|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|
National Organisations: Canada
Latest Research Publications from Canada
Alberta / Northwest Territories
British Columbia / Yukon Territory
Prince Edward Islands
National Organisations: Canada (19 links)
Acoustic Neuroma Association of Canada
A non-profit membership organization founded in 1983, which provides support, information and advocacy.
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.
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.
Canadian Association of Radiation Oncology
A professional association representing radiation oncology in Canada in relation to the public and professional interests. Established 1985.
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.
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.
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.
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.
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
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.
The Foundation, founded in 1998, focuses on lymphoma research, education and awareness in Canada.
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.
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.
Cancer Centers (17 links)
A regional service of the British Columbia Cancer Agency. Established 2008.
Located within the Pasqua Hospital, Regina
Atlantic Cancer Research Institute
A non-profit organization founded in late 1998 and housed at the Dr. Georges-L.-Dumont University Hospital Centre in Moncton
British Columbia Cancer Angency
A comprehensive provincial program of cancer control and health care delivery and research in British Columbia
CCO was formed in 1997 to co-ordinate cancer services in the province. The site includes details of the centres and divisions of CCO.
Cancer Centre of Southeastern Ontario
Located in Kingston General Hospital.
Centre for the North - BC Cancer Agency
A regional service of the British Columbia Cancer Agency. Established 2012.
Alberta Health Services
The Cross Cancer Institute in Edmonton is the comprehensive cancer centre for northern Alberta and a lead centre for the province-wide prevention, research and treatment program.
A regional service of the British Columbia Cancer Agency. Established 1995.
Grand River Regional Cancer Centre
A regional centre covering the Waterloo Region, Wellington County and surrounding areas. Established 2003.
London Regional Cancer Program
Regional service run by the London Health Science Centre, supported by Cancer Care Ontario.
Located on the University of Saskatchewan campus.
Sindi Ahluwalia Hawkins Centre for the Southern Interior
A regional service of the British Columbia Cancer Agency.
Alberta Health Services
The Tom Baker Cancer Centre in Calgary is the comprehensive cancer centre for southern Alberta and a lead centre for the province-wide prevention, research and treatment program.
A regional service of the British Columbia Cancer Agency.
Vancouver Island Cancer Centre
A regional service of the British Columbia Cancer Agency. Established 2001.
Windsor Regional Hospital - Cancer Program
The hospital hosts the Erie St. Clair Regional Cancer Program network, under the auspices of Cancer Care Ontario providing services for the Chatham-Kent, Sarnia/Lambton and Windsor/Essex areas.
Latest Research Publications from Canada
Retrospective study of intravascular large B-cell lymphoma cases diagnosed in Quebec: A retrospective study of 29 case reports.
Medicine (Baltimore). 2017; 96(5):e5985 [PubMed] Free Access to Full Article Related Publications
CONCLUSION: Unlike European studies on "classical" IVL, our study showed that the French Canadian presentation of this subtype of IVL is more frequently observed with neurological rather than cutaneous involvement. Finally, an early diagnosis is of primary importance since almost a quarter of patients receive a post-mortem diagnosis. A prompt diagnosis allows the introduction of an early treatment, associated with a CR in 53% of patients.
Utilization of pre-operative imaging for colon cancer: A population-based study.
J Surg Oncol. 2017; 115(2):202-207 [PubMed] Related Publications
METHODS: This population-based, retrospective cohort study used a random sample of 25% of colon cancer patients treated with surgery in the province of Ontario (2002-2008). Pre-operative imaging (<16 weeks from surgery) of the chest, abdomen-pelvis was identified. Modified poisson regression was used to analyze factors associated with practice patterns.
RESULTS: Of the 7,249 included patients, 48% had pre-operative imaging (CT abdomen and imaging of the chest) in keeping with guideline recommendations. The rate of guideline concordant pre-operative imaging increased over time: 64% in the most recent study period (2006-2008) versus 31% (2002-2004); P < 0.001. Variables associated with use of chest imaging: Age, co-morbidity, surgeon volume, and geographic region; no association with gender, hospital volume, or socio-economic status. Variables associated with use of abdomen imaging: Hospital volume and geographic region; no association with age, gender, comorbidity, socio-economic status, or surgeon volume.
CONCLUSION: In clinical practice, the majority of patients were not receiving pre-operative imaging that was in line with clinical practice guidelines; however, use increased over time indicating a possible association with dissemination of clinical practice guidelines. J. Surg. Oncol. 2017;115:202-207. © 2016 Wiley Periodicals, Inc.
Detection Rate, Recall Rate, and Positive Predictive Value of Digital Compared to Screen-Film Mammography in the Quebec Population-Based Breast Cancer Screening Program.
