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Article ; Online: Personalizing the Treatment of Women with Ductal Carcinoma In Situ (DCIS) Using the DCIS Score: A Qualitative Study on Score Use.

O'Brien, Mary Ann / Paszat, Lawrence / Makuwaza, Tutsirai / Fong, Cindy / Rakovitch, Eileen

2024 Volume 31, Issue 2, Page(s) 975–986

Abstract: Background: A twelve-gene molecular expression assay (DCIS score) may help guide radiation oncology treatment under specific circumstances. We undertook a study to examine radiation oncologist (RO), surgeon, and decision maker views on implementing the ... ...

Abstract	Background: A twelve-gene molecular expression assay (DCIS score) may help guide radiation oncology treatment under specific circumstances. We undertook a study to examine radiation oncologist (RO), surgeon, and decision maker views on implementing the DCIS score in practice for women with low-risk DCIS. Methods: We conducted a qualitative study involving telephone interviews that were audio-recorded and transcribed. Two researchers conducted a thematic analysis of transcripts. Results: Twenty-eight individuals (ROs, breast cancer surgeons, and cancer policy decision makers) were invited to participate; 22 out of the 28 people (79%) agreed. The final sample included 20 participants: 11 of 13 (85%) ROs, 5 of 7 (71%) surgeons, and 4 of 8 (50%) decision makers. Most ROs expressed concerns about overtreatment but could not predict with certainty which low-risk patients could safely avoid radiation. The DCIS score was viewed as contributing valuable personalized risk information as part of treatment decision making that included clinicopathological factors and women's preferences. Future implementation would require guidelines with input from the oncology team. Conclusions: ROs had concerns about the overtreatment of women with DCIS, but lacked the tools to reliably predict which women could safely avoid radiation. By providing oncologists and women with personalized tumor information, the DCIS score was an important component of treatment decision making.
MeSH term(s)	Humans ; Female ; Carcinoma, Intraductal, Noninfiltrating/therapy ; Carcinoma, Intraductal, Noninfiltrating/pathology ; Reactive Oxygen Species ; Breast Neoplasms/pathology ; Risk ; Qualitative Research
Chemical Substances	Reactive Oxygen Species
Language	English
Publishing date	2024-02-10
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	1236972-x
ISSN	1718-7729 ; 1198-0052
ISSN (online)	1718-7729
ISSN	1198-0052
DOI	10.3390/curroncol31020073
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Article: Impact of chronic obstructive pulmonary disease on lung cancer symptom burden: a population-based study in Ontario, Canada.

Butler, Stacey J / Louie, Alexander V / Sutradhar, Rinku / Paszat, Lawrence / Brooks, Dina / Gershon, Andrea S

Translational lung cancer research

2023 Volume 12, Issue 11, Page(s) 2260–2274

Abstract: Background: Chronic obstructive pulmonary disease (COPD) and lung cancer commonly coexist and have significant symptom overlap. We sought to compare the symptom burden of lung cancer patients with COPD to those without COPD.: Methods: We conducted a ... ...

Abstract	Background: Chronic obstructive pulmonary disease (COPD) and lung cancer commonly coexist and have significant symptom overlap. We sought to compare the symptom burden of lung cancer patients with COPD to those without COPD. Methods: We conducted a retrospective, cross-sectional study of stage I-IV lung cancer patients in Ontario, Canada, who completed the Edmonton Symptom Assessment Scale (ESAS) within 90 days of diagnosis. COPD was ascertained using a validated algorithm and patients were grouped as: no COPD, previously diagnosed COPD (at least 90 days prior to lung cancer diagnosis), and newly diagnosed COPD (within 90 days of lung cancer diagnosis). The association between COPD status and any moderate to severe symptom (ESAS ≥4) and the number of moderate to severe symptoms was determined using multivariable modified Poisson regression analyses. Multivariable linear regression analysis was used to compare total symptom distress scores. Analyses were stratified by limited (I/II) and advanced stage (III/IV). Results: Among 38,898 lung cancer patients, 53% had COPD (previously diagnosed 43%, newly diagnosed 10%). Collectively, those with previously diagnosed COPD had the most severe symptom burden. Across all stages, both COPD groups had a significantly higher risk of experiencing any (relative risk: 1.04 to 1.18) and multiple moderate to severe symptoms (RR 1.05 to 1.24), in addition to higher total symptom distress scores (P<0.0001). Differences in symptom burden between groups were most pronounced among early-stage patients. Conclusions: Lung cancer patients with underlying COPD have worse symptom burden, indicating a need for interventions that effectively alleviate symptoms.
Language	English
Publishing date	2023-11-28
Publishing country	China
Document type	Journal Article
ZDB-ID	2754335-3
ISSN	2226-4477 ; 2218-6751
ISSN (online)	2226-4477
ISSN	2218-6751
DOI	10.21037/tlcr-23-560
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Article ; Online: Association between COPD and Stage of Lung Cancer Diagnosis: A Population-Based Study.

