rate in urban was lower than that in rural. The crude cancer mortality was 184.67/100,000 （228.14/100,000 in male and 140.48/100,000 in female）, and the age‐standardized mortality rates by Chinese standard population （ASMRC） and by world population were 84.36/100,000 and 114.32/100,000, respectively. The cumulative mortality rate （0-74 years old） was of 12.89%. Age‐adjusted mortality rates in urban areas were lower than that in rural areas. The most common cancer sites were lung, stomach, colon‐rectum, liver, esophagus, pancreas, brain, lymphoma, breast and cervix which accounted for 75% of all cancer incidence. Lung cancer was the leading cause of cancer death, followed by gastric cancer, liver cancer, esophageal cancer, colorectal cancer and pancreas cancer, which accounted for 80% of all cancer deaths. The cancer spectrum varied by areas and sex in rural areas, cancers from digestive system were more common, such as esophageal cancer, gastric cancer and liver cancer, while incidence rates of lung cancer and colorectal cancer were much higher in urban areas. In addition, breast cancer was the most common cancer in urban women followed by liver cancer, gastric cancer and colorectal cancer. Conclusion： Lung cancer, gastric cancer, colorectal cancer, liver cancer, esophageal cancer and female breast cancer contributed to the increased incidence of cancer, which should be paid more attention to in further national cancer prevention and control program. Different cancer control strategies should be carried out due to the varied cancer spectrum in different groups.

Interim Outcomes and Adverse Events among Drug-Resistant Tuberculosis Patients Treated with Bedaquiline in the Philippines

Objectives: This study aimed to assess the interim outcomes for drug-resistant tuberculosis (DR-TB) patients treated with bedaquiline regimen under the operational research conditions compared to DR-TB patients treated without bedaquiline in their regimen, and to describe the adverse events that occurred among patients treated with bedaquiline in the Philippines. Design: Patients who were treated with a bedaquiline-containing regimen from June 2016 to May 2017 were included in this study as the intervention group, while patients who were treated without bedaquiline regimen from January 2013 to May 2016 were included as the comparison group. The interim treatment outcomes were compared using Chi-square test. The analysis of time to culture conversion within 6 months of treatment was conducted. A Cox proportional hazard model was constructed to identify the variables associated with a favorable interim treatment outcome. The R program was used for statistical analysis. Results: On the 6th month of treatment, the culture conversion for patients treated with a bedaquiline-containing regimen was significantly higher than with the comparison group [63/75 (84.0%) vs 84/117 (71.8%), p = 0.012)]. Nearly 15% of the patients treated with bedaquiline were lost to follow-up. Frequent adverse events included vomiting, dizziness, nausea, joint pain, and abdominal pain. Conclusion: The patients who were treated with bedaquiline-containing regimen have better interim treatment outcomes than those treated without bedaquiline, but the proportion of patients who were lost to follow-up remains substantial.

The Introduction of Bedaquiline Regimen for Drug-Resistant Tuberculosis in the Philippines: An Operational Study

Objectives: Bedaquiline (BDQ) is the first new anti-tuberculosis (TB) drug introduced to the market after 45 years. Recent studies have shown the potential benefits of adding bedaquiline to regimens for drug-resistant TB (DR-TB). In search of more effective regimens for DR-TB, bedaquiline was introduced in the TB program in the Philippines under operational research to assess its effectiveness, safety, and tolerability when given with background regimens among patients with multi-or extensively DR-TB (MDR/XDR-TB). Design: A prospective cohort study of patients with MDR/XDR-TB was given with a bedaquiline-containing regimen from June 2016 to May 2017. Demographic data, presence of comorbidities, and microbiologic profile on entry were recorded. Bedaquiline was administered at the recommended dose of 400 mg once daily for 14 days, then 200 mg three times a week for 22 weeks together with World Health Organization (WHO)-compliant background regimen. The time to culture conversion, interim outcomes at the 6th month of treatment, end-of-treatment outcomes, and post-treatment follow-up outcomes after one year was determined. The frequency and severity of adverse events (SAE) were recorded as part of pharmacovigilance. Results: Seventy-five patients were given with bedaquiline-containing regimen during the study period. Forty-two (56.0%) had second-line injectable resistance, 23 (30.7%) had fluoroquinolone-resistance, 6 (8.0%) had MDR-TB, and 4 (5.3%) had XDR-TB. In the 6th month of post-enrolment, 79% were culture-negative. The treatment success rate was 65.3% (37 were cured and 12 completed treatment), 7 (9.3%) died, 17 (22.7%) lost to follow-up, and 2 (2.7%) were withdrawn from treatment. Adverse events included vomiting (80%), dizziness (69%), nausea (52%), cough (44%), and headache (36%). The post-treatment follow-up of 49 patients in the 12th month showed 92% were culture-negative while 8% of TBC were not done. Conclusion: Bedaquiline-containing regimens for patients with MDR/XDR-TB were highly effective with an acceptable safety profile and favorable treatment outcomes, but the proportion of patients who lost to follow-up remains substantial.