Canada: cancer statistics from IARC GlobalCan (2012)
|Population in 2012: ||34.7m|
|People newly diagnosed with cancer (excluding NMSC) / yr: ||182,200|
|Age-standardised rate, incidence per 100,000 people/yr: ||295.7|
|Risk of getting cancer before age 75:||29.1%|
|People dying from cancer /yr: ||74,100|
Menu: Canadian Cancer Resources Directory National Organisations: Canada Cancer Centers Latest Research Publications from Canada Alberta / Northwest Territories British Columbia / Yukon Territory Manitoba New Brunswick Newfoundland Nova Scotia Nunavut Ontario Prince Edward Islands Quebec Saskatchewan
Acoustic Neuroma Association of Canada
A non-profit membership organization founded in 1983, which provides support, information and advocacy. Acoustic Neuroma
Bladder Cancer Canada
Founded in September 2009, Bladder Cancer Canada is a patient advocacy organization dedicated to bladder cancer issues. Bladder Cancer Canada is a Canadian registered charitable non-profit corporation.
Brain Tumor Foundation of Canada | Fondation canadienne des tumeurs cérébrales - English - Français
A national, not-for-profit organization, founded in 1982 to provide support to people affected by brain tumors. The Web site has both English and French language pages which provide details of the organisation, its services, events, collaborations. Brain and Spinal Cord Tumours
Canadian Association of Nurses in Oncology
Association canadienne des infirmières en oncologie
The national organization that supports Canadian nurses to promote and develop excellence in oncology nursing pratice, education, research and leadership. established in 1984. Oncology Nursing
Canadian Association of Radiation Oncology
A professional association representing radiation oncology in Canada in relation to the public and professional interests. Established 1985. Radiation Oncology
Canadian Breast Cancer Research Alliance
An alliance of governmental and non-governmental organisations in Canada, which is the primary granting agency for breast cancer research in Canada.
Canadian Cancer Sociey
Société Canadienne du Cancer
A national community-based organization, founded in 1938, which supports people with cancer and funds research. The Website includes information about cancers and support services. English and French language support.
Canadian Retinoblastoma Society
A membership organisation for those affected by Retinoblastoma and health professionals in Canada. It is a federally incorporated charity. Retinoblastoma
Chronic Myelogenous Leukemia Society of Canada
CML Society of Canada
Established in 2006, Society provides support, education and information on CML, current and emerging treatments and research initiatives for people living with CML and their families in Canada. Chronic Myeloid Leukemia (CML)
A non-profit organization which raises money for research into finding a cure and/or treatments for Fanconi Anemia. The Web site includes information about FA, news, FA family stories, and details of funded research. Fanconi Anaemia Fanconi Anemia
Health Canada | Santé Canada - English - Français
Health Canada is the Federal department responsible for helping Canadians maintain and improve their health.
Histiocytosis Association of Canada
Langerhan's Cell Histiocytosis Langerhan's Cell Histiocytosis
Lung Cancer Canada
Founded in 2002 to increase awareness about lung cancer, support patients living with lung cancer and the individuals who care for them and provide educational resources to lung cancer patients, their family members and health care professional. Lung Cancer
Lymphoma Foundation Canada
The Foundation, founded in 1998, focuses on lymphoma research, education and awareness in Canada. Hodgkin's Lymphoma Non Hodgkin's Lymphoma
NCIC Clinical Trials Group
A cooperative oncology group which carries out clinical trials in cancer therapy, supportive care and prevention across Canada and internationally. It is a national programme of the Canadian Cancer Society Research Institute, and supported by the Canadian Cancer Society.
Neuroblastoma Canada is a national community-based organization dedicated to uniting Canadian neuroblastoma families. Support includes a Family Mentoring Program. Neuroblastoma
Prostate Cancer Canada
A national foundation, founded in 1994, dedicated to the elimination of the disease through research, education, and support. Prostate Cancer
Radiation Therapy Oncology Group
RTOG is a national research study group running radiotherapy trials in centres across the USA and Canada. The Web site includes details of trials, procedures, member institutions, meetings, abstracts, newsletter, and tissue bank. Radiation Oncology
The James Fund for Neuroblastoma Research
An organisation set up by parents which raising funds for neuroblastoma, while supporting families. The site includes details of events, information and a blog. Neuroblastoma
Sublobar resection for non-small cell lung cancer (NSCLC) remains controversial owing to concern about local recurrence and long-term survival outcomes. We sought to determine the efficacy of wedge resection as an oncological procedure.METHODS:
We analyzed the outcomes of all patients with NSCLC undergoing surgical resection at the Cancer Centre of Southeastern Ontario between 1998 and 2009. The standard of care for patients with adequate cardiopulmonary reserve was lobectomy. Wedge resection was performed for patients with inadequate reserve to tolerate lobectomy. Predictors of recurrence and survival were assessed. Appropriate statistical analyses involved the χ(2) test, an independent samples t test and Kaplan-Meier estimates of survival. Outcomes were stratified for tumour size and American Joint Committee on Cancer seventh edition TNM stage for non-small cell lung cancer.RESULTS:
A total of 423 patients underwent surgical resection during our study period: wedge resection in 71 patients and lobectomy in 352. The mean age of patients was 64 years. Mean follow-up for cancer survivors was 39 months. There was no significant difference between wedge resection and lobectomy for rate of tumour recurrence, mortality or disease-free survival in patients with stage IA tumours less than 2 cm in diameter.CONCLUSION:
Wedge resection with lymph node sampling is an adequate oncological procedure for non-small cell lung cancer in properly selected patients, specifically, those with stage IA tumours less than 2 cm in diameter.Related: Non-Small Cell Lung Cancer Lung Cancer
From the Division of Thoracic Surgery, the Ottawa Hospital, Ottawa, Ont.
We sought to evaluate the adequacy of follow-up of thyroid cancer patients at a Canadian centre.METHODS:
We mailed a survey to the family physicians of thyroid cancer patients and analyzed the findings relative to follow-up guidelines published by the American Thyroid Association (ATA). Statistical significance between early and late follow-up patterns was analyzed using the χ(2) test.RESULTS:
Our survey response rate was 56.2% (91 of 162). The time from operation ranged from 1.24-7.13 (mean 3.96) years, and 87.9% of patients had undergone a physical exam within the previous year. Only 37.4% and 14% of patients had a serum thyroglobulin measurement within 6 and between 6 and 12 months before the survey, respectively. Thyroid simulating hormone (TSH) levels were measured within the prior 6 months in 67% of patients and between 6 and 12 months in 13.2%. The TSH levels were suppressed (< 0.1 μIU/L) in 24.2% of patients, 0.1-2 μIU/L in 44% and greater than 2 μIU/L in 17.6%. Ultrasonography was the most common imaging test performed.CONCLUSION:
There is significant variation in the follow-up patterns of patients with thyroid cancer, and there is considerable deviation from current ATA guidelines.Related: Thyroid Cancer
The Department of Surgery, St. Paul's Hospital & University of British Columbia, Vancouver, BC.
Kim ES, Neubauer M, Cohn A, et al.Docetaxel or pemetrexed with or without cetuximab in recurrent or progressive non-small-cell lung cancer after platinum-based therapy: a phase 3, open-label, randomised trial.
