Wikén Ida, Andersson Therese M-L, Radkiewicz Cecilia
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
Upper Gastrointestinal Surgery/Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
Acta Oncol. 2023 Feb;62(2):103-109. doi: 10.1080/0284186X.2023.2178325. Epub 2023 Feb 15.
It is unknown if the reduction in the expected number of cancer cases diagnosed during Swedish holidays are due to diagnostic delays, how different cancers are affected, and if the season of diagnosis influences long-term cancer survival. We aimed to quantify seasonal trends in incidence and excess mortality for a wide range of malignancies, requiring more or less urgent clinical management.
This nationwide cohort study included all Swedish residents aged 20-84 in 1990-2019. Incidence and relative survival in pancreatic, colorectal, lung, urothelial, breast, and prostate cancer, together with malignant melanoma, non-Hodgkin lymphoma, and acute leukemia diagnosed during holiday and post-holiday were compared to working (reference) season. Incidence rate ratios (IRR) were estimated using Poisson regression and excess (cancer) mortality rate ratios using flexible parametric models.
We identified 882,980 cancer cases. Incidence declined during holiday season for all malignancies and the IRR ranged from 0.58 (95% CI 0.57-0.59 in breast to 0.92 (95% CI 0.89-0.94) in pancreatic cancer. A post-holiday increase was noted for acute leukemia, pancreatic, and lung cancer. For all malignancies except lung cancer, non-Hodgkin lymphoma, and acute leukemia, the excess mortality at 2 years from diagnosis was higher among those diagnosed during the holiday season. A tendency toward elevated short-term (0.5 years) excess mortality was noted in the post-holiday group, but long-term effects only persisted in breast cancer.
This study demonstrates lower holiday detection rates and higher mortality rates in various cancer types diagnosed during holiday season. Healthcare systems should offer a uniform level of cancer care independent of calendar season.
瑞典节假日期间确诊的癌症病例预期数量减少是否是由于诊断延迟、不同癌症受何影响以及诊断季节是否影响癌症长期生存尚不清楚。我们旨在量化一系列恶性肿瘤的发病率和超额死亡率的季节性趋势，这些恶性肿瘤需要或多或少的紧急临床处理。
这项全国性队列研究纳入了1990 - 2019年所有年龄在20 - 84岁的瑞典居民。将节假日期间及节后诊断出的胰腺癌、结直肠癌、肺癌、尿路上皮癌、乳腺癌、前列腺癌，以及恶性黑色素瘤、非霍奇金淋巴瘤和急性白血病的发病率和相对生存率与工作（对照）季节进行比较。发病率比（IRR）采用泊松回归估计，超额（癌症）死亡率比采用灵活参数模型估计。
我们共识别出882,980例癌症病例。所有恶性肿瘤在节假日期间发病率均下降，IRR范围从乳腺癌的0.58（95%CI 0.57 - 0.59）到胰腺癌的0.92（95%CI 0.89 - 0.94）。急性白血病、胰腺癌和肺癌在节后出现上升。除肺癌、非霍奇金淋巴瘤和急性白血病外，所有恶性肿瘤在诊断后2年的超额死亡率在节假日期间诊断的患者中更高。节后组短期（0.5年）超额死亡率有升高趋势，但长期影响仅在乳腺癌中持续存在。
本研究表明，在节假日期间诊断的各种癌症类型中，检测率较低且死亡率较高。医疗保健系统应提供与日历季节无关的统一水平的癌症护理。
