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Improvements in survival among cancer patients have revealed the clinical impact of cardiotoxicity on both cardiovascular and hematological and oncological outcomes, especially when it leads to the interruption of highly effective antitumor therapies. Atrial fibrillation is a common complication in patients with active cancer and its treatment poses a major challenge. These patients have an increased thromboembolic and hemorrhagic risk but standard stroke prediction scores have not been validated in this population. The aim of this expert consensus-based document is to provide a multidisciplinary and practical approach to the prevention and treatment of atrial fibrillation in patients with active cancer. This is a position paper of the Spanish Cardio-Oncology working group and the Spanish Thrombosis working group, drafted in collaboration with experts from the Spanish Society of Cardiology, the Spanish Society of Medical Oncology, the Spanish Society of Radiation Oncology, and the Spanish Society of Hematology., (Copyright © 2019 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.)

In the context of a historical cohort study among workers in the pulp and paper industry, we examined the agreement between the underlying cause of death obtained from municipal mortality files and from the mortality register of Catalonia (n = 50 pairs). The percentage of simple agreement (P0) for major causes of death was 76%. The agreement and the Kappa index was higher for external causes (P0 = 98%; K = 0.87) and for cancer (P0 = 90%; K = 0.79). The agreement was moderate for mortality from circulatory diseases (K = 0.57). Agreement between 3 digit ICD codes was 48% but was higher for deaths from cancer (P0 = 67%). These results indicate that information on major causes of death and on specific causes of cancer retrieved from municipal mortality files may be used for the follow-up of historical cohort studies.

Precision medicine is an emerging approach to the prevention and treatment of disease that takes into account variability in genes, environment and lifestyle for each individual. Precision medicine is transforming clinical and biomedical research, as well as health care itself, from a conceptual, as well as a methodological viewpoint, providing extraordinary opportunities to improve public health and lower the costs of the healthcare system. However, the implementation of precision medicine poses ethical-legal, regulatory, organizational and knowledge-related challenges. Without a national strategy, precision medicine -which eventually will be implemented one way or another- could take place without the appropriate planning to guarantee technical quality and equal access to the best practices for all citizens, thus violating the rights of patients and professionals as well as jeopardizing the solvency of the healthcare system. This paper from the Spanish Societies of Medical Oncology (SEOM), Pathology (SEAP) and Hospital Pharmacy (SEFH), highlights the need to institute a consensual national strategy for the development of precision medicine in our country, reviews the national and international context, comments on the opportunities and challenges for implementing precision medicine and outlines the objectives of a national strategy on precision medicine in cancer., (Copyright © 2017. Publicado por Elsevier España, S.L.U.)

The increasing complexity of cancer care makes organisation of clinical decision-making one of the key elements in high-quality cancer care. The great number of professionals involved in this disease means that communication and co-ordination among such professionals is of pivotal importance. The prospect of an organised multidisciplinary care is highlighted for its ability to move from a sequential model of care to progress towards an inclusive process led by a multidisciplinary team. Scientific evidence shows that such a perspective contributes to improved survival and quality of life of cancer patients. In the context of highly frequent, costly and clinically complex cancer diseases, the priority is to develop a different approach to its management, based on the expertise of professionals and teams by tumour location. The organisation and management of many hospitals, however, does not generally reflect this dimension. The process of care is based on very rigid hospital services which restrict cross-communication. This hinders a redistribution of responsibilities of the professionals with the greatest potential to improve clinical effectiveness. The present paper shows the difficulty in developing a model of integrated professional cooperation and identifies the different models of implementation of multidisciplinary care, using cancer as an example, in the context of the Spanish National Health System., (Copyright © 2011 SECA. Published by Elsevier Espana. All rights reserved.)