Butler, Stacey J / Louie, Alexander V / Sutradhar, Rinku / Paszat, Lawrence / Brooks, Dina / Gershon, Andrea S

Current oncology (Toronto, Ont.)

2023 Volume 30, Issue 7, Page(s) 6397–6410

Abstract: Chronic obstructive pulmonary disease (COPD) is associated with an increased risk of lung cancer; however, the association between COPD and stage of lung cancer diagnosis is unclear. We conducted a population-based cross-sectional analysis of lung cancer ...

Abstract	Chronic obstructive pulmonary disease (COPD) is associated with an increased risk of lung cancer; however, the association between COPD and stage of lung cancer diagnosis is unclear. We conducted a population-based cross-sectional analysis of lung cancer patients (2008-2020) in Ontario, Canada. Using estimated propensity scores and inverse probability weighting, logistic regression models were developed to assess the association between COPD and lung cancer stage at diagnosis (early: I/II, advanced: III/IV), accounting for prior chest imaging. We further examined associations in subgroups with previously diagnosed and undiagnosed COPD. Over half (55%) of all lung cancer patients in Ontario had coexisting COPD (previously diagnosed: 45%, undiagnosed at time of cancer diagnosis: 10%). Compared to people without COPD, people with COPD had 30% lower odds of being diagnosed with lung cancer in the advanced stages (OR = 0.70, 95% CI: 0.68 to 0.72). Prior chest imaging only slightly attenuated this association (OR = 0.77, 95% CI: 0.75 to 0.80). The association with lower odds of advanced-stage diagnosis remained, regardless of whether COPD was previously diagnosed (OR = 0.68, 95% CI: 0.66 to 0.70) or undiagnosed (OR = 0.77, 95% CI: 0.73 to 0.82). Although most lung cancers are detected in the advanced stages, underlying COPD was associated with early-stage detection. Lung cancer diagnostics may benefit from enhanced partnership with COPD healthcare providers.
MeSH term(s)	Humans ; Cross-Sectional Studies ; Risk Factors ; Pulmonary Disease, Chronic Obstructive/complications ; Pulmonary Disease, Chronic Obstructive/diagnosis ; Lung Neoplasms/complications ; Lung Neoplasms/diagnosis ; Ontario
Language	English
Publishing date	2023-07-05
Publishing country	Switzerland
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	1236972-x
ISSN	1718-7729 ; 1198-0052
ISSN (online)	1718-7729
ISSN	1198-0052
DOI	10.3390/curroncol30070471
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Article ; Online: Palliative Care Among Lung Cancer Patients With and Without COPD: A Population-Based Cohort Study.

Butler, Stacey J / Louie, Alexander V / Sutradhar, Rinku / Paszat, Lawrence / Brooks, Dina / Gershon, Andrea S

Journal of pain and symptom management

2023 Volume 66, Issue 6, Page(s) 611–620.e4

Abstract: Context: Lung cancer patients with chronic obstructive pulmonary disease (COPD) may have greater palliative care needs due to poor prognosis and symptom burden.: Objectives: We sought to compare the provision of timely palliative care and symptom ... ...

