Current Oncology

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Open AccessLetter

Response to: What Is the Optimal Management of Dysphagia in Metastatic Esophageal Cancer?

by Wael C. Hanna and Lorenzo E. Ferri

Curr. Oncol. 2012, 19(6), 502; https://doi.org/10.3747/co.19.1179 - 01 Dec 2012

Viewed by 375

We appreciate the comments and elegant statistical analysis by Dr. Cavallin and others, but we believe that they miss the forest for the trees. [...] Full article

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Open AccessLetter

What Is the Optimal Management of Dysphagia in Metastatic Esophageal Cancer?

by Francesco Cavallin, Marco Scarpa, Matteo Cagol, Rita Alfieri and Carlo Castoro

Curr. Oncol. 2012, 19(6), 501; https://doi.org/10.3747/co.19.1153 - 01 Dec 2012

Cited by 2 | Viewed by 379

Abstract

Hanna et al. investigated the improvement in dysphagia score (ds) in inoperable esophageal cancer treated with endoluminal stenting or radiation therapy. [...] Full article

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Open AccessCase Report

Perianal Paget disease treated definitively with radiotherapy

by J. Mann, A. Lavaf, A. Tejwani, P. Ross and H. Ashamalla

Curr. Oncol. 2012, 19(6), 496-500; https://doi.org/10.3747/co.19.1144 - 01 Dec 2012

Cited by 11 | Viewed by 639

Abstract

Extramammary Paget disease (EMPD) is a relatively rare cutaneous disorder described as an apocrine gland tumour occurring in both a benign and a malignant form with metastatic potential. The areas of the body affected are the vulva, perianal region, penis, scrotum, [...] Read more.

Extramammary Paget disease (EMPD) is a relatively rare cutaneous disorder described as an apocrine gland tumour occurring in both a benign and a malignant form with metastatic potential. The areas of the body affected are the vulva, perianal region, penis, scrotum, perineum, and axilla, all of which contain apocrine glands. When EMPD affects the perianal region, it is called perianal Paget disease (PPD). All forms of EMPD, including PPD, are typically treated by wide surgical excision. Perianal Paget disease usually occurs later in life in patients who are often poor surgical candidates, but the available literature is scarce regarding other treatment modalities, including definitive radiotherapy. We contend that PPD can be safely and effectively treated with radiotherapy, and here, we present the case of a 75-year-old woman with PPD who was successfully so treated. A brief review of the literature concerning the diagnosis, natural history, and treatment of PPD is also included. Full article

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Open AccessCase Report

The Pedicled Myocutaneous Flap as a Choice Reconstructive Technique for Immediate Adjuvant Brachytherapy in Sarcoma Treatment

by S.C. Saba, A. Shaterian, C. Tokin, M.K. Dobke and A.M. Wallace

Curr. Oncol. 2012, 19(6), 491-495; https://doi.org/10.3747/co.19.1141 - 01 Dec 2012

Cited by 6 | Viewed by 457

Abstract

Successful treatment of soft-tissue sarcomas is highly dependent on total tumour resection coupled with adjuvant radiation therapy to achieve local control and decrease recurrence. Reconstruction of soft-tissue defects after resection aims to cover vital structures, while providing enough stable tissue to withstand adjuvant [...] Read more.

Successful treatment of soft-tissue sarcomas is highly dependent on total tumour resection coupled with adjuvant radiation therapy to achieve local control and decrease recurrence. Reconstruction of soft-tissue defects after resection aims to cover vital structures, while providing enough stable tissue to withstand adjuvant brachytherapy treatment. In the present study, pedicled myocutaneous flaps were used as a vital adjunct in the treatment of soft-tissue sarcoma, and our experience with 2 such patients is described. The flaps served to reconstruct large three-dimensional defects while providing stable coverage over brachytherapy hardware to allow for delivery of radiation in the immediate postoperative period. Pedicled locoregional myocutaneous flaps provide a safe, easy, and reliable reconstructive technique in the treatment of soft-tissue sarcoma. Full article

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Open AccessReview

Treatment of Metastatic Spinal Cord Compression: cepo Review and Clinical Recommendations

by S. L’Espérance, F. Vincent, M. Gaudreault, J.A. Ouellet, M. Li, A. Tosikyan, S. Goulet and

Curr. Oncol. 2012, 19(6), 478-490; https://doi.org/10.3747/co.19.1128 - 01 Dec 2012

Cited by 41 | Viewed by 879

Abstract

Background: Metastatic spinal cord compression (MSCC) is an oncologic emergency that, unless diagnosed early and treated appropriately, can lead to permanent neurologic impairment. After an analysis of relevant studies evaluating the effectiveness of various treatment modalities, the Comité de l’évolution [...] Read more.