Objective: To evaluate the accuracy of the time series model used to forecast cancer mortality rates in Spain published in Atención Primaria for the year 2000., Design: Descriptive study., Setting: Spain., Participants: All cancer deaths recorded in Spain during the year 2000., Main Measurements: The forecast for cancer mortality rates in males and females for the year 2000 was obtained from a paper published in 1999 in the journal Atención Primaria. Official data on cancer mortality rates for the year 2000 were obtained from the Spanish Statistical Office (INE) in 2003., Results: In 2000, 59,212 males and 35,860 females died of cancer. The figures predicted by the time series model were 60,561 for males and 36,183 for females. Thus, the actual cancer mortality figures published by the Statistical Office fell within the confidence intervals of the forecasts for both gross mortality and cancer deaths., Conclusions: The difference between the true cancer mortality rate and the forecast is very small and not significant for health planning. Time series analysis is highly effective as a basis for decision-taking in cancer health planning. Cancer health policy and management can also benefit from the strength of these models.

Asthenia in cancer patients is a highly controversial subject. A distinct definition of asthenia in medical literature is lacking as well as its prevalence and incidence. Also, no simple tools for its diagnosis are available. Moreover its etiopathogenesis is complex and multifactorial, thereby making therapeutic approaches difficult. Recently, a Spanish group has been set up for the study and treatment of asthenia in cancer patients. This paper reports on its establishment, objectives and first conclusions.

Background and Objectives: The knowledge of time-related changes occurring in cancer incidence and mortality is an essential element for cancer control. This paper aims to describe the time trends of the more important cancer sites in Navarra and Zaragoza., Methods: The influence of age, diagnosis period and birth cohort on the observed time trend cancer incidence in Navarre and Zaragoza was assessed using a log-linear model. Results are showed graphically, for the different tumour sites by sex and each registry., Results: Among males, a considerable rise in the incidence of lung cancer (5% per year), prostate cancer (> 2% per year) and non-Hodgkin's lymphomas was found. Among females, the highest increases corresponded to non-Hodgkin's lymphomas, with a yearly rise greater than 7%, and ovarian cancer (4% per year). Breast cancer in women increased in both registries (3.5% per year in Navarre and 0.9% per year in Zaragoza), part of the increment in Navarra being explained by a higher case detection rate. Finally, the incidence of colorectal, bladder and kidney cancer rose more than a 3% per year in both registries and sexes. For most types of tumours, cancer risk increased with subsequent generations., Conclusion: The substantial cancer increment observed points out the inefficacy of primary prevention policies, the importance of studying cancer incidence for long time periods and the need to increase the population coverage of Spanish cancer registries.

Background: Cumulative risk reflects the lifetime probability that a person will develop a disease or will die from a disease. In this paper we estimate the cumulative risk of developing cancer and dying from cancer during the period 1988-1992 in Catalonia (Spain)., Material and Methods: Data from the Tarragona Cancer Registry and Catalonia Mortality Registry are used. Cancer incidence from Tarragona is extrapolated to the total Catalan population. Cumulative risk is estimated from cumulative rate and with a life table method, which takes into account competing risks. The change in risk with age is also studied., Results: Lifetime risk of developing cancer in Catalonia is 38.9% for men and 28.0% for women. Risk of dying from cancer is 26.3% for men and 17.2% for women, that is, a 67.6% and a 61.5% of incident cases, respectively. One in 14 men will develop lung cancer and nearly all of them will die from the disease. One in 14 women will develop breast cancer and 45% of them will die from the disease., Conclusion: Cancer is an important health problem in Catalonia because its high impact at the individual level shown by the cumulative risk. More than one in 3 men and one in 4 women are diagnosed of cancer during their lives and, among them, two thirds die because the disease.