Lancet Oncol. 2013; 14(13):1326-36 [PubMed
] Related Publications
Available preclinical and phase 2 clinical data suggest that the addition of cetuximab, a monoclonal antibody directed against the epidermal growth factor receptor (EGFR), to chemotherapy might improve outcome in patients with advanced non-small-cell lung cancer (NSCLC). We aimed to assess whether the addition of cetuximab to chemotherapy improved progression-free survival in patients with recurrent or progressive NSCLC after platinum-based therapy.METHODS:
In this unmasked, open-label randomised phase 3 trial we enrolled patients with metastatic, unresectable, or locally advanced NSCLC from 121 sites in Canada and the USA. Eligible patients were those aged 18 years or older who had experienced progressive disease during or after one previous platinum-based regimen. Initially, patients were randomly assigned to receive either pemetrexed (500 mg/m(2)) or docetaxel (75 mg/m(2)) and then randomly assigned within each group to receive their chemotherapy with or without cetuximab (400 mg/m(2) at first dose and 250 mg/m(2) weekly thereafter) until disease progression or unacceptable toxicity. However, after a change in the standard of care, investigators chose whether to treat with pemetrexed or docetaxel on a patient-by-patient basis. The primary analysis was changed to compare progression-free survival with cetuximab plus pemetrexed versus pemetrexed, on an intention-to-treat basis. This study is registered with ClinicalTrials.gov, number NCT00095199.FINDINGS:
Between Jan 10, 2005, and Feb 10, 2010, we enrolled 939 patients; data for one patient was accidentally discarded. Of the remaining 938 patients, 605 received pemetrexed (301 patients with cetuximab and 304 alone) and 333 received docetaxel (167 in combination with cetuximab and 166 alone). Median progression-free survival with cetuximab plus pemetrexed was 2·9 months (95% CI 2·7-3·2) versus 2·8 months (2·5-3·3) with pemetrexed (HR 1·03, 95% CI 0·87-1·21; p=0·76). The most common grade 3-4 adverse events with cetuximab plus pemetrexed were fatigue (33 [11%] of 292 patients), acneiform rash (31 [11%]), dyspnoea (29 [10%]), and decreased neutrophil count (28 [10%]), and with pemetrexed alone were dyspnoea (35 [12%] of 289 patients), decreased neutrophil count (26 [9%]), and fatigue (23 [8%]). A significantly higher proportion of patients in the cetuximab plus pemetrexed group (119 [41%] of 292 patients) experienced at least one serious adverse event than those patients in the pemetrexed group (85 [29%] of 289 patients; p=0·0054). Nine (3%) of 292 treated patients in the cetuximab and pemetrexed group died of adverse events compared with five (2%) of 289 treated patients in the pemetrexed alone group.INTERPRETATION:
The use of cetuximab is not recommended in combination with chemotherapy in patients previously treated with platinum-based therapy.FUNDING:
Eli Lilly and Company and ImClone Systems LLC, a wholly owned subsidiary of Eli Lilly and Company.Related: Non-Small Cell Lung Cancer Lung Cancer USA Pemetrexed Docetaxel Cetuximab (Erbitux)
Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC, USA. Electronic address:
Chen J, Moir DA look at the grouping effect on population-level risk assessment of radon-induced lung cancer.
Glob J Health Sci. 2013; 5(6):1-11 [PubMed
] Related Publications
On the basis of considerable knowledge gained by studying health effects in uranium and other underground miners who worked in radon-rich environments, radon exposure has been identified as a cause of lung cancer. Recent pooled analyses of residential studies have shown that radon poses a similar risk of causing lung cancer in the general public when exposure occurs at generally lower levels found in homes. With the increasing accessibility of statistical data via the internet, people are performing their own analyses and asking why, in some cases, the lung cancer occurrence at the community level does not correlate to the radon levels. This study uses statistical data available to the general public from official websites and performs simple analyses. The results clearly show the difficulty in linking observed lung cancer incidence rates at the provincial/territorial level, with possible cause, such as smoking or radon exposure. Even the effect of smoking, a well-documented cause of lung cancer, can be overlooked or misinterpreted if the data being investigated is too general (i.e., summary data at population level) or is influenced by other factors. These difficulties with simple comparisons are one of the main reasons that epidemiological studies of lung cancer incidence and radon exposure requires the use of cohorts or case controls at the individual level as opposed to the more easily performed ecological studies at the population level.Related: Lung Cancer
Radiation Protection Bureau, Health Canada.
Alnaami IM, Al-Nuaimi SK, Senthilselvan A, et al.Effectiveness of adjuvant temozolomide treatment in patients with glioblastoma.
Neurosciences (Riyadh). 2013; 18(4):349-55 [PubMed
] Related Publications
To examine whether adjuvant temozolomide treatment improved glioblastoma patients` survival in a large Canadian cohort.METHODS:
We retrospectively studied 364 glioblastoma patients who received different modalities of treatment in 2 Canadian tertiary care centers in Edmonton and Halifax, Canada, between January 2000 and December 2006. The primary outcome was survival following the treatment protocol.RESULTS:
The following variables were associated with an increased risk of death: The hazard risk (HR) of on-gross total resection was 0.50 (95% confidence interval [CI]: 0.39-0.64). The HR for the surgery-only group was 5.2 (95% CI: 3.85-7.06). The standard treatment group (surgery, radiation therapy [RT], and temozolomide) had an HR of 0.52 (95% CI: 0.37-0.74). The HR for patients who presented with seizure or whose presentation included seizures was 0.88 (95% CI: 0.55-0.89). Patient entry into trials had an HR of 0.74 (95% CI: 0.57-0.96). Finally, the HR for age was 1.02 (95% CI: 1.01-1.03) for every extra year.CONCLUSION:
Concomitant temozolomide with RT and surgery was associated with longer survival compared with RT with surgery alone. We also found that younger age, surgical resection, seizure presence, and entry into trials are important prognostic factors for longer survival.Related: Dacarbazine Temozolomide
Division of Neurosurgery, Department of Surgery, College of Medicine, King Khalid University, PO Box 641, Abha, Kingdom of Saudi Arabia. Tel. +966 541499966. Fax. +966 (17) 2412807. E-mail:
Ramaswamy V, Remke M, Bouffet E, et al.Recurrence patterns across medulloblastoma subgroups: an integrated clinical and molecular analysis.
Lancet Oncol. 2013; 14(12):1200-7 [PubMed
] Related Publications
Recurrent medulloblastoma is a therapeutic challenge because it is almost always fatal. Studies have confirmed that medulloblastoma consists of at least four distinct subgroups. We sought to delineate subgroup-specific differences in medulloblastoma recurrence patterns.METHODS:
We retrospectively identified a discovery cohort of all recurrent medulloblastomas at the Hospital for Sick Children (Toronto, ON, Canada) from 1994 to 2012 (cohort 1), and established molecular subgroups using a nanoString-based assay on formalin-fixed paraffin-embedded tissues or frozen tissue. The anatomical site of recurrence (local tumour bed or leptomeningeal metastasis), time to recurrence, and survival after recurrence were assessed in a subgroup-specific manner. Two independent, non-overlapping cohorts (cohort 2: samples from patients with recurrent medulloblastomas from 13 centres worldwide, obtained between 1991 and 2012; cohort 3: samples from patients with recurrent medulloblastoma obtained at the NN Burdenko Neurosurgical Institute [Moscow, Russia] between 1994 and 2011) were analysed to confirm and validate observations. When possible, molecular subgrouping was done on tissue obtained from both the initial surgery and at recurrence.RESULTS:
Cohort 1 consisted of 30 patients with recurrent medulloblastomas; nine with local recurrences, and 21 with metastatic recurrences. Cohort 2 consisted of 77 patients and cohort 3 of 96 patients with recurrent medulloblastoma. Subgroup affiliation remained stable at recurrence in all 34 cases with available matched primary and recurrent pairs (five pairs from cohort 1 and 29 pairs from cohort 2 [15 SHH, five group 3, 14 group 4]). This finding was validated in 17 pairs from cohort 3. When analysed in a subgroup-specific manner, local recurrences in cohort 1 were more frequent in SHH tumours (eight of nine [89%]) and metastatic recurrences were more common in group 3 and group 4 tumours (17 of 20 [85%] with one WNT, p=0·0014, local vs metastatic recurrence, SHH vs group 3 vs group 4). The subgroup-specific location of recurrence was confirmed in cohort 2 (p=0·0013 for local vs metastatic recurrence, SHH vs group 3 vs group 4,), and cohort 3 (p<0·0001). Treatment with craniospinal irradiation at diagnosis was not significantly associated with the anatomical pattern of recurrence. Survival after recurrence was significantly longer in patients with group 4 tumours in cohort 1 (p=0·013) than with other subgroups, which was confirmed in cohort 2 (p=0·0075), but not cohort 3 (p=0·70).INTERPRETATION:
Medulloblastoma does not change subgroup at the time of recurrence, reinforcing the stability of the four main medulloblastoma subgroups. Significant differences in the location and timing of recurrence across medulloblastoma subgroups have potential treatment ramifications. Specifically, intensified local (posterior fossa) therapy should be tested in the initial treatment of patients with SHH tumours. Refinement of therapy for patients with group 3 or group 4 tumours should focus on metastases.Related: USA
Division of Neurosurgery, Hospital for Sick Children, Toronto, ON, Canada; Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada.