Background: Metastatic spinal cord compression (MSCC) is an oncologic emergency that, unless diagnosed early and treated appropriately, can lead to permanent neurologic impairment. After an analysis of relevant studies evaluating the effectiveness of various treatment modalities, the Comité de l’évolution des pratiques en oncologie (CEPO) made recommendations on MSCC management. Method: A review of the scientific literature published up to February 2011 considered only phase II and III trials that included assessment of neurologic function. A total of 26 studies were identified. Recommendations: Considering the evidence available to date, CEPO recommends that (1) cancer patients with MSCC be treated by a specialized multidisciplinary team. (2) dexamethasone 16 mg daily be administered to symptomatic patients as soon as MSCC is diagnosed or suspected. (3) high-loading-dose corticosteroids be avoided. (4) histopathologic diagnosis and scores from scales evaluating prognosis and spinal instability be considered before treatment. (5) corticosteroids and chemotherapy with radiotherapy be offered to patients with spinal cord compression caused by myeloma, lymphoma, or germ cell tumour without sign of spinal instability or compression by bone fragment. (6) short-course radiotherapy be administered to patients with spinal cord compression and short life expectancy. (7) long-course radiotherapy be administered to patients with inoperable spinal cord compression and good life expectancy. (8) decompressive surgery followed by long-course radiotherapy be offered to appropriate symptomatic MSCC patients (including spinal instability, displacement of vertebral fragment); and (9) patients considered for surgery have a life expectancy of at least 3–6 months. Full article

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Open AccessArticle

Report from the 13th Annual Western Canadian Gastrointestinal Cancer Consensus Conference; Calgary, Alberta; September 8–10, 2011

by M.M. Vickers, J. Pasieka, E. Dixon, S. McEwan, A. McKay, D. Renouf, D. Schellenberg and D. Ruether

Curr. Oncol. 2012, 19(6), 468-477; https://doi.org/10.3747/co.19.1167 - 01 Dec 2012

Cited by 1 | Viewed by 481

Abstract

The 13th annual Western Canadian Gastrointestinal Cancer Consensus Conference was held in Calgary, Alberta, September 8–10, 2011. Health care professionals involved in the care of patients with gastrointestinal cancers participated in presentation and discussion sessions for the purposes of developing the recommendations presented [...] Read more.

The 13th annual Western Canadian Gastrointestinal Cancer Consensus Conference was held in Calgary, Alberta, September 8–10, 2011. Health care professionals involved in the care of patients with gastrointestinal cancers participated in presentation and discussion sessions for the purposes of developing the recommendations presented here. This consensus statement addresses current issues in the management neuroendocrine tumours and locally advanced pancreatic cancer. Full article

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Open AccessReview

Melanoma Prevention: Are We Doing Enough? A Canadian Perspective

by A.M. Joshua

Curr. Oncol. 2012, 19(6), 462-467; https://doi.org/10.3747/co.19.1222 - 01 Dec 2012

Cited by 14 | Viewed by 624

Abstract

Melanoma is the most dangerous form of skin cancer, and its incidence is increasing significantly among Canadians. In parallel with the rising incidence and morbidity, the financial burden caused by this disease will continue to increase dramatically for the government and for individuals [...] Read more.

Melanoma is the most dangerous form of skin cancer, and its incidence is increasing significantly among Canadians. In parallel with the rising incidence and morbidity, the financial burden caused by this disease will continue to increase dramatically for the government and for individuals alike. More concerted effort to raise awareness of melanoma in Canada is therefore needed. Risk factors—such as family history, childhood sunburn exposure, and age—play a significant role in an individual’s likelihood to develop melanoma. Ultraviolet radiation exposure is the most modifiable variable in melanoma causation. It is therefore important for the general public, in particular the country’s youth, to understand the consequences of lifestyle choices—especially tanning bed use and “sun worshipping.” Many of these issues are not being addressed fully at either the national or the provincial level, with Canadian efforts trailing those of other nations facing similar challenges. Canada also has workforce issues, with an inadequate distribution and number of physicians who can detect and treat melanoma at an early curative stage. With proper education and public awareness, melanoma prevention can be an achievable goal in Canada. Full article

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Open AccessReview

A Systematic Review of Integrative Oncology Programs

by D.M. Seely, L.C. Weeks and S. Young

Curr. Oncol. 2012, 19(6), 436-461; https://doi.org/10.3747/co.19.1182 - 01 Dec 2012

Cited by 53 | Viewed by 1219

Abstract

Objective: This systematic review set out to summarize the research literature describing integrative oncology programs. Methods: Searches were conducted of 9 electronic databases, relevant journals (hand searched), and conference abstracts, and experts were contacted. Two investigators independently screened titles and abstracts [...] Read more.