Can Assoc Radiol J. 2016; 67(4):330-338 [PubMed] Related Publications
METHODS: This analysis involved women 50-69 years of age who participated in the breast screening program of Quebec (Canada) and who had screening mammogram between January 1, 2007, and September 30, 2012. The detection rate, recall rate, and positive predictive value of CR (n = 672,125 mammograms) and DR (n = 60,023) were compared to SFM (n = 782,894) using mixed-effect logistic regression, adjusting for potential confounders. No institutional review board approval was required.
RESULTS: CR was not associated with change in cancer detection rate (odds ratio [OR]: 0.95; 95% confidence interval [CI]: 0.88-1.03), but with a small increase in recall rate (OR: 1.03; 95% CI: 1.01-1.06) compared to SFM. The association of CR with recall rate varies with the CR plate reader manufacturer (P < .0001). DR was not associated with change in detection rate (OR: 1.06; 95% CI: 0.89-1.25), but with an increase in the recall rate (OR: 1.25; 95% CI: 1.19-1.30) compared to SFM.
CONCLUSIONS: In our screening program, digital mammograms gave detection rates equivalent to those of SFM, but with an increase of recall rate, particularly for DR. If this situation persists, the adoption of DR may increase the adverse effects of screening with little or no benefit for women.
Usefulness of Canadian Public Health Insurance Administrative Databases to Assess Breast and Ovarian Cancer Screening Imaging Technologies for BRCA1/2 Mutation Carriers.
Can Assoc Radiol J. 2016; 67(4):308-312 [PubMed] Related Publications
METHODS: Official public health insurance documents were considered potentially useful if they had specific procedure codes, and pertained to procedures performed in the public and private health care systems.
RESULTS: All 3 administrative databases have specific procedures codes for mammography and breast ultrasounds. Only Quebec and Ontario have a specific procedure code for breast magnetic resonance imaging. It is impossible to assess, on an individual basis, the frequency of others screening exams, with the exception of CA-125 testing in British Columbia. Screenings done in private practice are excluded from the administrative databases unless covered by special agreements for reimbursement, such as all breast imaging exams in Ontario and mammograms in British Columbia and Quebec. There are no specific procedure codes for risk-reduction surgeries for breast and ovarian cancer.
CONCLUSION: Population-based assessment of breast and ovarian cancer risk management strategies other than mammographic screening, using only administrative data, is currently challenging in the 3 Canadian provinces studied.
Frequency and Determinants of a Short-Interval Follow-up Recommendation After an Abnormal Screening Mammogram.
Can Assoc Radiol J. 2016; 67(4):322-329 [PubMed] Related Publications
METHODS: Between 1998 and 2008, 1,839,396 screening mammograms were performed and a total of 114,781 abnormal screens were assessed by imaging only. Multivariate analysis was done with multilevel Poisson regression models with robust variance and generalized linear mixed models.
RESULTS: A short-interval follow-up was recommended in 26.7% of assessments with imaging only, representing 2.3% of all screens. Case-mix adjusted proportion of short-interval follow-up recommendations varied substantially across physicians (range: 4%-64%). Radiologists with high recall rates (≥15%) had a high proportion of short-interval follow-up recommendation (risk ratio: 1.82; 95% confidence interval: 1.35-2.45) compared to radiologists with low recall rates (<5%). The adjusted proportion of short-interval follow-up was high (22.8%) even when a previous mammogram was usually available.
CONCLUSIONS: Short-interval follow-up recommendation at assessment is frequent in this Canadian screening program, even when a previous mammogram is available. Characteristics related to radiologists appear to be key determinants of short-interval follow-up recommendation, rather than characteristics of lesions or patient mix. Given that it can cause anxiety to women and adds pressure on the health system, it appears important to record and report short-interval follow-up and to identify ways to reduce its frequency. Short-interval follow-up recommendations should be considered when assessing the burden of mammography screening.
Metastatic pattern of invasive lobular carcinoma of the breast-Emphasis on gastric metastases.
J Surg Oncol. 2016; 114(5):543-547 [PubMed] Related Publications
METHODS: Patients with ILC treated at the Saint-Sacrement Hospital (Quebec City, Canada) and the Maisonneuve-Rosemont Hospital (Montreal, Canada) between January 2003 and December 2009 were retrospectively reviewed. Demographic, clinical, and follow-up data were retrieved from the medical charts. Metastases that were diagnosed during follow-up were recorded.
RESULTS: Among the 481 patients with ILC, 74 (15.4%) were diagnosed with metastases after a median follow-up of 46 months. Among these 74 patients, 41.9% had metastases in atypical sites. Five patients were diagnosed with histologically confirmed gastric metastases of ILC.