Hathout L, Hijal T, Théberge V, et al.Hypofractionated radiation therapy for breast ductal carcinoma in situ.
Int J Radiat Oncol Biol Phys. 2013; 87(5):1058-63 [PubMed
] Related Publications
Conventional radiation therapy (RT) administered in 25 fractions after breast-conserving surgery (BCS) is the standard treatment for ductal carcinoma in situ (DCIS) of the breast. Although accelerated hypofractionated regimens in 16 fractions have been shown to be equivalent to conventional RT for invasive breast cancer, few studies have reported results of using hypofractionated RT in DCIS.METHODS AND MATERIALS:
In this multicenter collaborative effort, we retrospectively reviewed the records of all women with DCIS at 3 institutions treated with BCS followed by hypofractionated whole-breast RT (WBRT) delivered in 16 fractions.RESULTS:
Between 2003 and 2010, 440 patients with DCIS underwent BCS followed by hypofractionated WBRT in 16 fractions for a total dose of 42.5 Gy (2.66 Gy per fraction). Boost RT to the surgical bed was given to 125 patients (28%) at a median dose of 10 Gy in 4 fractions (2.5 Gy per fraction). After a median follow-up time of 4.4 years, 14 patients had an ipsilateral local relapse, resulting in a local recurrence-free survival of 97% at 5 years. Positive surgical margins, high nuclear grade, age less than 50 years, and a premenopausal status were all statistically associated with an increased occurrence of local recurrence. Tumor hormone receptor status, use of adjuvant hormonal therapy, and administration of additional boost RT did not have an impact on local control in our cohort. On multivariate analysis, positive margins, premenopausal status, and nuclear grade 3 tumors had a statistically significant worse local control rate.CONCLUSIONS:
Hypofractionated RT using 42.5 Gy in 16 fractions provides excellent local control for patients with DCIS undergoing BCS.Related: Breast Cancer
Department of Radiation Oncology, Hôpital Maisonneuve-Rosemont, Centre affilié à l'Université de Montréal, Montreal, Quebec, Canada.
Barrera M, Hancock K, Rokeach A, et al.External validity and reliability of the Psychosocial Assessment Tool (PAT) among Canadian parents of children newly diagnosed with cancer.
Pediatr Blood Cancer. 2014; 61(1):165-70 [PubMed
] Related Publications
The Psychosocial Screening Tool (PAT) was developed and validated with a sample of caregivers of children newly diagnosed with cancer in the United States. This study aimed to assess cultural adaptation (Phase 1) and validity and reliability of the revised PAT (PATrev) with a Canadian sample (Phase 2).PROCEDURE:
In Phase 1, a convenience sample of seven parents of children who were treated for cancer and six pediatric oncology healthcare experts participated. In Phase 2, 67 parents of children newly diagnosed with cancer from 4 Canadian pediatric cancer centers participated. To assess reliability and validity of the PATrev, parents completed behavioral (BASC-2) and quality of life (PedsQL) instruments about the child and an anxiety inventory (STAI) about themselves.RESULTS:
The PAT required minor changes to be culturally adapted for the Canadian population. The PATrev had strong inter-rater (0.77) test-retest (0.75), and internal consistency reliability (0.85), as well as moderate to strong validity comparing PATrev child's problems and PedsQL total (-0.49), PedsQL anxiety (-0.47), BASC-2 internalizing (0.64), behavioral (0.63), and adaptive scores (-0.56). PATrev discriminative validity was confirmed with BASC-2 scores (AUR scores of 0.70-0.74). PATrev parental stressors were strongly correlated to STAI scores (0.53). Finally, agreement between PATrev child's problems and parental anxiety scores was moderate (0.47).CONCLUSION:
This study supports the original PAT, demonstrates PATrev is a reliable and valid psychosocial screening tool, and provides unique evidence regarding early psychosocial risk in the family, which have important implications for guiding psychosocial practice.Related: Cancer Prevention and Risk Reduction
The Hospital for Sick Children, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada.
Robidoux A, Tang G, Rastogi P, et al.Lapatinib as a component of neoadjuvant therapy for HER2-positive operable breast cancer (NSABP protocol B-41): an open-label, randomised phase 3 trial.
Lancet Oncol. 2013; 14(12):1183-92 [PubMed
] Related Publications
We studied the effect on tumour response to neoadjuvant therapy of the substitution of lapatinib for trastuzumab in combination with weekly paclitaxel after doxorubicin plus cyclophosphamide treatment, and of the addition of lapatinib and trastuzumab combined after doxorubicin plus cyclophosphamide treatment in patients with HER2-positive operable breast cancer to determine whether there would be a benefit of dual HER2 blockade in these patients.METHODS:
For this open-label, randomised phase 3 trial we recruited women aged 18 years or older with an ECOG performance status of 0 or 1 with operable HER2-positive breast cancer. Each received four cycles of standard doxorubicin 60 mg/m(2) and cyclophosphamide 600 mg/m(2) intravenously on day 1 every 3 weeks followed by four cycles of weekly paclitaxel (80 mg/m(2)) intravenously on days 1, 8, and 15, every 4 weeks. Concurrently with weekly paclitaxel, patients received either trastuzumab (4 mg/kg load, then 2 mg/kg intravenously) weekly until surgery, lapatinib (1250 mg orally) daily until surgery, or weekly trastuzumab plus lapatinib (750 mg orally) daily until surgery. After surgery, all patients received trastuzumab to complete 52 weeks of HER2-targeted therapy. Randomisation (ratio 1:1:1) was done centrally with stratification by clinical tumour size, clinical nodal status, hormone-receptor status, and age. The primary endpoint was the pathological complete response in the breast, and analysis was performed on an intention-to-treat population.FINDINGS:
Patient accrual started on July 16, 2007, and was completed on June 30, 2011; 529 women were enrolled in the trial. 519 patients had their pathological response determined. Breast pathological complete response was noted in 93 (52·5%, 95% CI 44·9-59·5) of 177 patients in the trastuzumab group, 91 (53·2%, 45·4-60·3) of 171 patients in the lapatinib group (p=0·9852); and 106 (62·0%, 54·3-68·8) of 171 patients in the combination group (p=0·095). The most common grade 3 and 4 toxic effects were neutropenia (29 [16%] patients in the trastuzumab group [grade 4 in five patients (3%), 28 [16%] in the lapatinib group [grade 4 in eight patients (5%)], and 29 [17%] in the combination group [grade 4 in nine patients (5%)]) and grade 3 diarrhoea (four [2%] patients in the trastuzumab group, 35 [20%] in the lapatinib group, and 46 [27%] in the combination group; p<0·0001). Symptomatic congestive heart failure defined as New York Heart Association Class III or IV events occurred in seven (4%) patients in the trastuzumab group, seven (4%) in the lapatinib group, and one (<1%) in the combination group; p=0·185).INTERPRETATION:
Substitution of lapatinib for trastuzumab in combination with chemotherapy resulted in similar high percentages of pathological complete response. Combined HER2-targeted therapy produced a numerically but insignificantly higher pathological complete response percentage than single-agent HER2-directed therapy; these findings are consistent with results from other studies. Trials are being undertaken to further assess these findings in the adjuvant setting.Related: Breast Cancer Cyclophosphamide Doxorubicin Paclitaxel USA Lapatinib (Tyverb) Trastuzumab (Herceptin)
National Surgical Adjuvant Breast and Bowel Project (NSABP), Pittsburgh, PA, USA; Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada. Electronic address:
Xu B, Abourbih S, Sircar K, et al.Enhancer of zeste homolog 2 expression is associated with metastasis and adverse clinical outcome in clear cell renal cell carcinoma: a comparative study and review of the literature.
