Current Oncology

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Open AccessArticle

by E. Aitini

Curr. Oncol. 2015, 22(4), 323-324; https://doi.org/10.3747/co.22.2282 - 01 Aug 2015

Viewed by 416

The young branches of the poplar trees moved lazily, wrapped in the pale blue spring, embraced by a soft breeze. [...] Full article

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Open AccessLetter

Increased Treatment-Related Toxicity Subsequent to an Anti–PD-1 Agent

by Leila Khoja, Marcus Ortho Butler, Mary Anne Chappell, David Hogg and Anthony M. Joshua

Curr. Oncol. 2015, 22(4), 320-322; https://doi.org/10.3747/co.22.2418 - 01 Aug 2015

Cited by 6 | Viewed by 471

Abstract

The approval of ipilimumab [...] Full article

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Open AccessCase Report

Unusual Presentation of Metastatic Sebaceous Crcinoma and Its Response to Chemotherapy: Is Genotyping a Right Answer for Guiding Chemotherapy in Rare Tumours?

by V. Kumar and Y. Xu

Curr. Oncol. 2015, 22(4), 316-319; https://doi.org/10.3747/co.22.2467 - 01 Aug 2015

Cited by 19 | Viewed by 606

Abstract

Sebaceous carcinoma is a rare malignant tumour of skin. It commonly occurs in the head and neck region. The standard of care for localized disease is wide local excision followed by radiotherapy. Occasionally, sebaceous carcinoma can be associated with Muir–Torre syndrome, which is [...] Read more.

Sebaceous carcinoma is a rare malignant tumour of skin. It commonly occurs in the head and neck region. The standard of care for localized disease is wide local excision followed by radiotherapy. Occasionally, sebaceous carcinoma can be associated with Muir–Torre syndrome, which is characterized by sebaceous lesions and carcinomas in the visceral organs. Metastatic sebaceous carcinoma is even rarer, with very little evidence about the role of chemotherapy in the treatment of metastatic disease. Here, we report a case of recurrent sebaceous carcinoma metastatic to the rectum (initially mimicking rectal cancer and Muir–Torre syndrome) in which the disease responded to multiple lines of chemotherapy. We also review the available literature on chemotherapy in this disease and discuss the role of tumour profiling and genotypeguided selection of chemotherapeutics in such rare tumours. Full article

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Open AccessArticle

Eastern Canadian Gastrointestinal Cancer Consensus Conference 2014

by E. Tsvetkova, S. Sud, N. Aucoin, J. Biagi, R. Burkes, B. Samson, S. Brule, C. Cripps, B. Colwell, C. Falkson, M. Dorreen, R. Goel, F. Halwani, J. Maroun, N. Michaud, M. Tehfe, M. Thirlwell, M. Vickers and T. Asmis

Curr. Oncol. 2015, 22(4), 305-315; https://doi.org/10.3747/co.22.2603 - 01 Aug 2015

Cited by 1 | Viewed by 509

Abstract

The annual Eastern Canadian Colorectal Cancer Consensus Conference was held in Montreal, Quebec, 23–25 October 2014. Expert radiation, medical, and surgical oncologists and pathologists involved in the management of patients with gastrointestinal malignancies participated in presentations and discussions resulting in consensus statements on [...] Read more.

The annual Eastern Canadian Colorectal Cancer Consensus Conference was held in Montreal, Quebec, 23–25 October 2014. Expert radiation, medical, and surgical oncologists and pathologists involved in the management of patients with gastrointestinal malignancies participated in presentations and discussions resulting in consensus statements on such hot topics as management of neuroendocrine tumours, advanced and metastatic pancreatic cancer, and metastatic colorectal cancer. Full article

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Open AccessCase Report

Dasatinib for a Child with Philadelphia Chromosome–Positive Acute Lymphoblastic Leukemia and Persistently Elevated Minimal Residual Disease during Imatinib Therapy

by K.H. Wu, H.P. Wu, T. Weng, C.T. Peng and Y.H. Chao

Curr. Oncol. 2015, 22(4), 303-306; https://doi.org/10.3747/co.22.2719 - 01 Aug 2015

Cited by 2 | Viewed by 388

Abstract

Imatinib has improved outcomes in patients with Philadelphia chromosome–positive (Ph+) acute lymphoblastic leukemia (all). Minimal residual disease (mrd) is a useful tool for predicting leukemia relapse. However, there is no consensus on how to treat children with elevation of [...] Read more.