Objective: This systematic review set out to summarize the research literature describing integrative oncology programs. Methods: Searches were conducted of 9 electronic databases, relevant journals (hand searched), and conference abstracts, and experts were contacted. Two investigators independently screened titles and abstracts for reports describing examples of programs that combine complementary and conventional cancer care. English-, French-, and German-language articles were included, with no date restriction. From the articles located, descriptive data were extracted according to 6 concepts: description of article, description of clinic, components of care, administrative structure, process of care, and measurable outcomes used. Results: Of the 29 programs included, most were situated in the United States (n = 12, 41%) and England (n = 10, 34%). More than half (n = 16, 55%) operate within a hospital, and 7 (24%) are community-based. Clients come through patient self-referral (n = 15, 52%) and by referral from conventional health care providers (n = 9, 31%) and from cancer agencies (n = 7, 24%). In 12 programs (41%), conventional care is provided onsite; 7 programs (24%) collaborate with conventional centres to provide integrative care. Programs are supported financially through donations (n = 10, 34%), cancer agencies or hospitals (n = 7, 24%), private foundations (n = 6, 21%), and public funds (n = 3, 10%). Nearly two thirds of the programs maintain a research (n = 18, 62%) or evaluation (n = 15, 52%) program. The research literature documents a growing number of integrative oncology programs. These programs share a common vision to provide whole-person, patient-centred care, but each program is unique in terms of its structure and operational model. Full article

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Open AccessArticle

Improving the Quality of Abstract Reporting for Economic Analyses in Oncology

by M.Y. Ho, K.K. Chan, S. Peacock and W.Y. Cheung

Curr. Oncol. 2012, 19(6), 428-435; https://doi.org/10.3747/co.19.1152 - 01 Dec 2012

Cited by 4 | Viewed by 401

Abstract

Background: he increasing cost of cancer drugs underscores the importance of economic analyses. Although guide-lines for abstract reporting of randomized controlled studies and phase i trials are available, similar rec-ommendations for conference abstracts of economic analyses are lacking. Our objectives were (1) [...] Read more.

Background: he increasing cost of cancer drugs underscores the importance of economic analyses. Although guide-lines for abstract reporting of randomized controlled studies and phase i trials are available, similar rec-ommendations for conference abstracts of economic analyses are lacking. Our objectives were (1) to identify items considered to be essential in abstracts of economic analyses; (2) to evaluate the quality of abstracts submitted to the American Society of Clinical Oncology (asco), the American Society of Hematology (ash), and the International Society for Pharma-coeconomics and Outcomes Research (ispor) meetings; and (3)to propose guidelines for future abstract reporting at conferences. Methods: Health economic experts were surveyed and asked to rate each of 24 possible abstract elements on a 5-point Likert scale. A scoring system for abstract quality was devised based on elements with an average ex-pert rating of 3.5 or greater. Abstracts for economic analyses from asco, ash, and ispor meetings were reviewed and assigned a quality score. Results: Of 99 experts, 50 (51%) responded to the survey (av-erage age: 53 years; 78% men; 54% from the United States, 28% from Europe, 18% from Canada). In total, 216 abstracts were reviewed: asco, 53%; ash, 14%; and ispor, 33%. The median quality score was 75, but notable deficiencies were observed. Cost per-spective was reported in only 61% of abstracts, and time horizon was described in only 47%. Abstracts from recent years demonstrated better quality scores. We also observed disparities in quality scores for various cancer sites (p = 0.005). Conclusions: The quality of conference abstracts for economic analyses in oncology has room for improvement. Abstracts may be enhanced using the guidelines derived from our survey of experts. Full article

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Open AccessArticle

Improving Referral of Patients for Consideration of Adjuvant Chemotherapy after Surgical Resection of Lung Cancer

by J.A. Zuccato and P.M. Ellis

Curr. Oncol. 2012, 19(6), 422-427; https://doi.org/10.3747/co.19.1133 - 01 Dec 2012

Cited by 4 | Viewed by 467

Abstract

Background: Clinical trials demonstrate improved survival for patients with completely resected non-small-cell lung cancer (NSCLC) who receive adjuvant chemotherapy. Concerns have been raised about the implementation of those data. The present study measured rates of referral for adjuvant chemotherapy and [...] Read more.

