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BackgroundPeople diagnosed with cancer are living longer and whilst cancer survival is improving for many cancers, there is not the same parity for all social groups - older people and people living in more deprived areas often have more chronic health conditions. We examined the association between those other health conditions and cancer incidence, prevalence and survival for all Welsh patients, for the four most common cancers and all malignant cancer cases (excluding non-melanoma skin cancer).
MethodsWe extracted data on all malignant cancer cases from the WCISU's population-based cancer registry for diagnosis periods 1995-2015. Cases were linked to a Cluster Network and to Patient Episode Database for Wales hospital data for the preceding year to establish pre-existing health conditions. From this, a Charlson score was calculated for each case - this is a validated score to predict risk of death and disease burden.
For incidence and prevalence, we calculated the proportion of patients with Charlson score 0, 1 and 2+, and proportions with each health condition examined. We calculated one-year net survival by Charlson score or condition. Where possible, analysis was by cancer type, age-band, area deprivation, rurality, sex and stage at diagnosis.
ResultsOne in four people were already living with another serious condition. Patients diagnosed in more deprived areas of Wales were more likely to have an existing condition at diagnosis. Survival worsened as the severity or number of existing conditions increased.
ConclusionPatients diagnosed with cancer in more deprived areas of Wales were more likely to be already living with another serious condition, showing a significant decrease in their projected survival at Charlson score 1 and 2+ compared to the least deprived areas.
This work will enable acute, primary and community care, and other organisations to understand the overall burden of ill health in the cancer population in Wales.

IntroductionSoft Tissue Sarcoma (STS) diagnosis is difficult due to its nature and the variability of its occurrence on the body. To improve patient outcomes a better understanding was needed of the care pathways experienced by the patient from initial presentation to final treatment.
Objectives and ApproachSeveral items of information are necessary, within the data, to identify a care pathway. A correct STS diagnosis, a presentation date or first investigation date, a diagnosis date and any subsequent treatment dates. Identifying cases in hospital data, using International Classification of Diseases (ICD10) codes - C40, C41, C47 and C49 - based on cancer site - can miss cases and cause difficulties when trying to distinguish the difference between the investigation and treatment stages. Having access to WCISU's national cancer registry, proved advantageous and enabled the routine data to be validated.
ResultsAttempts to identify differences between investigative and treatment procedures using the procedure codes available in hospital data was unhelpful due to variations in coding.
However, WCISU's national cancer registry records all cases of cancer diagnosed in Wales using both ICD10 and International Classification of Diseases for Oncology codes to record cancer morphology. In addition, it records the date of diagnosis and treatment start dates. Using the cancer registry it was possible to cross-check the cases extracted from the hospital data and identify the diagnosis and treatment dates. By matching the treatment dates back to the hospital data it then became possible to analyse the procedure codes to see how many treatments were being delivered, the type of treatment and the periods covered.
Conclusion/ImplicationsOnce accurate diagnosis and treatments dates were identified, it was possible to drill further into the hospital data to see the finer detail of the procedures the patient received. Utilising independent data sources made it possible to develop an enriched view of patient care pathways from diagnosis through to treatment.

This article examines the ways in which early medieval genealogical texts might be augmented over time in order to reflect changing political situations. Two early ninth-century tracts from the kingdoms of Powys and Dyfed in Wales are taken as case studies. Textual and chronological problems with the tracts are discussed, and contexts are proposed for the circumstances of their composition. It is suggested that each of these tracts stands at the head of a process of 'pedigree growth', whereby, during the course of textual transmission, the genealogical content of each tract was extended both backwards and forwards in time. ; This work was supported by the Arts and Humanities Research Council (grant number 03970).