Arch Pathol Lab Med. 2013; 137(10):1326-36 [PubMed
] Related Publications
Enhancer of zeste homolog 2 (EZH2), a histone methyltransferase mediating chromatin condensation and epigenetic modulation, is overexpressed in various human carcinomas and is associated with adverse clinicopathologic characteristics and biologic behavior. The expression of EZH2 in renal cell carcinomas (RCCs) has not been fully characterized yet.OBJECTIVE:
To evaluate the prognostic role of EZH2 in RCC by analyzing the immunohistochemical staining pattern of the marker in relation to pathologic features and clinical outcome.DESIGN:
We correlated the immunolabeling of EZH2 with multiple clinicopathologic features, including Fuhrman nuclear grade, pathologic stage, metastatic status, and clinical outcome in 223 clear cell RCCs (CRCCs) and 21 papillary RCCs, by using tissue microarrays of primary and metastatic cases.RESULTS:
Most CRCCs (75%) showed positive EZH2 staining, with most primary tumors showing focal staining in comparison to nonfocal staining in metastatic cases. In primary tumors, EZH2 expression was associated with higher nuclear grade and lower pathologic stage. Metastatic tumors showed a higher number of positive cases (81% versus 67%) and a more diffuse and more intense pattern of staining than primary CRCCs. For the 22 locally advanced primary tumors (T3/4) and 43 metastatic RCCs, patients who experienced RCC-related deaths significantly overexpressed the marker in comparison to patients who did not experience RCC-related mortality.CONCLUSIONS:
By showing that EZH2 expression is associated with increased metastatic potential and a worse clinical outcome, this study suggests that EZH2 can serve as a prognostic biomarker for RCC, thus confirming it as a key molecule driving oncogenesis and metastasis.Related: Kidney Cancer
From the Departments of Pathology (Drs Xu and Brimo) and Urology (Drs Abourbih, Kassouf, Mansure, Aprikian, and Tanguay), McGill University Health Centre, Montreal, Quebec, Canada; and the Department of Pathology (Dr Sircar), The University of Texas Maryland Anderson Cancer Center, Houston.
Basch E, Autio K, Ryan CJ, et al.Abiraterone acetate plus prednisone versus prednisone alone in chemotherapy-naive men with metastatic castration-resistant prostate cancer: patient-reported outcome results of a randomised phase 3 trial.
Lancet Oncol. 2013; 14(12):1193-9 [PubMed
] Related Publications
Abiraterone acetate plus prednisone significantly improves radiographic progression-free survival in asymptomatic or mildly symptomatic, chemotherapy-naive patients with metastatic castration-resistant prostate cancer compared with prednisone alone. We describe analyses of data for patient-reported pain and functional status in a preplanned interim analysis of a phase 3 trial.METHODS:
Between April 28, 2009, and June 23, 2010, patients with progressive, metastatic castration-resistant prostate cancer were enrolled into a multinational, double-blind, placebo-controlled trial. Patients were eligible if they were asymptomatic (score of 0 or 1 on item three of the Brief Pain Inventory Short Form [BPI-SF] questionnaire) or mildly symptomatic (score of 2 or 3) and had not previously received chemotherapy. Patients were randomly assigned (1:1) to receive oral abiraterone (1 g daily) plus prednisone (5 mg twice daily) or placebo plus prednisone in continuous 4-week cycles. Pain was assessed with the BPI-SF questionnaire, and health-related quality of life (HRQoL) with the Functional Assessment of Cancer Therapy-Prostate (FACT-P) questionnaire. We analysed data with prespecified criteria for clinically meaningful pain progression and deterioration in HRQoL. All patients who underwent randomisation were included in analyses.FINDINGS:
1088 patients underwent randomisation: 546 were assigned to abiraterone plus prednisone and 542 to placebo plus prednisone. At the time of the second prespecified interim analysis, median follow-up was 22·2 months (IQR 20·2-24·8). Median time to progression of mean pain intensity was longer in patients assigned to abiraterone plus prednisone (26·7 months [95% CI 19·3-not estimable]) than in those assigned to placebo plus prednisone (18·4 months [14·9-not estimable]; hazard ratio [HR] 0·82, 95% CI 0·67-1·00; p=0·0490), as was median time to progression of pain interference with daily activities (10·3 months [95% CI 9·3-13·0] vs 7·4 months [6·4-8·6]; HR 0·79, 95% CI 0·67-0·93; p=0·005). Median time to progression of worst pain was also longer with abiraterone plus prednisone (26·7 months [95% CI 19·4-not estimable]) than with placebo plus prednisone (19·4 months [16·6-not estimable]), but the difference was not significant (HR 0·85, 95% CI 0·69-1·04; p=0·109). Median time to HRQoL deterioration was longer in patients assigned to abiraterone plus prednisone than in those assigned to placebo plus prednisone as assessed by the FACT-P total score (12·7 months [95% CI 11·1-14·0] vs 8·3 months [7·4-10·6]; HR 0·78, 95% CI 0·66-0·92; p=0·003) and by the score on its prostate-cancer-specific subscale (11·1 months [8·6-13·8] vs 5·8 months [5·5-8·3]; HR 0·70, 95% CI 0·60-0·83; p<0·0001).INTERPRETATION:
Abiraterone plus prednisone delays patient-reported pain progression and HRQoL deterioration in chemotherapy-naive patients with metastatic castration-resistant prostate cancer. These results provide further support for the efficacy of abiraterone in this population.Related: Australia USA
Department of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. Electronic address:
BACKGROUND: In Canada, provincial cancer registries have been established to provide rigorous population-based data for patients with colorectal cancer. Databases maintained by regional cancer agencies contain a broader scope of information and have been used as a surrogate source of information for colorectal cancer research. It is unclear whether these data can be reliably extrapolated to all patients affected by colorectal cancer. We sought to determine whether patients included in a referral-based database are systematically different from patients who are not included.
METHODS: We conducted a retrospective cohort study to compare patients referred to the British Columbia Cancer Agency with those who were not referred. Comparison was based on age, sex and geographic location. We used univariate and logistic regression analysis to identify significant differences between the cohorts.
RESULTS: Univariate analysis demonstrated that the referral and nonreferral cohorts differed in sex, age and geographic location. For patients with rectal cancer, the referral and nonreferral cohorts varied in age and geographic location. Multivariate analysis demonstrated significant differences in age and geographic location but not sex for patients with colon and rectal cancer.
CONCLUSION: Patients included in the referral database differed in age and geographic location from those included only in the provincial database. Studies using large data sets from referral centres must be interpreted with caution and may not be representative of the entire patient population.
The Department of Surgery, St. Paul's Hospital and University of British Columbia, Vancouver, BC.
Euscher E, Fox P, Bassett R, et al.The pattern of myometrial invasion as a predictor of lymph node metastasis or extrauterine disease in low-grade endometrial carcinoma.