CONCLUSION: Metastases of breast ILC to atypical sites might be more frequent than previously reported. Clinicians should keep a high level of suspicion when a patient with a history of ILC develops digestive symptoms. It is important to differentiate metastases from a primary GI tumor by using immunohistochemical markers. J. Surg. Oncol. 2016;114:543-547. © 2016 Wiley Periodicals, Inc.
Equity and practice issues in colorectal cancer screening: Mixed-methods study.
Can Fam Physician. 2016; 62(4):e186-93 [PubMed] Free Access to Full Article Related Publications
DESIGN: Mixed-methods study using cross-sectional administrative data on patient sociodemographic characteristics and semistructured telephone interviews with physicians.
SETTING: Toronto, Ont.
PARTICIPANTS: Patients aged 50 to 74 years and physicians in family health teams in the Toronto Central Local Health Integration Network.
MAIN OUTCOME MEASURES: Rates of CRC screening by type; sociodemographic characteristics associated with CRC screening; thematic analysis using constant comparative method for semistructured interviews.
MAIN FINDINGS: Ontario administrative data on CRC screening showed lower overall screening rates among those who were younger, male patients, those who had lower income, and recent immigrants. Colonoscopy rates were especially low among those with lower income and those who were recent immigrants. Semistructured interviews revealed that physician opinions about CRC screening for average-risk patients were divided: one group of physicians accepted the evidence and recommendations for FOBT and the other group of physicians strongly supported colonoscopy for these patients, believing that the FOBT was an inferior screening method. Physicians identified specialist recommendations and patient expectations as factors that influenced their decisions regarding CRC screening type.
CONCLUSION: There was considerable variation in CRC screening by sociodemographic characteristics. A key theme that emerged from the interviews was that physicians were divided in their preference for FOBT or colonoscopy; factors that influenced physician preference included the health care system, recommendations by other specialists, and patient characteristics. Providing an informed choice of screening method to patients might result in higher screening rates and fewer disparities. Changes in policy and physician attitudes might be needed in order for this to occur.
Dietary patterns and the risk of female breast cancer among participants of the Canadian National Enhanced Cancer Surveillance System.
Can J Public Health. 2016; 107(1):e49-55 [PubMed] Related Publications
METHODS: Dietary and other risk factor data from cases and controls of the Canadian National Enhanced Cancer Surveillance System were collected using self-administered questionnaires. Principal component factor analysis was used to classify individuals based on their dietary patterns. The relationship between these dietary patterns and breast cancer was evaluated using logistic regression. The derived odds ratios and their 95% confidence limits were adjusted for several factors, such as smoking, alcohol intake, environmental tobacco smoke exposure and obesity.
RESULTS: In the 2,009 cases and 2,086 controls, three dietary patterns were identified: western, healthy and vitamin. The highest quartile of the "healthy" dietary pattern was related to a 22% decrease in breast cancer risk (95% CI: 0.61-1.00), relative to the lowest quartile. The fourth quartile of the "vitamin" dietary pattern was associated with a 14% decrease in breast cancer risk (95% CI: 0.70-1.04) relative to the first. No statistically significant associations between the "western" dietary pattern and breast cancer were found. These associations were neither confounded nor modified by menopausal status.
CONCLUSION: Our analyses reveal that individual dietary items tend to cluster together in such a way that there are three distinct dietary patterns in this sample of Canadian women. Some of these patterns, in turn, were associated with the risk of breast cancer.
Canadian brain cancer survival rates by tumour type and region: 1992-2008.
Can J Public Health. 2016; 107(1):e37-42 [PubMed] Related Publications
METHODS: Canadian Cancer Registry data were obtained for all patients with first-ever primary malignant brain tumours diagnosed between 1992 and 2008 (n = 38,095). Follow-up ended with patient death or December 31, 2008, whichever occurred first. Crude Kaplan-Meier estimates were calculated at one, two and five years post-diagnosis. Cox proportional hazard models were used to obtain adjusted hazard ratios by region for major histology types. A time-specific generalized linear model was used to obtain 5-year survival estimates for specific age group, sex and region for major histology types.
RESULTS: The overall five-year survival rate was 27%. No significant difference in survival rate over time is observed. The highest 5-year survival rate was 65% (95% CI: 62.5%-67.4%) for oligodendrogliomas and the lowest was 4.0% (95% CI: 3.7%-4.3%) for glioblastomas. Compared to Ontario, the adjusted 5-year glioblastoma survival estimates were lower in British Columbia, Alberta and the Prairie provinces (Manitoba and Saskatchewan), while the survival estimates were lower in all other regions for diffuse astrocytoma, and lower in Manitoba and Saskatchewan for anaplastic astrocytomas. Estimates were significantly higher for oligodendrogliomas in Alberta, and for anaplastic oligodendrogliomas in Alberta and Quebec (p < 0.05).