Most of mortality studies among steelworkers pointed out an increased frequency on cancer mortality, above all by lung cancer, and, in a lower proportion, by cancers of digestive and genitourinary systems. In Spain mortality rates are not published by occupation and economic activity to contrast these observations. It was carried out a proportionate mortality study among active or retired workers from an steel mill, Altos Hornos de Vizcaya, died from 1986 to 1993, to make a preliminary death risk assessment associated with job in the steel industry. A sample of 1553 men was drawn from the mortality register of a private Insurance Company. Death causes within the sample and in general population of the Autonomous Community of the Basque Country were compared using a proportionate analysis. Mortality odds ratios (OR) were also computed. The results show an excess of cancer mortality (OR = 1.26, IC: 1.11-1.42), stomach cancer (OR = 1.50, IC: 1.14-1.98) and renal cancer (OR = 1.89; IC: 1.14-3.14) as it has been stated by other authors. It has not been found an increased mortality risk from lung cancer (OR = 1.13, IC: 0.91-1.40), bladder cancer (OR = 1.13, IC: 0.74-1.72) and chronic respiratory disease (OR = 0.94, IC: 0.73-1.20). There is also an excess of liver cancer (OR = 1.56, IC: 1.06-2.28) and cancer of non specified location (OR = 1.85, IC: 1.45-2.36). This can be due to classification bias that affects the study. On the other hand, these and other selection bias, discussed in this paper, could underestimate the lung cancer mortality. We can not conclude that, among the workers of the study, the mortality from several kind of cancer is not associated to occupational exposure. Furthermore, this excess of stomach and kidney cancer mortality may lead us to pose the hypothesis of cause-effect relationship with some not well identified carcinogens present at the steel working place.

Background: Childhood mortality from tumors has decreased in industrialized countries. The aim of this paper is to study the trend of mortality from tumors in children (under 15 years old) during the period 1975-1992., Methods: Using data from the Department of Health and Social Security's Register of Mortality, age-group standardized (to world population) mortality rates for each sex were analyzed. Analysis was carried out on total mortality caused by childhood tumors and on main causes of death (leukemia, brain cancer, non-Hodgkin lymphoma, bone cancer and non-specified tumors). A Poisson's regression model was used to analyze mortality trends., Results: Childhood tumors caused 8.7% of all deaths in boys and 8.5% of all deaths in girls between 1990-1992. Thus, standardized mortality rates have decreased significantly, in 1975-1977 standardized mortality rates for boys and girls were 71.20 and 68.05 respectively, in 1990-1992 these rates had fallen to 55.45 and 41.30. The annual percentage decrease in cancer mortality rates for boys was 2% and for girls was 3.1%. Main causes of deaths were leukemia and brain cancer., Conclusions: Between 1975-1992 a significant downward trend in childhood tumors mortality has been observed, more prominent in main causes of death and in girls. The principal explanation for this trend is an increased survival, consequence of changes in childhood tumors therapy.

In this paper we study the general mortality trends by cancer in Spain (1951-1987), and also by sex and age groups. We focus on lung cancer, establishing comparisons with USA, England and Wales. We appreciate on the general mortality trend that only young age groups show a higher decrease, while in other countries this decrease was also in old age groups. We observed a lower mortality trend in Spain by lung cancer than in the other countries, however increasing the rates in both sexes and more in males. That evolution could be related with the evolution of cancer risk factors and especially lung cancer. On concluded that the general mortality trend in Spain is the same than other developed countries but with some delay in the evolution, when comparing lung cancer. Spain is now in an increasing phase and USA, England and Wales have stabilized their rates and begin to decrease their trends.

In industrialized countries the three main contaminant factors of the environment are: energy production, industrial activities and agricultural activities. A large number of epidemiologic proofs shows the great importance of the environmental factors on inducing different kinds of cancer. The purpose of this paper is studying the possible repercussions of human activities on the population health, specially focused on cancer. Four areas of the Valencian Community (two agricultural areas and two industrialized areas) has been selected. A cancer mortality study has been carried out in the different kinds of areas (CIE-IX revision) over the 1976-1989 period, calculating mortality rates per 100.000 inhabitants and standardizing them by direct method. A statistical significance test (chi square) has been applied with a reliability level for 95%. Finally, the prevailing tendency all over the studied period has been evaluated, applying a linear regression analysis to the gross rates. In industrial areas a statistically significant increase (p < 0.05) of GI system tumours, respiratory tract tumours, blood and hemopoietic tumours and benign tumours of unspecified nature has been observed. In agricultural areas the studied pathologies sustain a steady tendency, except for benign tumours and tumours of unspecified nature, showing significant increase in one of both agricultural areas. We can conclude that mortality patterns with regard to cancer are different in agricultural areas from regard to cancer are different in agricultural areas from those found in industrial areas--and this could be related to the distinct environmental and labour features in each population.