Am J Surg Pathol. 2013; 37(11):1728-36 [PubMed
] Article available free on PMC
after 01/11/2014 Related Publications
The purpose of this study was to examine predictors of lymph node (LN) metastases or extrauterine disease (ED) in low-grade (FIGO grade 1 or 2) endometrioid carcinoma (LGEC) in a multi-institutional setting. For LGEC with and without LN metastasis or ED, each of the 9 participating institutions evaluated patients' age, tumor size, myometrial invasion (MI), FIGO grade, % solid component, the presence or absence of papillary architecture, microcystic, elongated, and fragmented glands (MELF), single-cell/cell-cluster invasion (SCI), lymphovascular invasion (LVI), lower uterine segment (LUS) and cervical stromal (CX) involvement, and numbers of pelvic and para-aortic LNs sampled. A total of 304 cases were reviewed: LN(+) or ED(+), 96; LN(-)/ED(-), 208. Patients' ages ranged from 23 to 91 years (median 61 y). Table 1 summarizes the histopathologic variables that were noted for the LN(+) or ED(+) group: tumor size ≥2 cm, 93/96 (97%); MI>50%, 54/96 (56%); MELF, 67/96 (70%); SCI, 33/96 (34%); LVI, 79/96 (82%); >20% solid, 65/96 (68%); papillary architecture present, 68/96 (72%); LUS involved, 64/96 (67%); and CX involved, 41/96 (43%). For the LN(-)/ED(-) group, the results were as follows: tumor size ≥2 cm, 152/208 (73%); MI>50%, 56/208 (27%); MELF, 79/208 (38%); SCI, 19/208 (9%); LVI, 56/208 (27%); >20% solid, 160/208 (77%); papillary architecture present, 122/208 (59%); LUS involved, 77/208 (37%); CX involved, 24/208 (12%). There was no evidence of a difference in the number of pelvic or para-aortic LNs sampled between groups (P=0.9 and 0.1, respectively). After multivariate analysis, the depth of MI, CX involvement, LVI, and SCI emerged as significant predictors of advanced-stage disease. Although univariate analysis pointed to LUS involvement, MELF pattern of invasion, and papillary architecture as possible predictors of advanced-stage disease, these were not shown to be significant by multivariate analysis. This study validates MI, CX involvement, and LVI as significant predictors of LN(+) or ED(+). The association of SCI pattern with advanced-stage LGEC is a novel finding.Related: Endometrial (Uterus) Cancer Endometrial Cancer USA
*The University of Texas, MD Anderson Cancer Center, Houston, TX †Wayne State University, Detroit, MI ‡Cedars-Sinai Medical Center, Los Angeles, CA ∥Penn State University, Hershey, PA ††Cleveland Clinic, Cleveland, OH §The Ottawa Hospital, University of Ottawa, Ot...
Borkhoff CM, Saskin R, Rabeneck L, et al.Disparities in receipt of screening tests for cancer, diabetes and high cholesterol in Ontario, Canada: a population-based study using area-based methods.
Can J Public Health. 2013 Jul-Aug; 104(4):e284-90 [PubMed
] Related Publications
Few have compared socio-economic disparities in screening tests for cancer with recommended tests for other chronic diseases. We examined whether receipt of testing for colorectal, cervical and breast cancer, as well as diabetes and high cholesterol, differs by neighbourhood-level socio-economic and recent immigrant status.METHODS:
We conducted a population-based retrospective cohort study of patients identified as screen-eligible in 2009 living in Ontario, Canada. Postal codes were used to assign residents to a dissemination area (DA). Using Canadian census data, DAs were stratified by income quintile and proportion of recent immigrants. Prevalence of screening for cancer (colorectal, cervical, breast), diabetes, and high cholesterol, using administrative data, and prevalence ratios (least/most advantaged) were calculated.RESULTS:
The cohort comprised 7,652,592 people. Receipt of screening for colorectal cancer (women 61.6%; men 55.1%) and breast cancer (59.9%) were the lowest and diabetes (women 72.9%; men 61.4%) and high cholesterol (women 82.4%; men 70.3%) were the highest. We found disparities in the receipt of all tests, with the lowest uptake and largest disparities for cancer screening among those living in both low-income and high-immigration DAs: colorectal - women 48.6%; RR 0.77; 95% CI (0.74-0.79) and men 40.6%; RR 0.71 (0.68-0.74); cervical - 52.0%; RR 0.80 (0.78-0.81) and breast - 45.7%; RR 0.74 (0.72-0.77).CONCLUSION:
People living in low-income and high-immigration DAs had the lowest screening participation for all tests, although disparities were highest for cancer. An organized integrated chronic disease screening strategy leveraging the higher diabetes and high cholesterol screening participation may increase screening for cancer and other chronic diseases in never- and underscreened populations.Related: Cancer Screening and Early Detection Cancer Prevention and Risk Reduction
Women's College Research Institute, Women's College Hospital Room 728 - 790 Bay Street, Toronto, Ontario, Canada M5G 1N8.
Wanis K, Oucharek J, Groot GQuality of thyroid referrals in Saskatchewan.
Qual Prim Care. 2013; 21(4):247-52 [PubMed
] Related Publications
BACKGROUND: A thyroid nodule is a common presentation for thyroid pathology. A low proportion of thyroid nodules harbour malignancy and the investigation of these nodules should be performed in a cost-effective manner. The American Thyroid Association (ATA) has published guidelines which should aid physicians in performing the appropriate investigations.
AIM: To determine the proportion of patients referred to thyroid surgeons in Saskatchewan with appropriate pre-referral work-up.
METHODS: Data were retrospectively collected from the charts of all new thyroid referrals seen between 8 June 2011 and 8 June 2012 by two thyroid surgeons in the Saskatoon Health Region, Saskatchewan, Canada. Main outcome measures were the presence of thyroid stimulating hormone (TSH) and ultrasound results, and the appropriateness of ultrasound report recommendations in referrals to thyroid surgeons.
RESULTS: Recent TSH results were done and sent to the thyroid surgeon in 55.1% of referrals. A recent ultrasound was performed in 92.3% of referrals. Of patients with a high or normal TSH, a radionuclide scan was inappropriately recommended in 11.5% of cases.
CONCLUSION: There is room for improvement in pre-referral work-up of patients with thyroid nodules in Saskatchewan, in order to facilitate appropriate clinical decision making in a cost-effective manner.
College of Medicine, University of Saskatchewan, Saskatoon, Canada.
Chin-Lenn L, Craighead P, Bryant HE, et al.Quality indicators for ductal carcinoma in situ (DCIS) of the breast: development using a multidisciplinary delphi process and its use in monitoring population-based treatment.
J Surg Oncol. 2013; 108(6):348-51 [PubMed
] Related Publications
BACKGROUND AND OBJECTIVES:
Evaluation of the management of DCIS poses challenges, as standard breast cancer outcome measures such as mortality do not apply. We have developed quality indicators (QIs) to measure the quality of DCIS treatment in Alberta, Canada.METHODS:
A modified Delphi process was used to determine QIs in the treatment of DCIS after review of evidence-based clinical practice guidelines. Patients diagnosed with DCIS from 2000 to 2001 (cohort 1) and 2009-2010 (cohort 2) were identified from the Alberta Cancer Registry and QIs were retrospectively abstracted.RESULTS:
The expert panel developed eight QIs to assess the overall quality of care for DCIS patients. Five hundred eighty eligible patients were identified in the two cohorts. There was significant improvement in radiation oncology referral, radiation post lumpectomy and complete pathology reporting. Axillary staging significantly increased from 20% (axillary dissection in cohort 1) to 60% (sentinel node biopsy in cohort 2). Other QIs did not differ significantly.CONCLUSIONS:
By developing QIs, performance measures for DCIS may assessed and compared over time. Although there have been significant improvements with pathology reporting and radiation oncology assessment and treatment, axillary staging rates are unexpectedly high, necessitating further investigation.Related: Breast Cancer
Division of Surgical Oncology, University of Calgary, Calgary, Alberta, Canada.
Helewa RM, Turner D, Park J, et al.Longer waiting times for patients undergoing colorectal cancer surgery are not associated with decreased survival.