Imatinib has improved outcomes in patients with Philadelphia chromosome–positive (Ph+) acute lymphoblastic leukemia (all). Minimal residual disease (mrd) is a useful tool for predicting leukemia relapse. However, there is no consensus on how to treat children with elevation of BCR-ABL transcripts but no evidence of hematologic relapse during chemotherapy combined with imatinib. Here, we report the case of a child with Ph+ all who had persistent elevation of mrd, but no evidence of hematologic relapse while receiving imatinib plus intensive chemotherapy. Dasatinib was substituted for imatinib because no suitable donor for allogeneic hematopoietic stem-cell transplantation (hsct) was available. Less-intensive chemotherapy with methotrexate and 6-mercaptopurine was administered concomitantly. No serious adverse events were encountered. With continuous dasatinib combined with chemotherapy, but no allogeneic hsct, our patient reached complete molecular remission and has been in complete molecular remission for more than 13 months. This report is the first about the long-term use of dasatinib in patients with Ph+ all and mrd elevation but hematologic remission during imatinib chemotherapy. In a similar situation, chemotherapy combined with dasatinib instead of allogeneic hsct could be considered to avoid hsct-related mortality and morbidity. Clinical trials are needed. Full article

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Open AccessShort Communication

Recent Trends in Breast, Cervical, and Colorectal Cancer Screening Test Utilization in Canada, Using Self-Reported Data from 2008 and 2012

by D. Major, D. Armstrong, H. Bryant, W. Cheung, K. Decker, G. Doyle, V. Mai, C.M. McLachlin, J Niu, J. Payne and N. Shukla

Curr. Oncol. 2015, 22(4), 297-302; https://doi.org/10.3747/co.22.2690 - 01 Aug 2015

Cited by 6 | Viewed by 431

Abstract

In Canada, self-reported data from the Canadian Community Health Survey 2008 and 2012 provide an opportunity to examine overall utilization of breast, cervical, and colorectal cancer screening tests for both programmatic and opportunistic screening. Among women 50–74 years of age, utilization of screening [...] Read more.

In Canada, self-reported data from the Canadian Community Health Survey 2008 and 2012 provide an opportunity to examine overall utilization of breast, cervical, and colorectal cancer screening tests for both programmatic and opportunistic screening. Among women 50–74 years of age, utilization of screening mammography was stable (62.0% in 2008 and 63.0% in 2012). Pap test utilization for women 25–69 years of age remained high and stable across Canada in 2008 and 2012 (78.9% in 2012). The percentage of individuals 50–74 years of age who reporting having at least 1 fecal test within the preceding 2 years increased in 2012 (to 23.0% from 16.9% in 2008), but remains low. Stable rates of screening mammography utilization (about 30%) were reported in 2008 and 2012 among women 40–49 years of age, a group for which population-based screening is not recommended. Although declining over time, cervical cancer screening rates were high for women less than 25 years of age (for whom screening is not recommended). Interestingly, an increased percentage of women 70–74 years of age reported having a Pap test. In 2012, a smaller percentage of women 50–69 years of age reported having no screening test (5.9% vs. 8.5% in 2008), and more women reported having the three types of cancer screening tests (19.0% vs. 13.2%). Efforts to encourage use of screening within the recommended average-risk age groups are needed, and education for stakeholders about the possible harms of screening outside those age groups has to continue. Full article

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Open AccessGuidelines

Fertility Preservation in Reproductive-Age Women Facing Gonadotoxic Treatments

by J. Roberts, R. Ronn, N. Tallon and H. Holzer

Curr. Oncol. 2015, 22(4), 294-304; https://doi.org/10.3747/co.22.2334 - 01 Aug 2015

Cited by 21 | Viewed by 612

Abstract

Background: Advancements in the treatments for cancer and autoimmune and other hematologic conditions continue to improve survival and cure rates. Despite those changes, various gonadotoxic agents and other treatments can still compromise the future fertility of many women. Progress in medical and surgical [...] Read more.