Abstract	Context: Lung cancer patients with chronic obstructive pulmonary disease (COPD) may have greater palliative care needs due to poor prognosis and symptom burden. Objectives: We sought to compare the provision of timely palliative care and symptom burden by COPD status. Methods: We performed a retrospective, population-based cohort study of individuals diagnosed with lung cancer in Ontario, Canada (2009-2019) using health administrative databases and cancer registries. The impact of COPD on the probability of receiving palliative care was determined accounting for dying as a competing event, overall and stratified by stage. The provision of palliative care for patients with severe symptoms (Edmonton Symptom Assessment Scale score ≥ 7), location of the first palliative care visit and symptom severity were compared by COPD status. Results: A total of 74,993 patients were included in the study (48% of patients had available symptom data). At the time of lung cancer diagnosis, 50% of patients had COPD. Stage I-III patients with COPD were more likely to receive palliative care (adjusted Hazard Ratio (HR)s: 1.05-1.31) with no difference for stage IV (1.02, 95% CI: 1.00-1.04). Despite having severe symptoms, very few patients with early-stage disease received palliative care (Stage I: COPD-23% vs. no COPD-18%, SMD = 0.12). Most patients (84%) reported severe symptoms and COPD worsened symptom burden, especially among early-stage patients. Conclusion: COPD impacts the receipt of palliative care and symptom burden for patients with early-stage lung cancer. Many patients with severe symptoms did not receive palliative care, suggesting unmet needs among this vulnerable population.
MeSH term(s)	Humans ; Palliative Care ; Lung Neoplasms/epidemiology ; Lung Neoplasms/therapy ; Cohort Studies ; Retrospective Studies ; Pulmonary Disease, Chronic Obstructive/epidemiology ; Pulmonary Disease, Chronic Obstructive/therapy ; Ontario/epidemiology
Language	English
Publishing date	2023-08-22
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	639142-4
ISSN	1873-6513 ; 0885-3924
ISSN (online)	1873-6513
ISSN	0885-3924
DOI	10.1016/j.jpainsymman.2023.08.017
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Zs.A 2252: Show issues

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Article ; Online: The effect of postmastectomy radiotherapy on patient-reported outcomes.

Rakovitch, Eileen / Paszat, Lawrence

The Lancet. Oncology

2018 Volume 19, Issue 11, Page(s) 1429–1431

MeSH term(s)	Breast Neoplasms/surgery ; Follow-Up Studies ; Humans ; Mastectomy ; Patient Reported Outcome Measures ; Quality of Life ; Radiotherapy, Adjuvant
Language	English
Publishing date	2018-10-15
Publishing country	England
Document type	Journal Article ; Comment
ZDB-ID	2049730-1
ISSN	1474-5488 ; 1470-2045
ISSN (online)	1474-5488
ISSN	1470-2045
DOI	10.1016/S1470-2045(18)30586-2
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Zs.A 5696: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (2.OG) ab Jg. 2022: Lesesaal (EG)
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Article ; Online: The impact of ductal carcinoma in situ on health services utilization.

Paszat, Lawrence / Sutradhar, Rinku / Rakovitch, Eileen

Breast cancer research and treatment

2020 Volume 182, Issue 1, Page(s) 159–168

Abstract: Purpose: To determine the intermediate-term impact of diagnosis and treatment of ductal carcinoma in situ of the breast (DCIS) on health services utilization, we compared utilization by cases of DCIS to unaffected controls.: Methods: We identified a ... ...

Abstract	Purpose: To determine the intermediate-term impact of diagnosis and treatment of ductal carcinoma in situ of the breast (DCIS) on health services utilization, we compared utilization by cases of DCIS to unaffected controls. Methods: We identified a population-based cohort of Ontario females diagnosed with DCIS between 2010 and 2015. We matched 5 controls without any history of cancer to each case, on the date of diagnosis of the case (the index date), by age, annual mammography history, socioeconomic status, and comorbidity. We identified billing claims and hospital records, during the interval 13 to 60 months prior to, and subsequent to the index date, and computed rates per 100 person-years during both intervals, to conduct a difference-in-differences analysis. We used negative binomial regression to test if the change in rates in health services differed between cases and controls. Results: Visits with a breast diagnosis code, and claims for breast surgery and imaging, were significantly increased among cases compared to controls (all p values < 0.0001) after DCIS;however, there was no increase in visits for anxiety or depression (RR 1.13 (95% CI 0.97, 1.32, p = 0.11), visits to psychiatrists (RR 1.07 (95% CI 0.82, 1.40) p = 0.6), or hospital procedures other than breast surgery (RR 1.10 (95% CI 0.88, 1.37) p = 0.4). Conclusions: DCIS is associated with more visits and procedures related to the breast compared to controls following diagnosis and treatment, but other health services utilization and visits related to anxiety and depression were not increased.
MeSH term(s)	Aged ; Breast Neoplasms/pathology ; Breast Neoplasms/psychology ; Breast Neoplasms/therapy ; Carcinoma, Ductal, Breast/pathology ; Carcinoma, Ductal, Breast/psychology ; Carcinoma, Ductal, Breast/therapy ; Carcinoma, Intraductal, Noninfiltrating/pathology ; Carcinoma, Intraductal, Noninfiltrating/psychology ; Carcinoma, Intraductal, Noninfiltrating/therapy ; Case-Control Studies ; Facilities and Services Utilization/statistics & numerical data ; Female ; Follow-Up Studies ; Humans ; Mammography ; Middle Aged ; Patient Acceptance of Health Care/psychology ; Prognosis ; Retrospective Studies
Language	English
Publishing date	2020-05-08
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	604563-7
ISSN	1573-7217 ; 0167-6806
ISSN (online)	1573-7217
ISSN	0167-6806
DOI	10.1007/s10549-020-05664-9
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Zs.A 1655: Show issues