The file associated with this record is under embargo until 6 months after publication, in accordance with the publisher's self-archiving policy. The full text may be available through the publisher links provided above. ; Introduction: Population-based cancer survival estimates provide valuable insights into the effectiveness of cancer services, and can reflect the prospects of cure. This first study of the ICBP SURVMARK2 project aims to provide a comprehensive overview of cancer survival across high-income countries and a comparative assessment of corresponding incidence and mortality trends. Methods: Data on 3·9 million cancer cases were collected from populationbased cancer registries in 21 jurisdictions in seven countries (Australia, Canada, Denmark, Ireland, New Zealand, Norway and the UK) for seven cancer sites (oesophagus, stomach, colon, rectum, pancreas, lung and ovary) diagnosed 1995-2014 and followed up until 31 December 2015. Age-standardized net survival at 1 and 5 years after diagnosis were calculated by site, age group and period of diagnosis. Changes in incidence and mortality rates were mapped to changes in survival to assess progress in cancer control. Results: Over the 1995-2014 period, 1- and 5-year net survival increased in each country across cancer types, with, for example, 5-year rectal cancer survival rising more than 14 percentage points in Denmark, Ireland and the UK. Overall, survival was consistently higher in Australia, Canada and Norway, followed by New Zealand, Denmark, Ireland and the UK. Larger survival improvements were observed for patients aged less than 75 years at diagnosis, most notably for poorer prognosis sites. Progress in cancer control was evident for stomach, colon, lung (in males) and ovarian cancer. Interpretation: The joint evaluation of trends in incidence, mortality and survival indicated progress in four of the seven studied cancers. While cancer survival continues to increase across high-income countries, international disparities persist. While truly valid comparisons require differences in registration practice, classification and coding to be minimal, stage of disease at diagnosis, timely access to effective treatment, and the extent of comorbidity are likely the main determinants of patient outcomes. Funding: Canadian Partnership Against Cancer; Cancer Council Victoria; Cancer Institute New South Wales; Cancer Research UK; Danish Cancer Society; National Cancer Registry Ireland; The Cancer Society of New Zealand; NHS England; Norwegian Cancer Society; Public Health Agency Northern Ireland, on behalf of the Northern Ireland Cancer Registry; The Scottish Government; Western Australia Department of Health; Wales Cancer Network. ; This study was funded by: Canadian Partnership Against Cancer; Cancer Council Victoria; Cancer Institute New South Wales; Cancer Research UK; Danish Cancer Society; National Cancer Registry Ireland; The Cancer Society of New Zealand; NHS England; Norwegian Cancer Society; Public Health Agency Northern Ireland, on behalf of the Northern Ireland Cancer Registry; The Scottish Government; Western Australia Department of Health; Wales Cancer Network. ; Peer-reviewed ; Post-print

Book Reviews in this titleAUSTRALIA'S AGE OF IRON: History and Archaeology By R. Ian Jack and Aedeen Cremin. South Melbourne: Oxford University Press and Sydney University Press, 1994, pp. xiv+175, Illustrated. Thirteen maps. $39.95.BRISBANE: The Aboriginal Presence 1824–1860 Edited by Rod Fisher. Kelvin Grove: Brisbane History Group Papers No 11, 1992, pp. 106. Illustrated. Two maps. $20.AUSTRALIA'S FIRST LADY By Lennard Bickel. Sydney: Allen & Unwin, 1991, pp. xii +219. $34.95IRISH CONVICT LIVES Edited by Bob Reece. Sydney: Crossing Press, 1993, pp. x+266, illustrated. No price given.WAR ON THE HOMEFRONT: State Intervention in Queensland 1938–1948 By Kay Saunders. St Lucia: University of Queensland Press, 1993. pp. ix + 190. $29.95.CROWN OR COUNTRY: The Traditions of Australian Republicanism Ediled by David Headon, James Warden and Bill Gammage. St Leonards, NSW: Allen & Unwin, 1994, pp. xiv + 197. Illustrated. $24.95.VIETNAM: The Australian Dilemma By Terry Burstall. St Lucia: University of Queensland Press, 1993, pp. xxv + 329. Illustrated. Sixteen maps. $19.95.FOR BETTER OR FOR WORSE The Federal Coalition Edited by Brian Costar. Melbourne: Melbourne University Press, 1994, pp. xii + 163. $24.95.EMPLOYMENT RELATIONS: Industrial Relations and Human Resource Management in Australia By Margaret Gardner and Gill Palmer. Melbourne: Macmillan, 1992, pp. xii+ 522. $39.95.I WAS A TEENAGE FASCIST By David Greason. Melbourne: McPhee Gribble/penguin, 1994. $16.95.THE OXFORD HISTORY OF NEW ZEALAND Edited by Geoffrey W. Rice. Second revised edition. Auckland: Ogord University Press, 1993, pp. xviii i 755. Eleven tables. Four maps. Eight graphs $39.95STUDYING NEW ZEALAND HISTORY By G. A Wood. Second edition Revised by Simon Cauchi and G. A. Wood. Dunedin: University of Otago Press, 1992. pp. viii ‐+ 145. No price given.EUROPE JUSTINIAN By John Moorhead. London and New York: Longman, 1994, pp. ix + 202. Np price givenMIRACLES AND THE PULP PRESS DURING THE ENGLISH REVOLUTION: The Battle of the Frogs and Fairford's Flies By Jerome Friedman. London: University College London Press, 1993, pp. xv+304. Illustrated. $39.95.THE COMMODITY CULTURE OF VICTORIAN ENGLAND: Advertising and Spectacle 1851–1914 By Thomas Richards. London: Verso, 1991, pp. 306. $37.9Spb.CLASS AND ETHNICITY: Irish Catholics in England 1880–1939 By Steven Fielding. Buckingham, England: Open University Press, 1993, pp. mi + 180. No price given.THE POLlTICS OF IMMIGRATION AND "RACE" RELATIONS IN POST‐WAR BRITAIN By Zig Luyton‐Henry. Ogord: Blackwell, 1992, pp. xvii + 266. $34.95 pb.GOVERNMENT, INDUSTRY AND POLITICAL ECONOMY By Peter Barberis and Timothy May. Buckingham: Open University Press, 1993, pp. viii+ 260. $45.00.SOCIAL CHANGE IN CONTEMPORARY BRITAIN Edited by Nicholas Abercrombie and Alan Warde. Cambridge: Polity Press, 1992, pp xi + 189. $32.9Spb.EUROPE IN OUR TIME A History 1945–1992 By Walter L. uqueur. New York: Penguin Books, 1992, pp. xrii + 617. US$14.CONTEMPORARY FRANCE By Hilary P. M. Winchester. Longman Group UK Limited, 1993, pp. xiii + 273, illustrated with photographs, maps, tables, $16.IMPERIAL GERMANY 1871–1914: Economy, Society, Culture and Politics By Volker Berghahn Providence/Oxford: Berghahn Books, 1993, pp. xvii + 362. NO price givenTHE GERMAN SOCIAL DEMOCRATS SINCE 1969 A Party in Power and Opposition Gerard Braunthal. Second revised edition. BoulderBart Francisco/Oxford: Westview Press, 1994. pp. xiii + 402. Tables and charts. $54.95.WHAT ABOUT THE WORKERS? Workers and the Transition to Capitalism in Russia By Simon Clarke, Peter Fairbrother, Michael Burawoy and Pavel Krotov. London: Verso, 1993, pp. 241. No price given.REST OF WORLD THE GUERRILLA WARS OF CENTRAL AMERICA: Nicaragua, El Salvador and Guatemala By Saul Landau. London: Weidenfeld & Nicolson, 1993, pp. xiii + 222. Four maps. $49.45.A CRITICAL STUDY OF BINI AND YORUBA VALUE SYSTEMS OF NIGERIA IN CHANGE: Culture, Religion and the Self By Emmanuel D. Babatunde. Lampeter, Dyfed, Wales: me Edwin Mellen Press, 1992, pp. 283. No price given.IMPERIAL AFFINITIES: Nineteenth Century Analogies and Exchanges Between India and Ireland By S. B. Cook. New Delhi: Sage Publications, 1993, pp. 162, Rs 195 (approx $9.00).DENG XIAOPING AND THE MAKING OF MODERN CHINA By Richard Evans. London: Hamish Hamilton, 1993, pp. xi + 339:$39.95.TENNOZAN: The Battle of Okinawa and the Atomic Bomb By George Feifer. New York: Ticknor & Field 1992, pp. xvii + 622. Illustrated. $25.IDEAS DARWINISM, WAR AND HISTORY: The Debate Over the Biology of War From the "Origin of Species" to the First World War By Paul Crook. Cambridge, New York, and Melbourne: Cambridge University Press, 1994, pp. xii + 306. $49.95.PROSPECTS FOR DEMOCRACY: North, South, East, West Edited by David Held. Cambridge: Polity Press, 1993, pp. xi + 412. $45 cloth; $14 pb.RACE, NATION, CLASS: Ambiguous Identities By Etienne Balibar and Immanuel Wallerstein London, New York: Verso, 1991, pp. vii+232. $32.95.CULTURAL HISTORY By Roger Chartier. Cambridge: Polity Press, 1993, pp. 209. $39.95pb.CULTURES IN CONFLICT By Urs Bitterli, translated by Ritchie Robertson. Oqord: Polity Press, 1993, pp. 215. pb. $39.95.MARC BLOCH: A Life in History By Carole Fink Cambridge: Cambridge University Press, 1989, pp. 324. $17.95.