Background: Clinical trials demonstrate improved survival for patients with completely resected non-small-cell lung cancer (NSCLC) who receive adjuvant chemotherapy. Concerns have been raised about the implementation of those data. The present study measured rates of referral for adjuvant chemotherapy and barriers to referral, and it also evaluated a knowledge translation strategy to change practice. Methods: An audit and feedback approach was used. Using a retrospective cohort of patients undergoing thoracotomy at St. Joseph’s Hospital in Hamilton, Ontario, during January–December 2008, anonymized data were presented to a group of thoracic surgeons for evaluation and feedback. Results: Among 150 thoracotomies performed, 55 patients with NSCLC were potentially eligible for adjuvant chemotherapy, but only 27 (49%) were referred for it. Significant variability in referral between surgeons (19%–100%) was observed. Reasons for non-referral were poorly documented in the medical record, but appeared to be primarily the surgeon’s decision. The feedback session with surgeons produced a number of constructive suggestions to implement change in practice. Conclusions: Our findings suggest that surgeon choice was the most significant barrier to implementation of adjuvant chemotherapy for nsclc. Audit and feedback was a useful knowledge translation strategy. However, longer follow-up is needed to document change in practice. Full article

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Open AccessArticle

Prospective Validation of Risk Prediction Indexes for Acute and Delayed Chemotherapy-Induced Nausea and Vomiting

by N. Bouganim, G. Dranitsaris, S. Hopkins, L. Vandermeer, L. Godbout, S. Dent, P. Wheatley–Price, C. Milano and M. Clemons

Curr. Oncol. 2012, 19(6), 414-421; https://doi.org/10.3747/co.19.1074 - 01 Dec 2012

Cited by 43 | Viewed by 849

Abstract

Background: Despite the use of standardized anti-emetic guidelines, up to 20% of cancer patients suffer from moderate-to-severe chemotherapy-induced nausea and vomiting (CINV)—that is, grade 2 or greater according to the U.S. National Cancer Institute Common Terminology Criteria for Adverse Events [...] Read more.

Background: Despite the use of standardized anti-emetic guidelines, up to 20% of cancer patients suffer from moderate-to-severe chemotherapy-induced nausea and vomiting (CINV)—that is, grade 2 or greater according to the U.S. National Cancer Institute Common Terminology Criteria for Adverse Events, version 4.0. We previously developed cycle-based prediction models and associated scoring systems for acute and delayed CINV. As part of the validation process, we prospectively evaluated the ability of the scoring systems to accurately identify patients deemed to be high risk for grade 2 or greater CINV. Methods: Patients who were receiving any chemotherapy for solid tumours and who consented to participate were provided with symptom diaries. Compliance to the diaries was enhanced by 24-hour and 5-day telephone callbacks after chemotherapy in every cycle. All patients received anti-emetic prophylaxis as prescribed by the treating physician. Before each cycle of chemotherapy, the acute and delayed CINV scoring systems were used to stratify patients into low- and high-risk groups. Logistic regression modelling was then applied to compare the risk for grade 2 or greater CINV between patients considered to be at high and at low risk. The external validity of each system was also assessed using an area under the receiver operating characteristic curve (AUROC) analysis. Results: We collected CINV outcomes data from 95 patients during 181 cycles of chemotherapy. The incidence of grade 2 or greater acute and delayed CINV was 17.7% and 18.2% respectively. As previously identified, major predictors for grade 2 or greater CINV included younger patient age, platinum- or anthracycline-based chemotherapy, low alcohol consumption, earlier cycles of chemotherapy, previous history of morning sickness, and prior emetic episodes after chemotherapy. The acute and delayed scoring systems both had good predictive accuracy when applied to the external validation sample (acute—auroc: 0.69; 95% confidence interval: 0.59 to 0.79; delayed—AUROC: 0.70; 95% confidence interval: 0.60 to 0.80). Patients identified by the scoring systems to be at high risk were 2.8 (p = 0.025) and 3.1 (p = 0.001) times more likely to develop grade 2 or greater acute and delayed CINV. Conclusions: The present study demonstrates that our scoring systems are able to accurately identify patients at high risk for acute and delayed CINV. Application and planned continued refinement of the scoring systems will be an important means of patient-specific risk assessment that will allow for optimization of anti-emetic therapy. Full article

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Open AccessArticle

Disparities in Timeliness of Care for U.S. Medicare Patients Diagnosed with Cancer

by M.T. Halpern and D.J. Holden

Curr. Oncol. 2012, 19(6), 404-413; https://doi.org/10.3747/co.19.1073 - 01 Dec 2012

Cited by 36 | Viewed by 686

Abstract

Background: Timeliness of care (rapid initiation of treatment after definitive diagnosis) is a key component of high-quality cancer treatment. The present study evaluated factors influencing timeliness of care for U.S. Medicare enrollees. Methods: Data for Medicare enrollees diagnosed with breast, colorectal, [...] Read more.