CONCLUSION: These data are consistent with previous literature in observing higher survival rates at younger ages, in female patients and for tumours with mixed oligo components. There is a need to further explore the underlying reasons for the observed variation in survival rates by region in an effort to improve the prognosis of brain cancer in the Canadian patient population.
Canadian cost analysis comparing maintenance therapy with bortezomib versus lenalidomide for patients with multiple myeloma post autologous stem cell transplant.
J Popul Ther Clin Pharmacol. 2016; 23(1):e103-13 [PubMed] Related Publications
OBJECTIVE: To determine the incremental cost between bortezomib and lenalidomide maintenance therapies for patients with MM post ASCT.
METHODS: Analyses were conducted to compare the annual costs of bortezomib and lenalidomide maintenance treatments for patients with MM post ASCT in Canada. The base case analysis included the acquisition costs of the drugs and administration costs. Additional analyses were conducted which considered the cost of experiencing adverse events (AEs) and the cost of treating second primary malignancies (SPMs).
RESULTS: In the Canadian healthcare system, the total annual per patient cost was $33,967 for bortezomib maintenance therapy versus $131,765 for lenalidomide maintenance therapy. One-way sensitivity analyses demonstrated that both AEs and SPMs had little impact on the incremental cost, and that differences between the two maintenance therapies were mainly due to the acquisition costs of the drugs.
CONCLUSIONS: Bortezomib is significantly less costly than lenalidomide, and is an economically reasonable maintenance treatment option for patients with MM post ASCT.
A population-based comparison of 30-day readmission after surgery for colon and rectal cancer: How are they different?
J Surg Oncol. 2016; 114(3):354-60 [PubMed] Related Publications
METHODS: This was a retrospective analysis of the differences in predictors, diagnoses, and costs of readmission between colon and rectal cancer cohorts for 30-day readmission. This study included all patients aged >18 who received an elective colectomy or low anterior resection for colorectal cancer from April 2008 until March 2012 in the province of Ontario.
RESULTS: Overall, 13,571 patients were identified and the readmission rates significantly differed between rectal and colon cancer patients (7.1% colon and 10.7% rectal P = 0.001). Diabetes, age, and discharge to long term care were significantly different among colon and rectal patients in the prediction of readmission. Readmission for renal and stoma causes was more prominent in the rectal cohort. The adjusted cost difference for readmission did not significantly differ between rectal and colon cancer $178 ($1,924-1,568 P = 0.84) CONCLUSION: Several important differences in predictors and diagnoses exist between the two cohorts. Conversely, the costs associated with readmission were homogenous between rectal and colon cancer patients. J. Surg. Oncol. 2016;114:354-360. © 2016 Wiley Periodicals, Inc.
Impact of Breast Density Legislation on Breast Cancer Risk Assessment and Supplemental Screening: A Survey of 110 Radiology Facilities.
Breast J. 2016; 22(5):493-500 [PubMed] Related Publications
Diagnosis and management of gastrointestinal neuroendocrine tumors: An evidence-based Canadian consensus.
Cancer Treat Rev. 2016; 47:32-45 [PubMed] Related Publications
Does a dedicated program for young breast cancer patients affect the likelihood of fertility preservation discussion and referral?
Breast. 2016; 27:22-6 [PubMed] Related Publications
METHODS: A retrospective chart review and prospective survey were undertaken of breast cancer patients diagnosed at age 40 or younger between 2011 and 2013 who received adjuvant or neo-adjuvant chemotherapy at two academic cancer centers in Toronto, Canada. The Odette Cancer Centre (OCC) has a dedicated program for young breast cancer patients while Princess Margaret Cancer Centre (PM) does not. Patient demographics, tumor pathology, treatment and fertility discussion documentation prior to systemic chemotherapy administration were extracted from patient records. Prospective surveys were administered to the same cohort to corroborate data collected.
RESULTS: Eighty-one patient charts were reviewed at both OCC and PM. Forty-seven and 49 at OCC and PM returned surveys for a response rate of 58% and 60% respectively. Chart reviews demonstrated no difference in the frequency of fertility discussion documentation (78% versus 75% for OCC and PM, p = 0.71); however, surveys demonstrated higher rates of recall of fertility discussion at OCC (96% versus 80%, p = 0.02). A greater proportion of women were offered FP referrals at OCC, as observed in chart reviews (56% versus 41%, p = 0.09), and surveys (73% versus 51%, p = 0.04). Time to initiation of chemotherapy did not differ between women who underwent FP and those who did not.
CONCLUSION: A dedicated program for young breast cancer patients is associated with a higher frequency of FP referrals without delaying systemic therapy.
Is the false-positive rate in mammography in North America too high?