J Surg Oncol. 2013; 108(6):378-84 [PubMed
] Related Publications
BACKGROUND AND OBJECTIVES:
Wait times are a growing concern in Canada's publicly-funded healthcare system. We sought to determine if increased wait times for colorectal cancer (CRC) treatments resulted in worse outcomes.METHODS:
A population-based retrospective cohort analysis of wait times for CRC patients undergoing major surgical resections in Manitoba, Canada, between 2004 and 2006 was undertaken. Administrative records were utilized to estimate total wait time (TWT), defined as the sum of time from index contact with the healthcare system to diagnosis of CRC (diagnostic wait time [DWT]) and the time from diagnosis to first cancer treatment (treatment wait time [TxWT]). Multivariate Cox regression analysis of 5-year overall survival was performed to determine the effect of TWT quartiles on survival.RESULTS:
One thousand six hundred twenty eight patients with stage I-IV CRC underwent major surgery with a median TWT of 95 days. Predictors of lower 5-year survival included advanced age, higher stage, lower economic status, increased medical comorbidity, urgent presentation, living between 101 and 500 km from the Provincial cancer center, and not receiving adjuvant chemotherapy. After controlling for these variables, TWT quartiles were not associated with survival (P = 0.4898).CONCLUSIONS:
On a population basis, increased TWT was not associated with worse survival, while controlling for important confounders.Related: Colorectal (Bowel) Cancer
The University of Manitoba, Department of Surgery, Winnipeg, Manitoba.
Crawford J, Brudnoy L, Soong T, Graham TPatient navigation in oncology nursing: an innovative blended learning model.
J Contin Educ Nurs. 2013; 44(10):461-9 [PubMed
] Related Publications
Nurses are ideally suited to assume professional patient navigation roles in cancer care. Continuing education and staff development are essential for nurses to implement their roles to the fullest potential. This article describes an innovative patient navigation course that was developed to meet the educational needs of nurses who work with patients who have been diagnosed with cancer or are undergoing evaluation for cancer. Adult learning principles and interactive teaching strategies facilitated learning that was relevant and applicable to all nurses. Of the 200 participants, 77.5% completed questionnaires before and after the course. The questionnaire administered after the course showed a statistically significant increase in average total confidence scores on knowledge and skills in the seven domains examined (p < .00 to .03). This change reflected improvements in overall confidence in key principles and role functions of patient navigation. The course provided an opportunity for nurses to enhance their individual practice in patient navigation in the following areas: meeting patient needs for emotional and supportive care; providing information and education; and facilitating coordination and continuity of care.Related: Cancer Prevention and Risk Reduction
Dunn S, Rossiter L, Ferne J, et al.Improved adherence to colposcopy through nurse-led telephone counselling and multifaceted patient support.
J Obstet Gynaecol Can. 2013; 35(8):723-9 [PubMed
] Related Publications
In 2009, an on-site diagnostic colposcopy clinic was established within a large, urban sexual health clinic to enhance follow-up of abnormal cervical cancer screening among vulnerable women, including those who are uninsured. This service model uses a family physician colposcopist and a colposcopy nurse who provides pre-visit counselling, telephone reminders, patient-tailored ongoing support during the diagnostic process, and tracking of missed appointments. This study examined whether this program was associated with improved adherence to the first colposcopy visit after an abnormal Papanicolau smear among a high needs population.METHODS:
We conducted a retrospective chart review of women referred for colposcopy between January 2007 and September 2010, and examined non-adherence before (pre-group) and after (post-group) establishment of the on-site program. Univariable and multivariable logistic regression was used to examine patient and clinical factors associated with non-adherence.RESULTS:
Six hundred eighty-five women were referred during the study period, with 302 in the pre-group and 383 in the post-group. Non-adherence to the first colposcopy visit fell from 13% to 4% after institution of the on-site service. Pre-group status, cervical screening performed at an abortion-related visit (as opposed to a contraception or cervical screening visit), parity ≥ 1 and younger age were all associated with non-adherence in the multivariable analysis.CONCLUSION:
An on-site colposcopy service that incorporated multifaceted, client-tailored support throughout the diagnostic process significantly reduced non-attendance for an initial colposcopy visit in an urban sexual health clinic population. Broader adoption of this model could improve effectiveness of cervical cancer screening programs. However, future research should determine which specific elements of the model are more important in influencing adherence rates.Related: Cancer Screening and Early Detection Cervical Cancer
Department of Family and Community Medicine, University of Toronto, Toronto ON.
Maar M, Burchell A, Little J, et al.A qualitative study of provider perspectives of structural barriers to cervical cancer screening among first nations women.
Womens Health Issues. 2013 Sep-Oct; 23(5):e319-25 [PubMed
] Related Publications
In Canada, opportunistic screening programs have successfully reduced mortality from cervical cancer; however, minority or disadvantaged groups, as well as women in northern and rural areas, are inadequately recruited by this approach. Hence, we set out to examine the structural barriers that prevent First Nations women's participation in cervical cancer screening.METHODS:
Using a participatory action research approach and semistructured interview guides, we conducted in-depth interviews with 18 experienced health care professionals, 12 of whom were also community members. These individuals included nurses, nurse practitioners, community health representatives, social workers and physicians who provide care to women in our First Nations partner communities. In the current report, we explored perceived barriers to cervical cancer screening through the lens of service providers.RESULTS:
Structural barriers to cervical cancer screening for First Nations women included shortage of appropriate health care providers, lack of a recall-based screening system, geographic and transportation barriers; health literacy and socioeconomic inequalities, generational effects, and the colonial legacy.CONCLUSION:
Existing, opportunistic cervical cancer screening programs do not perform well for First Nations women who experience significant screening-related health inequalities that are largely influenced by structural barriers. Sustainable screening interventions in First Nations communities require approaches that resolve these structural barriers, explore new ways of screening, and provide education for both women and health care providers. Many of the structural barriers are rooted in colonial history. Given the negative impact of the consequences of colonization on indigenous women worldwide, many of our findings strongly resonate with marginalized populations in other countries.Related: Cancer Screening and Early Detection Cervical Cancer
Human Sciences, Northern Ontario School of Medicine, Sudbury, Ontario, Canada.
Toren P, Abouassaly R, Timilshina N, et al.Results of a national population-based study of outcomes of surgery for renal tumors associated with inferior vena cava thrombus.
Urology. 2013; 82(3):572-7 [PubMed
] Related Publications
To determine whether surgeon or hospital volume effects in-hospital mortality or complications of radical nephrectomy with concomitant removal of inferior vena cava (IVC) thrombus, we examine a national population-based cohort. Radical nephrectomy with removal of IVC thrombus is a complex urologic operation, which, similar to other major surgical procedures, may have an association between provider volume and outcomes.METHODS:
Canadian Institute for Health Information administrative codes were used to identify nephrectomies associated with IVC manipulation in Canada from 1998 to 2007. Canadian Institute for Health Information databases yielded information on in-hospital mortality and complications for the hospital admission at surgery. Multivariate regression analysis was performed to assess the effect of surgeon and hospital volume on in-hospital mortality and complications, adjusting for age, sex, comorbidity, year of surgery, and region.RESULTS:
During the study period, 816 radical nephrectomies with associated IVC thrombectomy were performed on 521 men and 295 women. The in-hospital mortality rate was 7%. Notably, 75% of deaths occurred in the first 2 cases of surgeon experience. Median length of stay was 10 days. Complications were noted in 633 patients (78%). Fifty-eight patients with concomitant cardiac bypass had increased in-hospital mortality and complications. Age, comorbidity, and cardiac bypass were the strongest predictors of in-hospital mortality. Increasing surgeon volume, but not hospital volume, was associated with lower in-hospital mortality on multivariate regression analysis; however, this was not statistically significant.CONCLUSION:
Radical nephrectomy with associated IVC thrombectomy has significant complications and mortality. Surgeon but not hospital volume may affect outcomes.Related: Kidney Cancer
Department of Surgical Oncology, Princess Margaret Hospital, Toronto, Ontario, Canada.