Background: Timeliness of care (rapid initiation of treatment after definitive diagnosis) is a key component of high-quality cancer treatment. The present study evaluated factors influencing timeliness of care for U.S. Medicare enrollees. Methods: Data for Medicare enrollees diagnosed with breast, colorectal, lung, or prostate cancer while living in U.S. seer (Surveillance, Epidemiology and End Results) regions in 2000–2002 were analyzed. Patients were classified as experiencing delayed treatment if the interval between diagnosis and treatment was greater than the 95th percentile for each cancer site. The impacts of patient sociodemographic, clinical, and area-based factors on the likelihood of delayed treatment were analyzed using multivariate logistic regression. Results: Black patients (compared with white patients) and patients initially treated with radiation therapy or chemotherapy (rather than surgery) had a greater likelihood of treatment delays across all four cancer sites. Hispanic status, dual Medicare–Medicaid status, location of initial treatment (inpatient vs. outpatient), and stage at diagnosis also affected timeliness of care for some cancer sites. Surprisingly, area-based factors reflecting availability of cancer care services were not significantly associated with timeliness of care or were associated with greater delays in areas with greater numbers of service providers. Conclusions: Multiple factors affected receipt of timely cancer care for members of the study population, all of whom had coverage of medical care services through Medicare. Because delays in treatment initiation can increase morbidity, decrease quality of life, shorten survival, and result in greater costs, prospective studies and tailored interventions are needed to address those factors among at-risk patient groups. Full article

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Open AccessArticle

Cost-Effectiveness of Zoledronic Acid Compared with Clodronate in Multiple Myeloma

by T.E. Delea, K. El Ouagari, J. Rotter, A. Wang, S. Kaura and G.J. Morgan

Curr. Oncol. 2012, 19(6), 392-403; https://doi.org/10.3747/co.19.1004 - 01 Dec 2012

Cited by 12 | Viewed by 553

Abstract

Background: In the U.K. Medical Research Council Myeloma IX trial (mmix), zoledronic acid 4 mg once every 3–4 weeks, compared with clodronate 1600 mg daily, reduced the incidence of skeletal related events (sres), increased progression-free survival (pfs [...] Read more.

Background: In the U.K. Medical Research Council Myeloma IX trial (mmix), zoledronic acid 4 mg once every 3–4 weeks, compared with clodronate 1600 mg daily, reduced the incidence of skeletal related events (sres), increased progression-free survival (pfs), and prolonged overall survival (os) in 1970 patients with newly-diagnosed multiple myeloma. The incidence of confirmed osteonecrosis of the jaw was higher with zoledronic acid than with clodronate. The objective of the present study was to evaluate, based on the findings in mmix, the cost-effectiveness of zoledronic acid compared with clodronate in patients with newly-diagnosed multiple myeloma. Methods: An economic model was used to project pfs, mmix, the incidence of sres and adverse events, and expected lifetime health care costs for patients with newly diagnosed multiple myeloma who are alternatively assumed to receive zoledronic acid or clodronate. The incremental cost-effectiveness ratio (icer) of zoledronic acid compared with clodronate was calculated as the ratio of the difference in cost to the difference in quality-adjusted life years (qalys). Model inputs were based on results of mmix and published sources. Results were generated under different assumptions regarding the beneficial effects of zoledronic acid on os beyond 5 years after treatment initiation. Results: Assuming lifetime treatment effects of zoledronic acid, treatment with zoledronic acid (compared with clodronate) increased qalys by 0.27 at an additional cost of CA$13,407, yielding an icer of CA$49,829 per qaly gained. If the threshold icer is CA$100,000 per qaly, the estimated probability that zoledronic acid is cost-effective is 80%. Assuming that the benefits of zoledronic acid on pfs and os diminish over 5 years beginning at the end of year 5, the icer is CAN$63,027 per qaly gained. If the benefits of zoledronic acid on pfs and os are assumed to persist for 5 years only, the icer is CAN$76,948 per qaly gained. Conclusions: Compared with clodronate, zoledronic acid represents a cost-effective treatment alternative in patients with multiple myeloma. Full article

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Open AccessArticle

Population-Based Home Care Services in Breast Cancer: Utilization and Costs

by N. Mittmann, P.K. Isogai, R. Saskin, N. Liu, J.M. Porter, M.C. Cheung, N.B. Leighl, J.S. Hoch, M.E. Trudeau, W.K. Evans, K.N. Dainty and C.C. Earle

Curr. Oncol. 2012, 19(6), 383-391; https://doi.org/10.3747/co.19.1078 - 01 Dec 2012

Cited by 14 | Viewed by 540

Abstract

Objective: To determine utilization and costs of home care services (HCS) for individuals with a diagnosis of breast cancer (BC). Methods: Incident cases of invasive BC in women were extracted from the Ontario Cancer Registry (2005–2009) and [...] Read more.