Br J Radiol. 2016; 89(1065):20160045 [PubMed] Article available free on PMC after 01/09/2017 Related Publications
A prospective study validating the EORTC QLQ-BM22 bone metastases module in patients with painful bone metastases undergoing palliative radiotherapy.
Radiother Oncol. 2016; 119(2):208-12 [PubMed] Related Publications
METHODS: The studied patients underwent palliative radiotherapy to bone metastases in the randomized NCIC CTG SC 23 trial. Multi-trait scaling analysis was performed to determine convergent and divergent validity among scales. Pearson coefficients were calculated to determine the correlation between items of the two instruments. The clinical validity and responsiveness of the QLQ-BM22 was tested by known group comparisons of different performance status and response to radiotherapy.
RESULTS: 204 patients completed both questionnaires at baseline and 42day follow-up. On multi-trait scaling analysis, there was mixed evidence of construct validity (explained by the questionnaire format and population characteristics). There was little correlation between most QLQ-BM22 and QLQ-C15-PAL items (except for conceptually related scales) validating their complementary nature. There were statistically significant differences in all QLQ-BM22 scale scores in groups with KPS<80 vs. KPS⩾80 and three out of four QLQ-BM22 scale scores in "responders" vs. "non-responders" to radiotherapy. In patients who responded to radiotherapy, there were statistically significant differences in all QLQ-BM22 scale scores between baseline and follow-up.
CONCLUSION: This study further validates the use of the QLQ-BM22 as a robust and sensitive instrument to assess QOL in patients with bone metastases treated with palliative radiotherapy.
Do invitations for cervical screening provide sufficient information to enable informed choice? A cross-sectional study of invitations for publicly funded cervical screening.
J R Soc Med. 2016; 109(7):274-81 [PubMed] Article available free on PMC after 01/09/2017 Related Publications
DESIGN: Cross-sectional study using a checklist of 23 information items on benefits and harms from cervical screening and the risks related to cervical cancer.
MATERIAL: Invitations to publicly funded cervical screening in 10 Scandinavian and English-speaking countries.
SETTING: Ten Scandinavian and English speaking countries.
PARTICIPANTS: Sixteen screening units representing 10 Scandinavian and English speaking countries.
MAIN OUTCOME MEASURES: Number of information items presented in invitations for cervical screening.
RESULTS: We contacted 21 coordinating units from 11 countries and 20 (95%) responded. Of these, four units did not issue invitations, but the remaining 16 coordinating units in 10 different countries supplied a sample. The invitations for cervical screening were generally information poor and contained a median of only four out of 23 information items possible (17%), ranging from 0 to 12 (0-52%). The most important harms of cancer screening, overdiagnosis and overtreatment, were typically downplayed or unmentioned. The same applied to other important harms, such as false-positive results and the psychological consequences from an abnormal test result. The majority of invitations took a paternalistic approach. While only two invitations (17%) included a pre-assigned appointment date, eight (70%) of the invitations contained strong appeals for participation.
CONCLUSIONS: Invitations to cervical cancer screening were information poor and biased in favour of participation. This means that informed choice is not possible, which is in conflict with modern requirements for personal involvement in medical decisions.
Minimal Residual Disease Evaluation in Childhood Acute Lymphoblastic Leukemia: An Economic Analysis.
Ont Health Technol Assess Ser. 2016; 16(8):1-83 [PubMed] Article available free on PMC after 01/09/2017 Related Publications
METHODS: A systematic literature search (1998-2014) identified studies that examined the incremental cost-effectiveness of MRD testing by either flow cytometry or PCR. We developed a lifetime state-transition (Markov) microsimulation model to quantify the cost-effectiveness of MRD testing followed by risk-directed therapy to no MRD testing and to estimate its marginal effect on health outcomes and on costs. Model input parameters were based on the literature, expert opinion, and data from the Pediatric Oncology Group of Ontario Networked Information System. Using predictions from our Markov model, we estimated the 1-year cost burden of MRD testing versus no testing and forecasted its economic impact over 3 and 5 years.
RESULTS: In a base-case cost-effectiveness analysis, compared with no testing, MRD testing by flow cytometry at the end of induction and consolidation was associated with an increased discounted survival of 0.0958 quality-adjusted life-years (QALYs) and increased discounted costs of $4,180, yielding an incremental cost-effectiveness ratio (ICER) of $43,613/QALY gained. After accounting for parameter uncertainty, incremental cost-effectiveness of MRD testing was associated with an ICER of $50,249/QALY gained. In the budget-impact analysis, the 1-year cost expenditure for MRD testing by flow cytometry in newly diagnosed patients with precursor B-cell ALL was estimated at $340,760. We forecasted that the province would have to pay approximately $1.3 million over 3 years and $2.4 million over 5 years for MRD testing by flow cytometry in this population.