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Article ; Online: Omission of Axillary Staging and Survival in Elderly Women With Early Stage Breast Cancer: A Population-Based Cohort Study.

Castelo, Matthew / Hansen, Bettina E / Paszat, Lawrence / Baxter, Nancy N / Scheer, Adena S

Annals of surgery open : perspectives of surgical history, education, and clinical approaches

2022 Volume 3, Issue 2, Page(s) e159

Abstract: Objectives: Determine if axillary staging is associated with survival in elderly women with breast cancer.: Background: Axillary staging in women ≥ 70 years with early-stage breast cancer is controversial. Older randomized evidence has not shown ... ...

Abstract	Objectives: Determine if axillary staging is associated with survival in elderly women with breast cancer. Background: Axillary staging in women ≥ 70 years with early-stage breast cancer is controversial. Older randomized evidence has not shown axillary staging improves survival, but recent observational studies have been mixed and widespread de-implementation of the practice has not occurred. Methods: This was a population-based cohort study using the Surveillance, Epidemiology, and End Results registry. Women ≥ 70 years diagnosed with T1-T2 invasive breast cancer from 2005 to 2015 were included. Overlap propensity score weighting was used to adjust for confounders. Overall survival (OS) was determined and hazard ratios (HRs) reported with 95% confidence intervals (CIs). Breast cancer-specific survival (BCSS) was determined using competing risks analysis and subdistribution hazard ratios (sdHRs) reported. Additional adjustment was performed for receipt of chemotherapy and radiotherapy. Results: One hundred forty-four thousand three hundred twenty-nine elderly women were included, of whom 22,621 (15.7%) did not undergo axillary staging. After overlap propensity score weighting, baseline characteristics were well balanced between the 2 groups. Women who did not undergo axillary staging were significantly less likely to receive chemotherapy (adjusted relative risk, 0.58; 95% CI, 0.54-0.62) or radiotherapy (adjusted relative risk, 0.53; 95% CI, 0.52-0.54), and had significantly worse OS (adjusted HR, 1.22; 95% CI, 1.19-1.25), and BCSS (adjusted sdHR, 1.14; 95% CI, 1.08-1.21) compared to those that had staging. Conclusions: These findings suggest elderly women with early-stage breast cancer who do not undergo axillary staging experience worse outcomes. Reasons for this disparity may be multifactorial and require further investigation.
Language	English
Publishing date	2022-04-25
Publishing country	United States
Document type	Journal Article
ISSN	2691-3593
ISSN (online)	2691-3593
DOI	10.1097/AS9.0000000000000159
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Article ; Online: Long-term survival in elderly women receiving chemotherapy for non-metastatic breast cancer: a population-based analysis.

Castelo, Matthew / Lu, Justin / Paszat, Lawrence / Veitch, Zachary / Liu, Kuan / Scheer, Adena S

Breast cancer research and treatment

2022 Volume 194, Issue 3, Page(s) 629–641

Abstract: Background: Older women are poorly represented in trials evaluating chemotherapy for breast cancer (BC). This study aimed to describe survival and associated factors among elderly women receiving chemotherapy for non-metastatic BC.: Methods: This was ...