Background: Advancements in the treatments for cancer and autoimmune and other hematologic conditions continue to improve survival and cure rates. Despite those changes, various gonadotoxic agents and other treatments can still compromise the future fertility of many women. Progress in medical and surgical reproductive technologies has helped to offset the reproductive consequences of the use of gonadotoxic therapies, and allows for future fertility and normal pregnancy. Methods: A review of the literature was performed to outline the pathophysiology of gonadotoxicity from various treatments. The success of fertility preservation, fertility sparing, and cryopreservation options are reviewed. Barriers and facilitators to referral and oncofertility treatment in Canada are also outlined. Results: According to the quality of the evidence, recommendations are made for fertility assessment, patient referral, cryopreservation, and other assisted reproductive technologies. Conclusions: To ensure ongoing fertility in women undergoing gonadotoxic treatments, assisted reproductive technologies can be combined with a multidisciplinary approach to patient assessment and referral. Full article

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Open AccessArticle

The Organization of Colposcopy Services in Ontario: Recommended Framework

by J. Murphy, N.P. Varela, L. Elit, A. Lytwyn, M. Yudin, M. Shier, V. Wu and S. El-Khatib

Curr. Oncol. 2015, 22(4), 287-296; https://doi.org/10.3747/co.22.2575 - 01 Aug 2015

Cited by 5 | Viewed by 518

Abstract

Objective: The purpose of this guideline is to help ensure the provision of high-quality colposcopy practices in the province of Ontario, including those conducted as diagnostic procedures in follow-up to an abnormal cervical screening test. Methods: This document updates the recommendations [...] Read more.

Objective: The purpose of this guideline is to help ensure the provision of high-quality colposcopy practices in the province of Ontario, including those conducted as diagnostic procedures in follow-up to an abnormal cervical screening test. Methods: This document updates the recommendations published in the 2008 colposcopy guideline from Cancer Care Ontario, The Optimum Organization for the Delivery of Colposcopy Service in Ontario. A systematic review of guidelines was conducted to evaluate the existing evidence and recommendations concerning these key aspects of colposcopy: (1) Training, qualification, accreditation, and maintenance of competence; (2) Practice setting requirements; (3) Operational practice; (4) Quality indicators and outcomes. Results: This guideline provides recommendations on training and maintenance of competence for colposcopists in the practice settings in which colposcopic evaluation and treatments are conducted. It also provides recommendations on operational issues and quality indicators for colposcopy. Conclusions: This updated guideline is intended to support quality improvement for colposcopy for all indications, including the follow-up of an abnormal cervical screening test and work-up for lower genital tract lesions that are not clearly malignant. The recommendations contained in this document are intended for clinicians and institutions performing colposcopy in Ontario, and for policymakers and program planners involved in the delivery of colposcopy services. Full article

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Open AccessReview

The Optimal Organization of Gynecologic Oncology Services: A Systematic Review

by M. Fung-Kee-Fung, E.B. Kennedy, J. Biagi, T. Colgan, D. D’Souza, L.M. Elit, A. Hunter, J. Irish, R. McLeod and B. Rosen

Curr. Oncol. 2015, 22(4), 282-293; https://doi.org/10.3747/co.22.2482 - 01 Aug 2015

Cited by 42 | Viewed by 1235

Abstract

Background: A system-level organizational guideline for gynecologic oncology was identified by a provincial cancer agency as a key priority based on input from stakeholders, data showing more limited availability of multidisciplinary or specialist care in lower-volume than in higher-volume hospitals in the relevant [...] Read more.