Background: Cancer is one of the most important health problems in developed countries. The aim of this paper is to analyze mortality trends due to cancer in Catalonia from 1975 to 1990., Methods: Cancer mortality trends have been studied for each sex separately. Rates were standardized by direct method, using world population as standard; also, truncated (35-65 years old) and cumulative rates (0-74) were calculated. Annual percentage of change was estimated from a Poisson's regression model., Results: An increase of cancer mortality was observed between 1975 and 1990 among men but not in women. Lung cancer is the main cause of death from cancer in men and breast cancer in women. Both these cancers showed a significative increase in their mortality during the period of study. Among men, there is a significative increase in the following cancers: oral cavity, colon, pancreas, melanoma, non-Hodgkin's lymphoma and myeloma; and there is a decrease in the following cancers: stomach, testicle and brain. Among women, there is a significative increase in cancer mortality due to the following: ovarian, colon, pancreas, melanoma and non-Hodgkin's lymphoma; while decrease in the following: stomach, liver and uterus. Also, lung cancer mortality among women is decreasing., Conclusion: The increasing trend observed in lung cancer mortality rates among men and in breast cancer among women are the main causes of concern. Therefore, priorities in cancer control underlined by this analysis should include emphasis on smoking control and developing breast cancer screening.

In this paper, correlations between ischaemic heart disease and several cancers associated with cigarette smoking are examined. Also, tobacco consumption data are correlated against ischaemic heart disease mortality incidence rates. Furthermore, correlations between ischaemic heart disease incidences and per capita consumption of fattening foods (meat, milk and eggs) are analyzed. In this work, results referring to Spain, and at an ecologic level, confirm conclusions of observational and experimental studies carried out in other countries, which points out a strong association between ischaemic heart disease, cigarette consumption and fattening diet.

Since 1977, 64 children were diagnosed with cancer in the Department of Pediatrics of the University of Granada. Incidence and mortality rates from specific tumor types are discussed. Most common malignant neoplasms of children are: 1. Leukemia (36.3%). 2. Tumors of central nervous system (10.7%). 3. Lymphoma, and tumors of sympathetic nervous system (19.9%). 4. Soft tissue (6.1%). 5. Kidney (7.6%). 6. Bone (4.6%). Most of the male excess (1.9:1, p less than 0.01) is accounted for by acute lymphocytic leukemia, and central nervous system tumors. It is evident that about one-half of all children diagnosed currently with a malignant disease will survive for a long period. Psychosocial aspects of cancer in the young are commented. This paper examines how patients, family members and medical staff feel and behave in response to occurrence of cancer in adolescent.

The aim of this paper is to evaluate the quality of the Death Certificates by means of the Death Statistics Bulletins, in their NEOPLASIC aspect in the year 1985 in the Province of Soria, determining the histopathologic confirmation of the deaths by means of the neoplasic patients' records in the two existing Pathology Services. An overall histologic verification of 80.76% is observed in the cases with an I.C. of +/- 4.79. In the case of BREAST, HEMATOLOGIC, OROPHARYNX, ENDOMETRIUM, ESOPHAGUS, OVARIAN, LARYNX and VULVA tumors, it is 100%. Whereas it is 14.3% in HEPATIC Tumors. Of the total of deaths registered in said year, the percentage of deaths caused by malignant neoplasias is over 26%, more than a fourth of which were Gastric. The preparation of the Death Certificates should be modified so that they can be objectively evaluated epidemiologically without bias or mistakes.