Objective: To determine utilization and costs of home care services (HCS) for individuals with a diagnosis of breast cancer (BC). Methods: Incident cases of invasive BC in women were extracted from the Ontario Cancer Registry (2005–2009) and linked with other Ontario health care administrative databases. Control patients were selected from the population of women never diagnosed with any type of cancer. The types and proportions of HCS used were determined and stratified by disease stage. Attributable home care utilization and costs for BC patients were determined. Factors associated with HCS costs were assessed using regression analysis. Results: Among the 39,656 BC and 198,280 control patients identified (median age: 61.6 years for both), 75.4% of BC patients used HCS (62.1% stage I; 85.7% stage II; 94.6% stage III; 79.1% stage IV) compared with 14.6% of control patients. The number of HCS used per patient–year were significantly higher for the BC patients than for the control patients (14.97 vs. 6.13, p < 0.01), resulting in higher costs per patient–year ($1,210 vs. $325; $885 attributable cost to BC, p < 0.01). The number of HCS utilized and the associated costs increased as the BC stage increased. In contrast, HCS costs decreased as income increased and as previous health care exposure decreased. Interpretation: Patients with BC used twice as many HCS, resulting in costs that were almost 4 times those observed in a matched control group. Less than an additional $1000 per BC patient per year were spent on HCS utilization in the study population. Full article

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Open AccessCommentary

Disparity in Cancer Care: A Canadian Perspective

by S. Ahmed and R.K. Shahid

Curr. Oncol. 2012, 19(6), 376-382; https://doi.org/10.3747/co.19.1177 - 01 Dec 2012

Cited by 54 | Viewed by 1721

Abstract

Canada is facing cancer crisis. Cancer has become the leading cause of death in Canada. Despite recent advances in cancer management and research, growing disparities in cancer care have been noticed, especially in socio-economically disadvantaged groups and under-served communities. With the rising incidence [...] Read more.

Canada is facing cancer crisis. Cancer has become the leading cause of death in Canada. Despite recent advances in cancer management and research, growing disparities in cancer care have been noticed, especially in socio-economically disadvantaged groups and under-served communities. With the rising incidence of cancer and the increasing numbers of minorities and of social disparities in general, and without appropriate interventions, cancer care disparities will become only more pronounced. This paper highlights the concepts and definitions of equity in health and health care and examines several health determinants that increase the risk of cancer. It also reviews cancer care inequity in the high-risk groups. A conceptual framework is proposed and recommendations are made for the eradication of disparities within the health care system and beyond. Full article

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Open AccessShort Communication

Febrile Neutropenia Rates with Adjuvant Docetaxel and Cyclophosphamide Chemotherapy in Early Breast Cancer: Discrepancy between Published Reports and Community Practice—An Opdated Analysis

by J. Younus, T. Vandenberg, M. Jawaid and M.A. Jawaid

Curr. Oncol. 2012, 19(6), 332-334; https://doi.org/10.3747/co.19.1174 - 01 Dec 2012

Cited by 19 | Viewed by 441

Abstract

Chemotherapy in the adjuvant setting for early breast cancer (EBC) has improved disease-free and overall survival, with benefits extended to elderly patients and to those with lymph-node-negative pathology. [...] Full article

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Open AccessReview

A Retrospective Chart Review Validates Indicator Results and Provides Insight into Reasons for Non-Concordance with Evidence-Based Guidelines

by J. Klein–Geltink, T. Forte, R. Rahal, J. Niu, D. He, G. Lockwood, W. Cheung, G. Darling and H. Bryant

Curr. Oncol. 2012, 19(6), 329-331; https://doi.org/10.3747/co.19.1224 - 01 Dec 2012

Viewed by 332

Abstract

As part of the system performance initiative of the Canadian Partnership Against Cancer, indicators measuring treatment practice patterns across the country relative to evidence-based guidelines were first published in 2010 and are updated annually. Among the treatment indicators examined is the percentage of [...] Read more.

As part of the system performance initiative of the Canadian Partnership Against Cancer, indicators measuring treatment practice patterns across the country relative to evidence-based guidelines were first published in 2010 and are updated annually. Among the treatment indicators examined is the percentage of resected stage ii and iii rectal cancer patients receiving neoadjuvant (preoperative) radiation therapy (RT), the treatment approach recommended for locally advanced rectal cancer Full article

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Open AccessReview

Ubiquitin Pathway and Ovarian Cancer

by Z. Rao and Y. Ding

Curr. Oncol. 2012, 19(6), 324-328; https://doi.org/10.3747/co.19.1175 - 01 Dec 2012

Cited by 5 | Viewed by 486

Abstract

The ubiquitin–proteasome pathway is a common cellular process in eukaryotic tissue. Ubiquitin binds to proteins and tags them for destruction; this tagging directs proteins to the proteosome in the cell that degrades and recycles unneeded pro-teins. The ubiquitin–proteasome pathway plays an important role [...] Read more.