Background: A system-level organizational guideline for gynecologic oncology was identified by a provincial cancer agency as a key priority based on input from stakeholders, data showing more limited availability of multidisciplinary or specialist care in lower-volume than in higher-volume hospitals in the relevant jurisdiction, and variable rates of staging for ovarian and endometrial cancer patients. Methods: A systematic review assessed the relationship of the organization of gynecologic oncology services with patient survival and surgical outcomes. The electronic databases medline and embase (ovid: 1996 through 9 January 2015) were searched using terms related to gynecologic malignancies combined with organization of services, patterns of care, and various facility and physician characteristics. Outcomes of interest included overall or disease-specific survival, short-term survival, adequate staging, and degree of cytoreduction or optimal cytoreduction (or both) for ovarian cancer patients by hospital or physician type, and rate of discrepancy in initial diagnoses and intraoperative consultation between non-specialist pathologists and gyne-oncology–specialist pathologists. Results: One systematic review and sixteen additional primary studies met the inclusion criteria. The evidence base as a whole was judged to be of lower quality; however, a trend toward improved outcomes with centralization of gynecologic oncology was found, particularly with respect to the gynecologic oncology care of patients with advanced-stage ovarian cancer. Conclusions: Improvements in outcomes with centralization of gynecologic oncology services can be attributed to a number of factors, including access to specialist care and multidisciplinary team management. Findings of this systematic review should be used with caution because of the limitations of the evidence base; however, an expert consensus process made it possible to create recommendations for implementation. Full article

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Open AccessArticle

Patient Preferences for Timing and Access to Radiation Therapy

by I.A. Olivotto, J. Soo, R.A. Olson, L. Rowe, J. French, B. Jensen, A. Pastuch, R. Halperin and P.T. Truong

Curr. Oncol. 2015, 22(4), 279-286; https://doi.org/10.3747/co.22.2532 - 01 Aug 2015

Cited by 4 | Viewed by 489

Abstract

Purpose: Patient preferences for radiation therapy (rt) access were investigated. Methods: Patients completing a course of rt at 6 centres received a 17-item survey that rated preferences for time of day; day of week; actual, ideal, and reasonable travel times for [...] Read more.

Purpose: Patient preferences for radiation therapy (rt) access were investigated. Methods: Patients completing a course of rt at 6 centres received a 17-item survey that rated preferences for time of day; day of week; actual, ideal, and reasonable travel times for rt; and actual, ideal, and reasonable times between referral and first oncologic consultation. Patients receiving single-fraction rt or brachytherapy alone were excluded. Results: Of the respondents who returned surveys (n = 1053), 54% were women, and 74% had received more than 15 rt fractions. With respect to appointment times, 88% agreed or strongly agreed that rt between 08h00 and 16h30 was preferred; 14%–15% preferred 07h30–08h00 or 16h30–17h00; 10% preferred 17h00–18h00; and 6% or fewer preferred times before 07h30 or after 18h00. A preference not to receive rt before 07h30 or after 18h00 was expressed by 30% or more of the respondents. When days of the week were considered, 18% and 11% would have preferred to receive rt on a Saturday or Sunday respectively; 52% and 55% would have preferred not to receive rt on those days. A travel time of 1 hour or less for rt was reported by 82%, but 61% felt that a travel time of 1 hour or more was reasonable. A first consultation within 2 weeks of referral was felt to be ideal or reasonable by 88% and 73% of patients respectively. Conclusions: An rt service designed to meet patient preferences would make most capacity available between 08h00 and 16h30 on weekdays and provide 10%–20% of rt capacity on weekends and during 07h30–08h00 and 16h30–18h00 on weekdays. Approximately 80%, but not all, of the responding patients preferred a 2-week or shorter interval between referral and first oncologic consultation. Full article

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Open AccessReview

Nonsurgical Treatment of Recurrent Glioblastoma

by O. Gallego

Curr. Oncol. 2015, 22(4), 273-281; https://doi.org/10.3747/co.22.2436 - 01 Aug 2015

Cited by 226 | Viewed by 3257

Abstract

Standard treatment for glioblastoma multiforme is surgery followed by radiotherapy and chemotherapy, generally with temozolomide. However, disease recurs in almost all patients. Diagnosis of progression is complex given the possibility of pseudoprogression. The Response Assessment in Neuro-Oncology criteria increase the sensitivity for detecting [...] Read more.