CONCLUSIONS: Compared with no testing, MRD testing by flow cytometry in newly diagnosed patients with precursor B-cell ALL represents good value for money at commonly used willingness-to-pay thresholds of $50,000/QALY and $100,000/QALY.
Differences in cancer survival in Canada by sex.
Health Rep. 2016; 27(4):19-27 [PubMed] Related Publications
DATA AND METHODS: Data are from the Canadian Cancer Registry, with mortality follow-up through record linkage to the Canadian Vital Statistics Death Database. The percentage unit difference in five-year relative survival ratios (RSRs) between women and men and the relative excess risk (RER) of death for women compared with men were used as measures of differences in cancer survival.
RESULTS: A significant advantage for women compared with men was observed in 13 of the 18 cancers studied. Point estimates of RER were almost uniformly lower among those diagnosed at younger ages (15 to 54). For all cancers combined, women had a 13% lower excess risk of death-23% lower among women younger than 55. The overall advantage was greatest for thyroid cancer (RER = 0.31), skin melanoma (0.52) and Hodgkin lymphoma (0.65). The advantage for thyroid cancer was somewhat attenuated, though still significant, in earlier time periods. Bladder cancer was the only cancer for which women had a significant disadvantage (RER = 1.23); this excess risk seemed to be restricted to the first 12 to 18 months after diagnosis.
INTERPRETATION: The reasons behind sex-specific differences in cancer survival are not well understood. Many explanations are possible, and differences are best explored on a cancer-by-cancer basis. The pronounced advantage for women at younger ages lends indirect support to a hypothesized hormonal influence.
Moderate hypofractionated external beam radiotherapy alone for intermediate risk prostate cancer: long term outcomes.
Can J Urol. 2016; 23(2):8209-14 [PubMed] Related Publications
MATERIALS AND METHODS: We studied the first consecutive 100 men with intermediate risk (stage T2b-T2c, or PSA = 10-20 ug/L, or Gleason score = 7) adenocarcinoma of the prostate treated between October 2002 and May 2010 in our institution with moderate HypoRT. Patients were treated using three-dimensional conformal HypoRT to a dose of 66 Gy in 22 daily fractions prescribed to the isocenter. Androgen suppression was not given to any patient. A uniform 7 mm margin was created around the prostate for the planning target volume. Daily ultrasound was used to guide the radiotherapy. Common Terminology Criteria for Adverse Events, version 3.0, was used to prospectively score toxicity. Biochemical failure was defined as the nadir PSA level plus 2 ng/m.
RESULTS: After a median follow up time of 80 months (range: 7-152), the 8 year actuarial freedom from biochemical relapse survival rate was 90%. The 8 year cancer specific survival and overall survival rates were 96% and 84%, respectively. Only 2 patients died from prostate cancer. The worst grade ≥ 2 late genitourinary (GU) or gastrointestinal (GI) toxicities ever documented were 19% and 20%, respectively. At the last follow up the incidence of grade ≥ 2 late GI or GU toxicity was of only 2% and 3%, respectively. No grade 4 or 5 late toxicity was seen.
CONCLUSION: Our long term experience with HypoRT delivering 66 Gy/22 fractions prescribed to the isocenter using three-dimensional conformal radiotherapy shows excellent tumor control with acceptable toxicity.
Practice Patterns Analysis of Ocular Proton Therapy Centers: The International OPTIC Survey.
Int J Radiat Oncol Biol Phys. 2016; 95(1):336-43 [PubMed] Related Publications
METHODS AND MATERIALS: Ten centers from 7 countries completed a questionnaire survey with 109 queries on the eye treatment planning system (TPS), hardware/software equipment, image acquisition/registration, patient positioning, eye surveillance, beam delivery, quality assurance (QA), clinical management, and workflow.
RESULTS: Worldwide, 28,891 eye patients were treated with protons at the 10 centers as of the end of 2014. Most centers treated a vast number of ocular patients (1729 to 6369). Three centers treated fewer than 200 ocular patients. Most commonly, the centers treated uveal melanoma (UM) and other primary ocular malignancies, benign ocular tumors, conjunctival lesions, choroidal metastases, and retinoblastomas. The UM dose fractionation was generally within a standard range, whereas dosing for other ocular conditions was not standardized. The majority (80%) of centers used in common a specific ocular TPS. Variability existed in imaging registration, with magnetic resonance imaging (MRI) rarely being used in routine planning (20%). Increased patient to full-time equivalent ratios were observed by higher accruing centers (P=.0161). Generally, ophthalmologists followed up the post-radiation therapy patients, though in 40% of centers radiation oncologists also followed up the patients. Seven centers had a prospective outcomes database. All centers used a cyclotron to accelerate protons with dedicated horizontal beam lines only. QA checks (range, modulation) varied substantially across centers.