Background: Population-based cancer survival estimates provide valuable insights into the effectiveness of cancer services and can reflect the prospects of cure. As part of the second phase of the International Cancer Benchmarking Partnership (ICBP), the Cancer Survival in High-Income Countries (SURVMARK-2) project aims to provide a comprehensive overview of cancer survival across seven high-income countries and a comparative assessment of corresponding incidence and mortality trends. Methods: In this longitudinal, population-based study, we collected patient-level data on 3·9 million patients with cancer from population-based cancer registries in 21 jurisdictions in seven countries (Australia, Canada, Denmark, Ireland, New Zealand, Norway, and the UK) for seven sites of cancer (oesophagus, stomach, colon, rectum, pancreas, lung, and ovary) diagnosed between 1995 and 2014, and followed up until Dec 31, 2015. We calculated age-standardised net survival at 1 year and 5 years after diagnosis by site, age group, and period of diagnosis. We mapped changes in incidence and mortality to changes in survival to assess progress in cancer control. Findings: In 19 eligible jurisdictions, 3 764 543 cases of cancer were eligible for inclusion in the study. In the 19 included jurisdictions, over 1995–2014, 1-year and 5-year net survival increased in each country across almost all cancer types, with, for example, 5-year rectal cancer survival increasing more than 13 percentage points in Denmark, Ireland, and the UK. For 2010–14, survival was generally higher in Australia, Canada, and Norway than in New Zealand, Denmark, Ireland, and the UK. Over the study period, larger survival improvements were observed for patients younger than 75 years at diagnosis than those aged 75 years and older, and notably for cancers with a poor prognosis (ie, oesophagus, stomach, pancreas, and lung). Progress in cancer control (ie, increased survival, decreased mortality and incidence) over the study period was evident for stomach, colon, lung (in males), and ovarian cancer. Interpretation: The joint evaluation of trends in incidence, mortality, and survival indicated progress in four of the seven studied cancers. Cancer survival continues to increase across high-income countries; however, international disparities persist. While truly valid comparisons require differences in registration practice, classification, and coding to be minimal, stage of disease at diagnosis, timely access to effective treatment, and the extent of comorbidity are likely the main determinants of patient outcomes. Future studies are needed to assess the impact of these factors to further our understanding of international disparities in cancer survival. Funding: Canadian Partnership Against Cancer; Cancer Council Victoria; Cancer Institute New South Wales; Cancer Research UK; Danish Cancer Society; National Cancer Registry Ireland; The Cancer Society of New Zealand; National Health Service England; Norwegian Cancer Society; Public Health Agency Northern Ireland, on behalf of the Northern Ireland Cancer Registry; The Scottish Government; Western Australia Department of Health; and Wales Cancer Network.

BACKGROUND: Population-based cancer survival estimates provide valuable insights into the effectiveness of cancer services and can reflect the prospects of cure. As part of the second phase of the International Cancer Benchmarking Partnership (ICBP), the Cancer Survival in High-Income Countries (SURVMARK-2) project aims to provide a comprehensive overview of cancer survival across seven high-income countries and a comparative assessment of corresponding incidence and mortality trends. METHODS: In this longitudinal, population-based study, we collected patient-level data on 3·9 million patients with cancer from population-based cancer registries in 21 jurisdictions in seven countries (Australia, Canada, Denmark, Ireland, New Zealand, Norway, and the UK) for seven sites of cancer (oesophagus, stomach, colon, rectum, pancreas, lung, and ovary) diagnosed between 1995 and 2014, and followed up until Dec 31, 2015. We calculated age-standardised net survival at 1 year and 5 years after diagnosis by site, age group, and period of diagnosis. We mapped changes in incidence and mortality to changes in survival to assess progress in cancer control. FINDINGS: In 19 eligible jurisdictions, 3 764 543 cases of cancer were eligible for inclusion in the study. In the 19 included jurisdictions, over 1995-2014, 1-year and 5-year net survival increased in each country across almost all cancer types, with, for example, 5-year rectal cancer survival increasing more than 13 percentage points in Denmark, Ireland, and the UK. For 2010-14, survival was generally higher in Australia, Canada, and Norway than in New Zealand, Denmark, Ireland, and the UK. Over the study period, larger survival improvements were observed for patients younger than 75 years at diagnosis than those aged 75 years and older, and notably for cancers with a poor prognosis (ie, oesophagus, stomach, pancreas, and lung). Progress in cancer control (ie, increased survival, decreased mortality and incidence) over the study period was evident for stomach, colon, lung (in males), and ovarian cancer. INTERPRETATION: The joint evaluation of trends in incidence, mortality, and survival indicated progress in four of the seven studied cancers. Cancer survival continues to increase across high-income countries; however, international disparities persist. While truly valid comparisons require differences in registration practice, classification, and coding to be minimal, stage of disease at diagnosis, timely access to effective treatment, and the extent of comorbidity are likely the main determinants of patient outcomes. Future studies are needed to assess the impact of these factors to further our understanding of international disparities in cancer survival. FUNDING: Canadian Partnership Against Cancer; Cancer Council Victoria; Cancer Institute New South Wales; Cancer Research UK; Danish Cancer Society; National Cancer Registry Ireland; The Cancer Society of New Zealand; National Health Service England; Norwegian Cancer Society; Public Health Agency Northern Ireland, on behalf of the Northern Ireland Cancer Registry; The Scottish Government; Western Australia Department of Health; and Wales Cancer Network.