Standard treatment for glioblastoma multiforme is surgery followed by radiotherapy and chemotherapy, generally with temozolomide. However, disease recurs in almost all patients. Diagnosis of progression is complex given the possibility of pseudoprogression. The Response Assessment in Neuro-Oncology criteria increase the sensitivity for detecting progression. Most patients will not be candidates for new surgery or re-irradiation, and anticancer drugs are the most common approach for second-line treatment, if the patient’s condition allows. Antiangiogenics, inhibitors of the epidermal growth factor receptor, nitrosoureas, and re-treatment with temozolomide have been studied in the second line, but a standard therapy has not yet been established. This review considers currently available medical treatment options for patients with glioblastoma recurrence. Full article

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Open AccessArticle

Diagnosing Lung Cancer in the 21st Century: Are We Ready to Meet the Challenge of Individualized Care?

by R. VanderMeer, S. Chambers, A. Van Dam, J.C. Cutz, J.R. Goffin and P.M. Ellis

Curr. Oncol. 2015, 22(4), 272-278; https://doi.org/10.3747/co.22.2526 - 01 Aug 2015

Cited by 8 | Viewed by 460

Abstract

Background: Histologic and molecular subtyping have become increasingly important as predictors of treatment benefit in lung cancer. The objective of the present study was to determine whether current diagnostic approaches provide adequate tissue to allow for individualized treatment decisions. Methods: Our retrospective cohort [...] Read more.

Background: Histologic and molecular subtyping have become increasingly important as predictors of treatment benefit in lung cancer. The objective of the present study was to determine whether current diagnostic approaches provide adequate tissue to allow for individualized treatment decisions. Methods: Our retrospective cohort study of new lung cancer patients seen at an academic centre between July 2007 and June 2008 collected baseline demographic and diagnostic information, including mode of diagnosis, type of diagnostic material, and pathology diagnosis. Results: Of the 431 study patients, 20% had stage i or ii non-small-cell lung cancer (nsclc), 24% stage iii disease, and 39% stage iv nsclc. Three quarters of the small-cell lung cancer (sclc) cases were extensive stage. Diagnostically, 18% of patients had sclc; 30%, adenocarcinoma; 27%, squamous-cell cancer; 2%, large-cell carcinoma; 1%, bronchoalveolar carcinoma; 1%, mixed histology; 18%, nsclc not otherwise specified; 4%, other; and 2%, no pathology diagnosis. Surgical pathology material was available in 80% of cases, and cytology material alone in 20%. Surgical pathology material was more common in patients with early-stage than with advanced disease (89% for stages i and ii vs. 74% for stages iii and iv, p < 0.0001). The pathology report included ambiguous terms in 24% of cases: “consistent” (12%), “suspicious” (3%), “favour” (2%), “suggestive” (2%), “likely” (1%), “compatible” with malignancy (1%), “at least” (1%), “atypical” (0.5%), and “no pathology” (1.5%). Conclusions: Current diagnostic approaches in most lung cancer patients appear adequate, but complete histopathologic identification is missing in nearly 20% of cases, and some uncertainty as to the final diagnosis is expressed in 24% of pathology reports. Some improvement in diagnostic sampling and pathology reporting are required to allow for implementation of current treatment approaches. Full article

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Open AccessArticle

Revealing a Cancer Diagnosis to Patients: Attitudes of Patients, Families, Friends, Nurses, and Physicians in Lebanon—Results of a Cross-Sectional Study

by F. Farhat, A. Othman, G. el Baba and J. Kattan

Curr. Oncol. 2015, 22(4), 264-272; https://doi.org/10.3747/co.22.2351 - 01 Aug 2015

Cited by 28 | Viewed by 1427

Abstract

Background: Disclosure of a cancer diagnosis to patients is a major problem for physicians in Lebanon. Our survey aimed to identify the attitudes of patients, families and friends, nurses, and physicians regarding disclosure of a cancer diagnosis. Methods: Study participants included 343 physicians, [...] Read more.