CONCLUSIONS: The first worldwide multi-institutional ophthalmic proton therapy survey of the clinical and technical approach shows areas of substantial overlap and areas of progress needed to achieve sustainable and systematic management. Future international efforts include research and development for imaging and planning software upgrades, increased use of MRI, development of clinical protocols, systematic patient-centered data acquisition, and publishing guidelines on QA, staffing, treatment, and follow-up parameters by dedicated ocular programs to ensure the highest level of care for ocular patients.
The incidence of bone metastasis after early-stage breast cancer in Canada.
Breast Cancer Res Treat. 2016; 156(3):587-95 [PubMed] Related Publications
Advice about Work-Related Issues to Peers and Employers from Head and Neck Cancer Survivors.
PLoS One. 2016; 11(4):e0152944 [PubMed] Article available free on PMC after 01/09/2017 Related Publications
METHODS: Data were gathered through 10 individual semi-structured in-depth interviews with HNC clinic patients at a regional cancer center's head and neck clinic in Ontario, Canada. A constant comparative method of theme development was used. Codes identified in and derived from the data were discussed by research team members until consensus was reached. Codes with similar characteristics were grouped together and used to develop overarching themes.
RESULTS: Work-related advice for peers focused on personal self-care and interactions within workplaces. Work-related advice to employers focused on demonstrating basic human values as well as the importance of communication.
DISCUSSION: The study results suggest HNC clinic patients should be proactive with employers and help to set reasonable expectations and provide a realistic plan for work to be successfully completed. HNC clinic patients should develop communication skills to effectively disclose their cancer and treatment to employers.
CONCLUSIONS: In this exploratory study, HNC clinic patients' advice was solution-focused underscoring the importance of self-care and pro-active communication and planning with employers. Employers were advised to demonstrate core human values throughout all phases of the work disability episode beginning at diagnosis.
Trends in colorectal cancer incidence and related lifestyle risk factors in 15-49-year-olds in Canada, 1969-2010.
Cancer Epidemiol. 2016; 42:90-100 [PubMed] Related Publications
METHODS: Incidence data for colorectal, colon and rectum/rectosigmoid cancers were obtained for 1969-2010 from the Canadian Cancer Registry, and trends in age-standardized incidence rates (ASIRs) were examined by Joinpoint regression for three age groups (15-29, 30-39, 40-49 years) and by sex. Trends in the prevalence of some CRC risk factors were similarly examined from national health surveys for various periods ranging from 1970 to 2012.
RESULTS: In both sexes combined, ASIRs rose by 6.7%/year (1997-2010) for 15-29-year-olds, 2.4%/year (1996-2010) for 30-39-year-olds, and 0.8%/year (1997-2010) for 40-49-year-olds. Similar trends were observed by sex. The rise in ASIR was more rapid for cancers of the rectum/rectosigmoid compared to colon for all age groups. Risk factor trends varied: excess weight rose substantially, vegetables and fruit consumption increased slightly, physical inactivity rates declined but remained high, alcohol consumption changed little, and smoking rates declined. Data on red/processed meat consumption were unavailable.
CONCLUSION: The ASIR of CRC in young Canadians has increased since about the mid-1990s. The rising prevalence of excess weight in younger generations has likely played a role in the CRC trend, but more research is needed.
Surgical management of rectal carcinoids: trends and outcomes from the Surveillance, Epidemiology, and End Results database (1988 to 2012).
Am J Surg. 2016; 211(5):877-85 [PubMed] Related Publications
METHODS: Surveillance, Epidemiology, and End Results database (1988 to 2012) was interrogated for rectal carcinoid patients. Chi-square testing and Kaplan-Meier survival analysis were used to compare survival outcomes.
RESULTS: Of all, 11,329 patients were identified-9,605 with only localized disease. The majority (77%) underwent local excision only. Full rectal resection was performed more frequently for tumors greater than 10 mm (11.7% to 12.2%) than for tumors less than 10 mm (4.5% to 4.9%, P < .001), and for higher T stage (T1: 4.0%, T2: 11.4%, T3/4:30.4%, P < .001). Nonoperative management was more common after year 2000 (11.2% to 13.7%) than prior (7.4% to 8.5%, P < .001). Cancer-specific survival improved across time periods but did not differ between nonoperative, local excision, or surgical resection.
CONCLUSIONS: Nonexcisional management of small, localized rectal carcinoids is becoming more common and may offer equivalent survival to excision or resection.
A multi-national report on stereotactic body radiotherapy for oligometastases: Patient selection and follow-up.
Acta Oncol. 2016; 55(5):633-7 [PubMed] Related Publications
Effects of Tadalafil Once-Daily or On-Demand vs Placebo on Return to Baseline Erectile Function After Bilateral Nerve-Sparing Radical Prostatectomy--Results from a Randomized Controlled Trial (REACTT).