Background: Greater understanding of international cancer survival differences is needed. We aimed to identify predictors and consequences of cancer diagnosis through emergency presentation in different international jurisdictions in six high-income countries. Methods: Using a federated analysis model, in this cross-sectional population-based study, we analysed cancer registration and linked hospital admissions data from 14 jurisdictions in six countries (Australia, Canada, Denmark, New Zealand, Norway, and the UK), including patients with primary diagnosis of invasive oesophageal, stomach, colon, rectal, liver, pancreatic, lung, or ovarian cancer during study periods from Jan 1, 2012, to Dec 31, 2017. Data were collected on cancer site, age group, sex, year of diagnosis, and stage at diagnosis. Emergency presentation was defined as diagnosis of cancer within 30 days after an emergency hospital admission. Using logistic regression, we examined variables associated with emergency presentation and associations between emergency presentation and short-term mortality. We meta-analysed estimates across jurisdictions and explored jurisdiction-level associations between cancer survival and the percentage of patients diagnosed as emergencies. Findings: In 857 068 patients across 14 jurisdictions, considering all of the eight cancer sites together, the percentage of diagnoses through emergency presentation ranged from 24·0% (9165 of 38 212 patients) to 42·5% (12 238 of 28 794 patients). There was consistently large variation in the percentage of emergency presentations by cancer site across jurisdictions. Pancreatic cancer diagnoses had the highest percentage of emergency presentations on average overall (46·1% [30 972 of 67 173 patients]), with the jurisdictional range being 34·1% (1083 of 3172 patients) to 60·4% (1317 of 2182 patients). Rectal cancer had the lowest percentage of emergency presentations on average overall (12·1% [10 051 of 83 325 patients]), with a jurisdictional range of 9·1% (403 of 4438 patients) to 19·8% (643 of 3247 patients). Across the jurisdictions, older age (ie, 75–84 years and 85 years or older, compared with younger patients) and advanced stage at diagnosis compared with non-advanced stage were consistently associated with increased emergency presentation risk, with the percentage of emergency presentations being highest in the oldest age group (85 years or older) for 110 (98%) of 112 jurisdiction-cancer site strata, and in the most advanced (distant spread) stage category for 98 (97%) of 101 jurisdiction-cancer site strata with available information. Across the jurisdictions, and despite heterogeneity in association size (I2=93%), emergency presenters consistently had substantially greater risk of 12-month mortality than non-emergency presenters (odds ratio >1·9 for 112 [100%] of 112 jurisdiction-cancer site strata, with the minimum lower bound of the related 95% CIs being 1·26). There were negative associations between jurisdiction-level percentage of emergency presentations and jurisdiction-level 1-year survival for colon, stomach, lung, liver, pancreatic, and ovarian cancer, with a 10% increase in percentage of emergency presentations in a jurisdiction being associated with a decrease in 1-year net survival of between 2·5% (95% CI 0·28–4·7) and 7·0% (1·2–13·0). Interpretation: Internationally, notable proportions of patients with cancer are diagnosed through emergency presentation. Specific types of cancer, older age, and advanced stage at diagnosis are consistently associated with an increased risk of emergency presentation, which strongly predicts worse prognosis and probably contributes to international differences in cancer survival. Monitoring emergency presentations, and identifying and acting on contributing behavioural and health-care factors, is a global priority for cancer control. Funding: Canadian Partnership Against Cancer; Cancer Council Victoria; Cancer Institute New South Wales; Cancer Research UK; Danish Cancer Society; National Cancer Registry Ireland; The Cancer Society of New Zealand; National Health Service England; Norwegian Cancer Society; Public Health Agency Northern Ireland, on behalf of the Northern Ireland Cancer Registry; the Scottish Government; Western Australia Department of Health; and Wales Cancer Network.