Background: Disclosure of a cancer diagnosis to patients is a major problem for physicians in Lebanon. Our survey aimed to identify the attitudes of patients, families and friends, nurses, and physicians regarding disclosure of a cancer diagnosis. Methods: Study participants included 343 physicians, nurses, cancer patients, families, and friends from clinics in two major hospitals in Lebanon. All completed a 29-item questionnaire that assessed, by demographic group, the information provided about cancer, opinions about the disclosure of the diagnosis to cancer patients, perceived consequences to patients, and the roles of family, friends, and religion. Results: Overall, 7.8% of the patients were convinced that cancer is incurable. Nearly 82% preferred to be informed about their diagnosis. Similarly, 83% of physicians were in favour of disclosing a cancer diagnosis to their patients. However, only 14% of the physicians said that they revealed the truth to the patients themselves, with only 9% doing so immediately after confirmation of the diagnosis. Disclosure of a cancer diagnosis was preferred before the start of the treatment by 59% of the patients and immediately after confirmation of the diagnosis by 72% of the physicians. Overall, 86% of physicians, 51% of nurses, and 69% of patients and their families believed that religion helped with the acceptance of a cancer diagnosis. A role for family in accepting the diagnosis was reported by 74% of the patients, 56% of the nurses, and 88% of the physicians. All participants considered that fear was the most difficult feeling (63%) experienced by cancer patients, followed by pain (29%), pity (8%), and death (1%), with no statistically significant difference between the answers given by the participant groups. Conclusions: The social background in Lebanese society is the main obstacle to revealing the truth to cancer patients. Lebanese patients seem to prefer direct communication of the truth, but families take the opposite approach. Physicians also prefer to communicate the reality of the disease at the time of diagnosis, but in actuality, they instead disclose it progressively during treatment. Faith is helpful for acceptance of the diagnosis, and families play a key role in the support of the patients. An open discussion involving all members of society is necessary to attain a better understanding of this issue and to promote timely disclosure of a cancer diagnosis. Full article

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Open AccessArticle

An Open-Label Expanded-Access Trial of Bendamustine in Patients with Rituximab-Refractory Indolent Non-Hodgkin Lymphoma or Previously Untreated Chronic Lymphocytic Leukemia: BEND-ACT

by C.T. Kouroukis, M. Crump, D. MacDonald, J.F. Larouche, D.A. Stewart, J. Johnston, S. Sauvageau, E. Beausoleil, P. Sage, S.G. Dubois, A. Christofides, S. Di Clemente and L. Sehn

Curr. Oncol. 2015, 22(4), 260-271; https://doi.org/10.3747/co.22.2431 - 01 Aug 2015

Cited by 5 | Viewed by 530

Abstract

Background: Bendamustine is a bifunctional alkylating agent with unique properties that distinguish it from other agents in its class. Bendamustine is used as monotherapy or in combination with other agents to treat patients with non-Hodgkin lymphoma (NHL) and chronic lymphocytic leukemia [...] Read more.