J Sex Med. 2016; 13(4):679-83 [PubMed] Related Publications
METHODS: REACTT included 422 men <68 years with adenocarcinoma of the prostate and preoperative IIEF-EF ≥22 who underwent nsRP at 50 centers from 9 European countries and Canada. Patients were randomized post-nsRP 1:1:1 to 9-month double-blind treatment (DBT) with tadalafil 5 mg OaD (n = 139), tadalafil 20 mg on-demand (pro-re-nata, PRN; n = 142), or placebo (n = 141), followed by 6-week drug-free washout (DFW) and 3-month open-label tadalafil OaD treatment (OLT).
MAIN OUTCOME MEASURES: Proportion of patients returning to their preoperative IIEF-EF category (22-25 or ≥26) at the end of DBT, DFW, and OLT.
RESULTS: Overall, 92.4% of patients had pre-surgery (baseline) IIEF-EF scores ≥26 (tadalafil OaD 94.2%, PRN 91.6%, placebo 91.5%), 7.4% had IIEF-EF 22-25. At the end of DBT, 22.3% of patients on tadalafil OaD had achieved "back-to-baseline" IIEF-EF, compared with 11.3% on tadalafil PRN and 7.8% on placebo. Of all 58 patients "back-to-baseline" at the end of DBT, only 1 PRN-group patient had started from a baseline IIEF-EF <26. The treatment-group difference at the end of DBT was not maintained after DFW. After 3 months of OLT with tadalafil OaD, the proportion of patients with "back-to-baseline" IIEF-EF had almost doubled in all 3 groups.
CONCLUSION: Changing the definition for EF-recovery from IIEF-EF ≥22 to the more strict definition of "returning back-to-baseline IIEF-EF" had no major impact. Tadalafil OaD started early after nsRP improved drug-assisted EF, but had no effect on unassisted EF following treatment cessation after 9 months.
Rapid and Complete Remission of Metastatic Adrenocortical Carcinoma Persisting 10 Years After Treatment With Mitotane Monotherapy: Case Report and Review of the Literature.
Medicine (Baltimore). 2016; 95(13):e3180 [PubMed] Article available free on PMC after 01/09/2017 Related Publications
Assessing the EORTC QLQ-BM22 Module Using Rasch Modeling and Confirmatory Factor Analysis across Countries: a Comprehensive Psychometric Evaluation in Patients with Bone Metastases.
Asian Pac J Cancer Prev. 2016; 17(3):1405-10 [PubMed] Related Publications
MATERIALS AND METHODS: A total of 573 patients with bone metastases were enrolled from eight countries with a mean±SD age of 55.8±13.7 years. Slightly more than two thirds of them were female (n=383; 66.8%). CFA was used to examine the BM22 framework; Rasch models were applied to understand misfit items and differential item functioning (DIF).
RESULTS: The fit indices were satisfactory in CFA (comparative fit index=0.972, Tucker-Lewis index=0.964, root mean square error of approximation=0.076, and standardized root mean square residual=0.045). All items fit well in the Rasch models (mean square values were between 0.5 and 1.5), and only one item (number 17) displayed DIF across gender. However, there were six DIF items across Canada and Taiwan, ten across Canada and Iran, and six across Taiwan and Iran.
CONCLUSIONS: The BM22 has satisfactory psychometric properties, and could assess the QoL of patients with bone metastases specifically focusing on their symptoms. Clinicians may want to use it to capture the underlying QoL for patients with bone metastases. However, the score of item 17 should be interpreted with caution when comparing male and female patients. In addition, researchers should note that variation in DIF items may occur when conducting an international study.
Determining the natural history of pancreatic cystic neoplasms: a Manitoban cohort study.
HPB (Oxford). 2016; 18(4):383-8 [PubMed] Article available free on PMC after 01/09/2017 Related Publications
METHODS: All adult patients (age 18+) with PCN seen between 2000 and 2012 by the two main institutions in Manitoba were included in this study. PCN were graded as high and low risk, which dictated initial treatment plan (surgery or observation). Predictors of initial surgical treatment, delayed surgery in the observation group and the clinical/radiological predictors of malignancy were determined.
RESULTS: 497 patients were included in this study. 43 (8.7%) high-risk lesions underwent initial surgery, with 13 (30.2%) cases of malignancy discovered. 450 (90.5%) low-risk cysts were observed for a median of 17.3 months (range: 0.00-142.3). 29 (6.4%) cases of delayed surgery occurred, with malignancy discovered in five (17.2%).
CONCLUSIONS: This study supports current selection criteria for management of PCNs. Due to the low incidence of malignancy in low-risk PCN, it appears that long-term observation is safe and should be the treatment modality of choice in the absence of high-risk features.