Lawler PR, Afilalo J, Eisenberg MJ, Pilote LComparison of cancer risk associated with low-dose ionizing radiation from cardiac imaging and therapeutic procedures after acute myocardial infarction in women versus men.
Am J Cardiol. 2013; 112(10):1545-50 [PubMed
] Related Publications
Patients with cardiovascular disease are increasingly exposed to low-dose ionizing radiation (LDIR) from diagnostic and therapeutic procedures. Previous studies have suggested that the malignancy risk associated with LDIR may be greatest in women and in young patients. We sought to compare the effect of LDIR on incident cancer across gender and age strata in a population-based cohort of patients with myocardial infarction (MI). All initially cancer-free patients with MI from 1996 to 2006 were identified in a province-wide administrative database. Procedure-specific LDIR dose estimates were used to generate a cumulative cardiac LDIR exposure variable. Time-dependent multivariate Cox regression was used to determine the relation between cardiac LDIR and incident cancer. A time-lag covariate of 3 years was used wherein a de novo cancer could only be attributed to LDIR incurred at least 3 years earlier. The effect of age and gender on LDIR-associated risk of cancer was evaluated with stratified models and the addition of interaction terms. The study cohort consisted of 56,606 men and 26,255 women. For each millisievert of cardiac LDIR, women were more likely to develop a cancer (hazard ratio 1.005, 95% confidence interval 1.002 to 1.008) than men (hazard ratio 1.002, 95% confidence interval 1.001 to 1.004) after adjusting for age, noncardiac LDIR, and covariates (p for interaction = 0.014). Contrarily, over the range studied (predominantly patients aged >50 years), age was not a determinant of LDIR-associated risk of cancer. In conclusion, women exposed to LDIR from cardiac imaging and therapeutic procedures after MI are at a greater risk of incident cancer compared with men after similar exposure. The extrapolated absolute risk from LDIR exposure would nonetheless be expected to be low.
Department of Medicine, McGill University Health Center, Montreal, Quebec, Canada; Division of Cardiology, Department of Medicine, Jewish General Hospital, Montreal, Quebec, Canada; Division of Clinical Epidemiology, Department of Medicine, Jewish General Hospital, Montreal, Quebec, Canada.
Kim JO, Ma R, Akagami R, et al.Long-term outcomes of fractionated stereotactic radiation therapy for pituitary adenomas at the BC Cancer Agency.
Int J Radiat Oncol Biol Phys. 2013; 87(3):528-33 [PubMed
] Related Publications
To assess the long-term disease control and toxicity outcomes of fractionated stereotactic radiation therapy (FSRT) in patients with pituitary adenomas treated at the BC Cancer Agency.METHODS AND MATERIALS:
To ensure a minimum of 5 years of clinical follow-up, this study identified a cohort of 76 patients treated consecutively with FSRT between 1998 and 2007 for pituitary adenomas: 71% (54/76) had nonfunctioning and 29% (22/76) had functioning adenomas (15 adrenocorticotrophic hormone-secreting, 5 growth hormone-secreting, and 2 prolactin-secreting). Surgery was used before FSRT in 96% (73/76) of patients. A median isocenter dose of 50.4 Gy was delivered in 28 fractions, with 100% of the planning target volume covered by the 90% isodose. Patients were followed up clinically by endocrinologists, ophthalmologists, and radiation oncologists. Serial magnetic resonance imaging was used to assess tumor response.RESULTS:
With a median follow-up time of 6.8 years (range, 0.6 - 13.1 years), the 7-year progression-free survival was 97.1% and disease-specific survival was 100%. Of the 2 patients with tumor progression, both had disease control after salvage surgery. Of the 22 patients with functioning adenomas, 50% (11/22) had complete and 9% (2/22) had partial responses after FSRT. Of the patients with normal pituitary function at baseline, 48% (14/29) experienced 1 or more hormone deficiencies after FSRT. Although 79% (60/76) of optic chiasms were at least partially within the planning target volumes, no patient experienced radiation-induced optic neuropathy. No patient experienced radionecrosis. No secondary malignancy occurred during follow-up.CONCLUSION:
In this study of long-term follow-up of patients treated for pituitary adenomas, FSRT was safe and effective.Related: Pituitary Tumors
Department of Radiation Oncology, British Columbia Cancer Agency, Vancouver, Canada; Division of Radiation Oncology and Developmental Radiotherapeutics, University of British Columbia, Vancouver, Canada.
Decker KM, Turner D, Demers AA, et al.Evaluating the effectiveness of cervical cancer screening invitation letters.
J Womens Health (Larchmt). 2013; 22(8):687-93 [PubMed
] Related Publications
The objective of this study was to evaluate the effectiveness of an invitation letter on cervical screening participation among unscreened women 30 to 69 years of age.METHODS:
A cluster randomized trial design was used in which unscreened women (n=31,452) were randomized by the forward sortation area (FSA) of their postal code to an intervention group that was sent an invitation letter (n=17,068) or a group that was not sent an invitation letter (n=14,384).RESULTS:
Six months after the letters were mailed, 1,010 women in the intervention group (5.92%) and 441 women in the control group (3.06%) had a Pap test. After adjusting for variables that have previously shown to influence screening participation, women who were sent an invitation letter were significantly more likely to have had a Pap test in the next 6 months compared with women who were not sent an invitation letter (odds ratio [OR]=2.60, 95% confidence interval [CI] 2.09-3.35, p<0.001). Overall, the effectiveness of the invitation letter improved with increasing age (p=0.02).CONCLUSIONS:
Sending invitation letters increased cervical screening participation but because the overall effect was small, additional strategies that remove barriers to screening for unscreened women are also necessary.Related: Cancer Screening and Early Detection Cervical Cancer Cervical Cancer Screening
Screening Programs, CancerCare Manitoba, Winnipeg Manitoba, Canada.
Jones KD, Churg A, Henderson DW, et al.Data set for reporting of lung carcinomas: recommendations from International Collaboration on Cancer Reporting.
Arch Pathol Lab Med. 2013; 137(8):1054-62 [PubMed
] Related Publications
The International Collaboration on Cancer Reporting (ICCR) is a quadripartite alliance formed by the Royal College of Pathologists of Australasia, the Royal College of Pathologists of the United Kingdom, the College of American Pathologists, and the Canadian Partnership Against Cancer. The ICCR was formed with a view to reducing the global burden of cancer data set development and reduplication of effort by different international institutions that commission, publish, and maintain standardized cancer-reporting data sets. The resultant standardization of cancer reporting would be expected to benefit not only those countries directly involved in the collaboration but also others not in a position to develop their own data sets.OBJECTIVES:
To develop an evidence-based reporting data set for each cancer site.DESIGN:
A project to develop data sets for prostate, endometrium, and lung cancers and malignant melanoma was piloted by the quadripartite group.RESULTS:
A set of required and recommended data elements and appropriate responses for each element were agreed upon for the reporting of lung cancer.CONCLUSIONS:
This review describes the process of development of the lung cancer data set.Related: Lung Cancer USA
Department of Pathology, University of California-San Francisco, San Francisco, USA.
Pelletier JS, Degara C, Porter G, et al.Retrospective review of rectal cancer surgery in northern Alberta.
Can J Surg. 2013; 56(4):E51-8 [PubMed
] Article available free on PMC
after 01/11/2014 Related Publications
INTRODUCTION: Previous studies, including research published more than 10 years ago in Northern Alberta, have demonstrated improved outcomes with increased surgical volume and subspecialisation in the treatment of rectal cancer. We sought to examine contemporary rectal cancer care in the same region to determine whether practice patterns have changed and whether outcomes have improved.