Background: Bendamustine is a bifunctional alkylating agent with unique properties that distinguish it from other agents in its class. Bendamustine is used as monotherapy or in combination with other agents to treat patients with non-Hodgkin lymphoma (NHL) and chronic lymphocytic leukemia (CLL). Methods: The prospective interventional open-label BEND-ACT trial evaluated bendamustine in patients with rituximab-refractory indolent NHL (iNHL) and previously untreated CLL. Study objectives were to assess the safety and tolerability of bendamustine monotherapy and to provide patients with access to bendamustine before Health Canada approval. The study aimed to enrol up to 100 patients. All patients with iNHL received an intravenous dose of bendamustine 120 mg/m² over 60 minutes on days 1 and 2 for up to eight 21- or 28-day treatment cycles. All patients with CLL received an intravenous dose of bendamustine 100 mg/m² over 30 minutes on days 1 and 2 for up to six 28-day treatment cycles. Results: Of 90 patients treated on study (16 with CLL and 74 with iNHL), 35 completed the study (4 with CLL and 31 with iNHL). The most common treatment-emergent adverse events (TEAES) were nausea (70%), fatigue (57%), vomiting (40%), and diarrhea (33%)—mostly grades 1 and 2. Ondansetron was the most common supportive medication used in the patients (63.5% of those with iNHL and 68.8% of those with CLL). Neutropenia (32%), anemia (23%), and thrombocytopenia (21%) were the most frequent hematologic TEAES, with neutropenia being the most common grade 3 or 4 TEAES leading to dose modification. Dose delays occurred in 28 patients (31.3%) because of grade 3 or 4 TEAES, with a higher incidence of dose delays being observed in iNHL patients on the 21-day treatment cycle than in those on the 28-day treatment cycle (50.0% vs. 24.1%). During the study, 33 patients (36.7%) experienced at least 1 serious adverse event, and 4 deaths were reported (all in patients with iNHL). Conclusions: The type and frequency of the TEAES reported accorded with observations in earlier clinical trials and post-marketing experiences, thus confirming the acceptable and manageable safety profile of bendamustine. Full article

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Open AccessArticle

In Serum, Higher Parathyroid Hormone but Not Lower Vitamin D Is Associated with Oral Squamous Cell Carcinoma

by H. Zhang, H. Lu, C. Shrestha, Y. Feng, Y. Li, J. Peng, Y. Li and Z. Xie

Curr. Oncol. 2015, 22(4), 259-263; https://doi.org/10.3747/co.22.2259 - 01 Aug 2015

Cited by 6 | Viewed by 389

Abstract

Introduction: Vitamin D and calcium are known to regulate differentiation and proliferation of keratinocytes; they might potentially have a role in suppressing carcinogenesis in squamous epithelium. Serum parathyroid hormone (pth) is a sensitive indicator of calcium and vitamin D deficiency, and 25-hydroxyvitamin [...] Read more.

Introduction: Vitamin D and calcium are known to regulate differentiation and proliferation of keratinocytes; they might potentially have a role in suppressing carcinogenesis in squamous epithelium. Serum parathyroid hormone (pth) is a sensitive indicator of calcium and vitamin D deficiency, and 25-hydroxyvitamin D [25(OH)D] is an established marker of vitamin D status. Methods: To determine whether levels of 25(OH)D, calcium, or pth in serum are associated with oral squamous cell carcinoma (oscc), we examined those parameters in serum collected from 70 patients with oscc and from an equal number of matched control subjects. Results: The results showed that intact pth was significantly higher in serum from oscc patients than in serum from control subjects. However, we observed no significant differences in 25(OH)D or calcium in serum from oscc patients and from control subjects. Conclusions: We conclude that higher serum pth, but not lower serum vitamin D or calcium, is associated with oscc. Full article

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Open AccessArticle

Relationships between Patient Knowledge and the Severity of Side Effects, Daily Nutrient Intake, Psychological Status, and Performance Status in Lung Cancer Patients

by J. Tian, L.N. Jia and Z.C. Cheng

Curr. Oncol. 2015, 22(4), 254-258; https://doi.org/10.3747/co.22.2366 - 01 Aug 2015

Cited by 13 | Viewed by 701

Abstract

Aim: We aimed to assess the relationships of patient education with the severity of treatment-induced side effects, daily calorie and protein intake, psychological status, and performance status in patients with lung cancer. Methods: The study patients were divided into an intervention (n [...] Read more.