The ubiquitin–proteasome pathway is a common cellular process in eukaryotic tissue. Ubiquitin binds to proteins and tags them for destruction; this tagging directs proteins to the proteosome in the cell that degrades and recycles unneeded pro-teins. The ubiquitin–proteasome pathway plays an important role in the regulation of cellular proteins with respect to cell cycle control, transcription, apoptosis, cell adhesion, angiogenesis, and tumour growth. This review article discusses the various ways that the ubiquitin pathway is involved in ovarian cancer, such as modulating the ovarian-cancer-related gene BRCA1 and tumour suppres-sor p53, and interfering with the ERK pathway, the cyclin-dependent cell cycle regulation process, and ERBB2 gene expression. Full article

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Open AccessReview

Testing for HER2 in Breast Cancer: Current Pathology Challenges Faced in Canada

by W. Hanna, P. Barnes, R. Berendt, M. Chang, A. Magliocco, A.M. Mulligan, H. Rees, N. Miller, L. Elavathil, B. Gilks, N. Pettigrew, D. Pilavdzic and S. SenGupta

Curr. Oncol. 2012, 19(6), 315-323; https://doi.org/10.3747/co.19.1173 - 01 Dec 2012

Cited by 10 | Viewed by 455

Abstract

This review is designed to highlight several key challenges in the diagnosis of human epidermal growth factor receptor 2 (HER2)–positive breast cancer currently faced by pathologists in Canada: (1) Pre-analysis issues affecting the accuracy of HER2 testing in non-excision sample [...] Read more.

This review is designed to highlight several key challenges in the diagnosis of human epidermal growth factor receptor 2 (HER2)–positive breast cancer currently faced by pathologists in Canada: (1) Pre-analysis issues affecting the accuracy of HER2 testing in non-excision sample types: core-needle biopsies, effusion samples, fine-needle aspirates, and bone metastases (2) HER2 testing of core-needle biopsies compared with surgical specimens (3) Criteria for retesting HER2 status upon disease recurrence. Literature searches for each topic were carried out using the MEDLINE, Embase, International Pharmaceutical Abstracts, and biosis databases. In addition, the congress databases of the American Society of Clinical Oncology (2005–2011) and the San Antonio Breast Cancer Symposium (2007–2011) were searched for relevant abstracts. All authors are expert breast pathologists with extensive experience of HER2 testing, and several participated in the development of Canadian HER2 testing guidelines. For each topic, the authors present an evaluation of the current data available for the guidance of pathology practice, with recommendations for the optimization or improvement of HER2 testing practice. Full article

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Open AccessArticle

Extended Adjuvant Temozolomide with cis-Retinoic Acid for Adult Glioblastoma

by M.W. Pitz, M. Lipson, B. Hosseini, P. Lambert, K. Guilbert, D. Lister, G. Schroeder, K. Jones, C. Mihalicioiu and D.D. Eisenstat

Curr. Oncol. 2012, 19(6), 308-314; https://doi.org/10.3747/co.19.1151 - 01 Dec 2012

Cited by 9 | Viewed by 502

Abstract

Objective: To determine the toxicity and effectiveness of 24 months of adjuvant temozolomide (TMZ) with cis-retinoic acid (CRA) for patients with glioblastoma. Methods: This retrospective population-based review considered the charts of all patients diagnosed with glioblastoma [...] Read more.

Objective: To determine the toxicity and effectiveness of 24 months of adjuvant temozolomide (TMZ) with cis-retinoic acid (CRA) for patients with glioblastoma. Methods: This retrospective population-based review considered the charts of all patients diagnosed with glioblastoma in Manitoba and referred to a provincial cancer centre during 2002–2008. Consecutive patients came from a population-based referral centre and provincial cancer registry. All patients were treated according to the local standard of care with surgical resection followed by concurrent radiotherapy and TMZ 75 mg/m² daily, followed by TMZ 150–200 mg/m² for days 1–5, repeated every 28 days for up to 24 cycles, and CRA 50 mg/m² twice daily for days 1–21, repeated every 28 days. The main outcome measures were safety, tolerability, and effectiveness of long-term TMZ and CRA. Results: Of 247 patients diagnosed with glioblastoma in Manitoba during the study period, 116 started concurrent chemoradiotherapy, and 80 received adjuvant TMZ. Of the patients who started concurrent chemoradiotherapy, 80 began adjuvant chemotherapy. Patients completed a median of 5.5 cycles of TMZ and 3 cycles of CRA. Grade 3 or 4 hematologic toxicity was noted in 16% of patients. Median overall survival was 15.1 months, and 26.7% of patients remained alive at 2 years. Conclusions: Extended adjuvant TMZ and CRA is well tolerated. However, the population-based effectiveness of this regimen is similar to the clinical trial efficacy of 6 months of adjuvant TMZ. Future studies in glioblastoma should incorporate duration of adjuvant chemotherapy into the study design. Full article