Abstract	Background: Older women are poorly represented in trials evaluating chemotherapy for breast cancer (BC). This study aimed to describe survival and associated factors among elderly women receiving chemotherapy for non-metastatic BC. Methods: This was a population-based cohort study including women ≥ 70 years old diagnosed with invasive, non-metastatic BC from 2010 to 2017 in SEER. Among those who received chemotherapy, overall survival (OS) was determined using Kaplan-Meier curves and hazard ratios were reported with 95% confidence intervals (CIs). Adjustment was made for available confounders. Co-morbidity is not available in SEER. BC-specific survival (BCSS) and subdistribution hazard ratios were determined using competing risks analysis. Results: The cohort consisted of 109,239 women aged 70+, of whom 17,961 (16%) received chemotherapy. Chemotherapy patients were younger (median 73.0 years vs. 77.0), had more advanced disease (25% stage III vs. 5.2%), and were more likely to receive mastectomy (50% vs. 33%). Among chemotherapy patients, 5-year OS was 77.8% (95% CI 76.9-78.6%), and for women 80+ was 60.2% (95% CI 57.5-63.1%). More recent diagnoses, no previous history of cancer, and receipt of radiotherapy were all associated with improved BCSS. Conversely, older age, higher tumour grade, advanced stage, and human epidermal growth factors receptor (HER)2 negative tumours were associated with worse BCSS. 56% of deaths were due to BC, and women aged 80+ had worse BCSS compared to those aged 70-79 (adjusted sdHR 1.62, 95% CI 1.43-1.84). Conclusions: Elderly women with advanced disease can achieve good survival after chemotherapy for non-metastatic BC. Those with HER2+ disease have superior survival, reinforcing benefit in this population.
MeSH term(s)	Aged ; Breast Neoplasms/pathology ; Cohort Studies ; Female ; Humans ; Mastectomy ; Neoplasm Staging ; Proportional Hazards Models ; SEER Program
Language	English
Publishing date	2022-06-22
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	604563-7
ISSN	1573-7217 ; 0167-6806
ISSN (online)	1573-7217
ISSN	0167-6806
DOI	10.1007/s10549-022-06646-9
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Zs.A 1655: Show issues

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Article ; Online: Analysis of Time to Treatment and Survival Among Adults Younger Than 50 Years of Age With Colorectal Cancer in Canada.

Castelo, Matthew / Paszat, Lawrence / Hansen, Bettina E / Scheer, Adena S / Faught, Neil / Nguyen, Lena / Baxter, Nancy N

JAMA network open

2023 Volume 6, Issue 8, Page(s) e2327109

Abstract: Importance: Colorectal cancer (CRC) is uncommon in adults younger than 50 years of age, so this population may experience delays to treatment that contribute to advanced stage and poor survival.: Objective: To investigate whether there is an ... ...