METHODS: We reviewed the charts of all patients with rectal adenocarcinoma diagnosed between 1998 and 2003 who had a potentially curative resection. The main outcomes examined were 5-year local recurrence (LR) and disease-specific survival (DSS). Surgeons were classified into 3 groups according to training and volume, and we compared outcome measures among them. We also compared our results to those of the previous study from our region.
RESULTS: We included 433 cases in the study. Subspecialty-trained colorectal surgeons performed 35% of all surgeries in our study compared to 16% in the previous study. The overall 5-year LR rate and DSS in our study were improved compared to the previous study. On multivariate analysis, the only factor associated with increased 5-year LR was presence of obstruction, and the factors associated with decreased 5-year DSS were high-volume noncolorectal surgeons, presence of obstruction and increased stage.
CONCLUSION: Over the past 10 years, the long-term outcomes of treatment for rectal cancer have improved. We found that surgical subspecialization was associated with improved DSS but not LR. Increased surgical volume was not associated with LR or DSS.
Department of Surgery, University of Alberta, Edmonton, Alta.
Spiegle G, Schmocker S, Huang H, et al.Physicians' awareness of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for colorectal cancer carcinomatosis.
Can J Surg. 2013; 56(4):237-42 [PubMed
] Article available free on PMC
after 01/11/2014 Related Publications
Recent trials have shown that cytoreductive surgery and heated intraperitoneal chemotherapy (S+HIPEC) for colorectal cancer carcinomatosis (CRC-C) leads to 5-year, disease-free survival rates of more than 30%. Since these data represent a substantial change in the management of CRC-C, the objectives of this study were to determine physicians' awareness of S+HIPEC for CRC-C and physician characteristics predictive of awareness of S+HIPEC for CRC-C.METHODS:
This study was a mailed, cross-sectional survey of general surgeons and medical oncologists in Ontario.RESULTS:
The response rate was 44.0% (214 of 487). Most respondents were men and younger than 50 years. There was an even split between those at academic and community hospitals. Overall, 46% of respondents were aware of S+HIPEC for CRC-C, and multivariate analysis showed that there were no physician characteristics predictive of awareness of S+HIPEC for CRC-C.CONCLUSION:
Physician awareness of S+HIPEC for CRC-C is low. Therefore, strategies to improve patient and physician knowledge about S+HIPEC for CRC-C are important to ensure appropriate treatment for patients.Related: Colorectal (Bowel) Cancer
Department of Medicine, University of Toronto, Toronto, Ont.
Regier DA, van der Hoek K, Ogilvie G, et al.Exploring colposcopists' attitudes towards use of HPV testing as a primary screening tool for cervical cancer in British Columbia.
J Obstet Gynaecol Can. 2013; 35(7):657-63 [PubMed
] Related Publications
To examine colposcopists' attitudes regarding human papillomavirus (HPV) DNA testing as a primary screening tool for cervical cancer.METHODS:
Questionnaires administered in 2010 and 2011 during workshops in British Columbia elicited colposcopists' attitudes using a series of five-point Likert-style scales (strongly disagree to strongly agree) and binary (yes/no) response questions. The frequency of "agree" or "strongly agree" was used to characterize attitudes. Regression analyses examined statistically significant changes in attitudes after the 2010 workshop.RESULTS:
Responses generally indicated positive changes in attitudes toward HPV testing. Statistically significant changes after the 2010 workshop were observed for the items relating to strong agreement that HPV is a necessary cause of cervical cancer (39% increase; P < 0.001) and the likelihood of openly advocating for HPV testing (19% increase; P < 0.04). In 2010, 40% of colposcopists stated that four years between HPV tests is too long, and in 2011, 53% did so.CONCLUSION:
Colposcopists are viewed as opinion leaders and will have a critical role in implementing HPV testing in BC; our study obtained responses from 73% (2010) and 84% (2011) of BC-registered colposcopists. Colposcopists were in favour of HPV testing for primary screening for cervical cancer but did not support an extended interval for HPV testing, which suggests future knowledge translation workshops are crucial. We found that knowledge translation workshops can be an effective approach for translating evidence on screening and screening practices.Related: Cervical Cancer Cervical Cancer Screening
Canadian Centre for Applied Research in Cancer Control, Vancouver, Canada.
Lee MH, Aquino-Parsons C, Hoskins PJ, et al.Preoperative radiotherapy for inoperable stage II endometrial cancer: insights into improving treatment and outcomes.
J Obstet Gynaecol Can. 2013; 35(7):635-9 [PubMed
] Related Publications
To review recurrence patterns and survival outcomes of women receiving preoperative radiotherapy for clinical stage II endometrial cancer in British Columbia.METHODS:
We performed a retrospective population-based cohort study of all patients with clinical stage II endometrial cancer who were referred to the British Columbia Cancer Agency from 2000 to 2008, deemed ineligible for primary surgery, and therefore offered preoperative radiotherapy followed by surgery. Patient demographics, uterine risk factors, timing and details of treatments, and timing and sites of recurrence were obtained from patient records. Primary outcome measures were the sites and rates of recurrence and recurrence-free survival.RESULTS:
We identified 29 patients with a mean age of 61 years (range 41 to 83) and median follow-up of 3.1 years (range 0.3 to 5.3). Three-year overall survival was 79%, and median recurrence-free survival was 2.5 years. Eight patients had recurrence of disease (27.6%), with a median time to recurrence of 1.3 years, (range 0.4 to 2.7). Six of these eight women had two or more high-risk uterine factors (deep myometrial invasion, grade 3 tumour), ovarian involvement, or adverse histological type (carcinosarcoma), compared with only one of 21 patients without recurrence. Seven of eight women had recurrence outside the radiated volume of tissue. Median survival after recurrence was 1.0 years (range 0.4 to 2.2).CONCLUSIONS:
Women with clinical stage II endometrial cancer had a significant risk of recurrence when treated with preoperative radiotherapy followed by surgery. They were more likely to have distant recurrences, implying the need for an alternate treatment paradigm.Related: Endometrial (Uterus) Cancer Endometrial Cancer
Division of Gynaecologic Oncology, University of British Columbia, Vancouver BC, Canada.
Reade CJ, Finlayson S, McAlpine J, et al.Risk-reducing salpingectomy in Canada: a survey of obstetrician-gynaecologists.
J Obstet Gynaecol Can. 2013; 35(7):627-34 [PubMed
] Related Publications
OBJECTIVE: Performing risk-reducing salpingectomy (RRS) at the time of hysterectomy or as a method of tubal ligation has been suggested as a way to reduce the incidence of high grade serous carcinoma (HGSC) of the ovary, since this type of cancer is hypothesized to originate in the fallopian tube. We conducted a survey of Canadian obstetrician-gynaecologists to better understand the uptake and knowledge of implementing this procedure, and to identify barriers to doing so.
METHODS: An anonymous, web-based survey using both quantitative and qualitative methods was sent to obstetrician-gynaecologist members of the Society of Obstetricians and Gynaecologists of Canada and the Society of Gynecologic Oncology of Canada. The survey contained questions about demographics, knowledge and beliefs about RRS, and possible barriers to its implementation in women at average risk for ovarian cancer.
RESULTS: One hundred ninety-two physicians responded to the survey, a response rate of 25%. Respondents varied in their duration in practice, came from all provinces, and spent a large proportion of their time practising gynaecology. Ninety percent of respondents had heard of RRS; however, 37% were unaware of the evidence supporting the hypothesis that HGSC originates in the fallopian tube, and 38% were unsure whether there would be any population benefit from performing RRS at the time of other gynaecologic surgery. Multiple barriers to implementation were identified.
CONCLUSION: Most Canadian obstetrician-gynaecologists responding to our survey were aware of RRS as a possible method to prevent ovarian cancer in women at average risk; however, barriers still exist to widespread implementation. Further research is needed to quantify the population benefit of this procedure.
Department of Obstetrics and Gynaecology, University of Toronto, Toronto, ON, Canada.
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