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Open AccessArticle

Clinicopathologic Characteristics and Survival Outcomes of Patients with Advanced Esophageal, Gastroesophageal Junction, and Gastric Adenocarcinoma: A Single-Institution Experience

by A. Dechaphunkul, K. Mulder, F. El-Gehani, S. Ghosh, J. Deschenes and J. Spratlin

Curr. Oncol. 2012, 19(6), 302-307; https://doi.org/10.3747/co.19.1081 - 01 Dec 2012

Cited by 3 | Viewed by 448

Abstract

Most patients with gastric or gastroesophageal junction (GEJ) cancer are diagnosed with inoperable advanced or metastatic disease. In these cases, chemotherapy is the only treatment demonstrating survival benefit. The present study compares clinicopathologic characteristics and survival outcomes for patients with advanced [...] Read more.

Most patients with gastric or gastroesophageal junction (GEJ) cancer are diagnosed with inoperable advanced or metastatic disease. In these cases, chemotherapy is the only treatment demonstrating survival benefit. The present study compares clinicopathologic characteristics and survival outcomes for patients with advanced esophageal, GEJ, and gastric adenocarcinoma treated with first-line chemotherapy [epirubicin–cisplatin–5-fluorouracil (ECF), epirubicin–cisplatin–capecitabine (ECX), or etoposide–leucovorin–5-fluorouracil (ELF)] or best supportive care (BSC) at our institution with those for historical controls. Methods: We retrospectively reviewed medical information for 401 patients with newly diagnosed advanced esophageal, GEJ, or gastric adenocarcinoma treated with first-line chemotherapy (ECF, ECX, or ELF) or BSC from January 1, 2004, through December 31, 2010. Descriptive statistics were used to compare the data collected with data for historical control patients. Results: Of the study patients, 93% were diagnosed with metastatic disease (n = 374), and 63% received BSC only (n = 251). The main reasons that patients received BSC only included poor Eastern Cooperative Oncology Group performance status (55%), patient decision (31%), and comorbidities (14%). Of the remaining patients, 98 (24%) received ECF or ECX and 52 (13%) received ELF as first-line treatment. Median overall survival was significantly longer in patients treated with ECF or ECX or with ELF than in those receiving BSC (12.7 months vs. 12.7 months vs. 5.5 months respectively). Chemotherapy also significantly reduced the risk of death (64% reduction with ECF or ECX, 58% with ELF). Conclusions: We confirmed the substantial overall survival benefit of combination chemotherapy compared with BSC, with better survival in our patient population than in historical controls. However, novel treatment options are still warranted to improve outcomes in this patient population. Full article

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Open AccessArticle

Views of Breast and Colorectal Cancer Survivors on Their Routine Follow-Up Care

by R. Urquhart, A. Folkes, J. Babineau and E. Grunfeld

Curr. Oncol. 2012, 19(6), 294-301; https://doi.org/10.3747/co.19.1051 - 01 Dec 2012

Cited by 34 | Viewed by 709

Abstract

Objective: Our understanding of optimum health care delivery for cancer survivors is limited by the lack of a patient-centred perspective. The objectives of the present study were to explore the views of breast and colorectal cancer survivors on their routine follow-up care, [...] Read more.

Objective: Our understanding of optimum health care delivery for cancer survivors is limited by the lack of a patient-centred perspective. The objectives of the present study were to explore the views of breast and colorectal cancer survivors on their routine follow-up care, with respect to needs, preferences, and quality of follow-up, and their views on cancer specialist– compared with family physician (FP)–led follow-up care. Methods: In Nova Scotia, Canada, 23 cancer survivors (13 breast, 10 colorectal) participated in either a focus group or a one-on-one interview. Participants were asked to reflect upon their lives as cancer survivors and on the type and quality of care and support they received during the follow-up period. Each focus group or interview was transcribed verbatim, and the transcripts were audited and subjected to a thematic analysis. Results: Six themes were identified: (1) My care is my responsibility; (2) How I receive information on follow-up care; (3) I have many care needs; (4) I want to be prepared and informed; (5) The role of my FP in my cancer experience and follow-up care; (6) The role of media Survivors often characterized the post–primary treatment experience as lacking in information and preparation for follow-up and providing inadequate support to address many of the care needs prevalent in survivor populations. Despite valuing fp participation in follow-up care, many survivors continued to receive comfort and reassurance from specialist care. Conclusions: Our findings point to the need to implement strategies that better prepare breast cancer and colorectal cancer survivors for post-treatment care and that reassure survivors of the ability of their FP to provide quality care during this period. Full article

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Curr. Oncol., Volume 19, Issue 6 (December 2012) – 22 articles

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