Abstract	Importance: Colorectal cancer (CRC) is uncommon in adults younger than 50 years of age, so this population may experience delays to treatment that contribute to advanced stage and poor survival. Objective: To investigate whether there is an association between time from presentation to treatment and survival in younger adults with CRC. Design, setting, and participants: This retrospective cohort study used linked population-based data in Ontario, Canada. Participants included patients with CRC aged younger than 50 years who were diagnosed in Ontario between 2007 and 2018. Analysis was performed between December 2019 and December 2022. Exposure: Administrative and billing codes were used to identify the number of days between the date of first presentation and treatment initiation (overall interval). Main outcomes and measures: The associations between increasing overall interval, overall survival (OS), and cause-specific survival (CSS) were explored with restricted cubic spline regression. Multivariable Cox proportional hazards models were also fit for OS and CSS, adjusted for confounders. Analyses were repeated in a subset of patients with lower urgency, defined as those who did not present emergently, did not have metastatic disease, did not have cross-sectional imaging or endoscopy within 14 days of first presentation, and had an overall interval of at least 28 days duration. Results: Among 5026 patients included, the median (IQR) age was 44.0 years (40.0-47.0 years); 2412 (48.0%) were female; 1266 (25.2%) had metastatic disease and 1570 (31.2%) had rectal cancer. The lower-urgency subset consisted of 2548 patients. The median (IQR) overall interval was 108 days (55-214 days) (15.4 weeks [7.9-30.6 weeks]). Patients with metastatic CRC had shorter median (IQR) overall intervals (83 days [39-183 days]) compared with those with less advanced disease. Five-year overall survival was 69.8% (95% CI, 68.4%-71.1%). Spline regression showed younger patients with shorter overall intervals (<108 days) had worse OS and CSS with no significant adverse outcomes of longer overall intervals. In adjusted Cox models, overall intervals longer than 18 weeks were not associated with significantly worse OS or CSS compared with those waiting 12 to 18 weeks (OS: HR, 0.83 [95% CI, 0.67-1.03]; CSS: HR, 0.90 [95% CI, 0.69-1.18]). Results were similar in the subset of lower-urgency patients, and when stratified by stage. Conclusions and relevance: In this cohort study of 5026 patients with CRC aged younger than 50 years of age in Ontario, time from presentation to treatment was not associated with advanced disease or poor survival. These results suggest that targeting postpresentation intervals may not translate to improved outcomes on a population level.
MeSH term(s)	Adult ; Humans ; Female ; Aged ; Male ; Colorectal Neoplasms/epidemiology ; Colorectal Neoplasms/therapy ; Retrospective Studies ; Cohort Studies ; Time-to-Treatment ; Rectal Neoplasms ; Ontario/epidemiology
Language	English
Publishing date	2023-08-01
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ISSN	2574-3805
ISSN (online)	2574-3805
DOI	10.1001/jamanetworkopen.2023.27109
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Article ; Online: Comparing Time to Diagnosis and Treatment Between Younger and Older Adults With Colorectal Cancer: A Population-Based Study.

Castelo, Matthew / Paszat, Lawrence / Hansen, Bettina E / Scheer, Adena S / Faught, Neil / Nguyen, Lena / Baxter, Nancy N

Gastroenterology

2023 Volume 164, Issue 7, Page(s) 1152–1164

Abstract: Background & aims: Younger adults (aged <50 years) with colorectal cancer (CRC) may have prolonged delays to diagnosis and treatment that are associated with adverse outcomes. We compared delay intervals by age for patients with CRC in a large ... ...

Abstract	Background & aims: Younger adults (aged <50 years) with colorectal cancer (CRC) may have prolonged delays to diagnosis and treatment that are associated with adverse outcomes. We compared delay intervals by age for patients with CRC in a large population. Methods: This was a population-based study of adults diagnosed with CRC in Ontario, Canada, from 2003 to 2018. We measured the time between presentation and diagnosis (diagnostic interval), diagnosis and treatment start (treatment interval), and the time from presentation to treatment (overall interval). We compared interval lengths between adults aged <50 years, 50 to 74 years, and 75 to 89 years using multivariable quantile regression. Results: Included were 90,225 patients with CRC. Of these, 6853 patients (7.6%) were aged <50 years. Younger patients were more likely to be women, present emergently, have stage IV disease, and have rectal cancer compared with middle-aged patients. Factors associated with significantly longer overall intervals included female sex (8.7 days; 95% confidence interval [CI], 6.6-10.9 days) and rectal cancer compared with proximal colon cancer (9.8 days; 95% CI, 7.4-2.2 days). After adjustment, adults aged <50 years had significantly longer diagnostic intervals (4.3 days; 95% CI. 1.3-7.3 days) and significantly shorter treatment intervals (-4.5 days; 95% CI, -5.3 to -3.7 days) compared with middle-aged patients. However, there was no significant difference in the overall interval (-0.6 days; 95% CI, -4.3 to 3.2 days). In stratified models, younger adults with stage IV disease who presented emergently and patients aged >75 years had longer overall intervals. Conclusions: Younger adults present more often with stage IV CRC but have overall similar times from presentation to treatment as screening-eligible older adults.
MeSH term(s)	Middle Aged ; Humans ; Female ; Aged ; Male ; Colorectal Neoplasms/diagnosis ; Colorectal Neoplasms/epidemiology ; Colorectal Neoplasms/therapy ; Ontario/epidemiology ; Time Factors ; Colonic Neoplasms ; Rectal Neoplasms
Language	English
Publishing date	2023-02-24
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	80112-4
ISSN	1528-0012 ; 0016-5085
ISSN (online)	1528-0012
ISSN	0016-5085
DOI	10.1053/j.gastro.2023.02.024
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