Aim: We aimed to assess the relationships of patient education with the severity of treatment-induced side effects, daily calorie and protein intake, psychological status, and performance status in patients with lung cancer. Methods: The study patients were divided into an intervention (n = 62) and a control group (n = 110). The patients in the intervention group were provided with information about treatment, diet, and rehabilitation during chemotherapy. The patients in the control group were not specially provided with that information. Results: We observed significant differences between the intervention and control groups with respect to low daily protein intake (54.84% vs. 70.00%, p = 0.046), prevalence of depression (51.61% vs. 70.91%, p = 0.011), prevalence of severe side effects of treatment (14.52% vs. 37.27%, p = 0.002), and good performance status (75.81% vs. 55.45%, p = 0.008). Conclusions: Our results suggest that educating patients about cancer treatment and rehabilitation can lead to increased protein intake, a lower prevalence of depression, lesser side effects from cancer treatments, and improved performance status. Full article

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Open AccessArticle

Views of Family Physicians about Survivorship Care Plans to Provide Breast Cancer Follow-Up Care: Exploration of Results from a Randomized Controlled Trial

by M.A. O’Brien, E. Grunfeld, J. Sussman, G. Porter and M. Hammond Mobilio

Curr. Oncol. 2015, 22(4), 252-259; https://doi.org/10.3747/co.22.2368 - 01 Aug 2015

Cited by 20 | Viewed by 527

Abstract

Background: The U.S. Institute of Medicine recommends that cancer patients receive survivorship care plans, but evaluations to date have found little evidence of the effectiveness of such plans. We conducted a qualitative follow-on study to a randomized controlled trial (RCT) to [...] Read more.

Background: The U.S. Institute of Medicine recommends that cancer patients receive survivorship care plans, but evaluations to date have found little evidence of the effectiveness of such plans. We conducted a qualitative follow-on study to a randomized controlled trial (RCT) to understand the experiences of family physicians using survivorship care plans to support the follow-up of breast cancer patients. Methods: A subset of family physicians whose patients were enrolled in the parent RCT in Ontario and Nova Scotia were eligible for this study. In interviews, the physicians discussed survivorship care plans (intervention) or usual discharge letters (control), and their confidence in providing follow-up cancer care. Results: Of 123 eligible family physicians, 18 (10 intervention, 8 control) were interviewed. In general, physicians receiving a survivorship care plan found only the 1-page care record to be useful. Physicians who received only a discharge letter had variable views about the letter’s usefulness; several indicated that it lacked information about potential cancer- or treatment-related problems. Most physicians were comfortable providing care 3–5 years after diagnosis, but desired timely and informative communication with oncologists. Conclusions: Although family physicians did not find extensive survivorship care plans useful, discharge letters might not be sufficiently comprehensive for follow-up breast cancer care. Effective strategies for two-way communication between family physicians and oncologists are still lacking. Full article

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Open AccessArticle

A Retrospective Review of Cancer Treatments and Outcomes among Inuit Referred from Nunavut, Canada

by T.R. Asmis, M. Febbraro, G.G. Alvarez, J.N. Spaans, M. Ruta, A. Lalany, G. Osborne and G.D. Goss

Curr. Oncol. 2015, 22(4), 246-251; https://doi.org/10.3747/co.22.2421 - 01 Aug 2015

Cited by 17 | Viewed by 1155

Abstract

Background: Cancer is a health concern in Inuit populations. Unique cultural, dietary, and genetic factors and geographic isolation influence cancer epidemiology in this group. Inuit-specific data about oncology treatments and survival outcomes in Canadian Inuit referred to urban treatment centres are lacking. Methods: [...] Read more.

Background: Cancer is a health concern in Inuit populations. Unique cultural, dietary, and genetic factors and geographic isolation influence cancer epidemiology in this group. Inuit-specific data about oncology treatments and survival outcomes in Canadian Inuit referred to urban treatment centres are lacking. Methods: A retrospective chart review of Inuit patients referred to The Ottawa Hospital Cancer Centre (TOHCC) from the Baffin region of Nunavut between 2000 and 2010 was conducted. Nunavut cancer registry data were used to establish the percentage of cancer cases referred and their survival outcomes. Results: Of 307 cancer patients registered among Baffin-region Inuit, 216 [70% (63 men, 153 women)] were referred to TOHCC for chemotherapy (CT) and radiation therapy (RT). Mean age in the referred group was 59.3 years (range: 25–89 years), and current smokers constituted half the group (52%). The cancers most commonly leading to referral in men were lung (55%), colorectal (19%), and nasopharyngeal (11%) cancers; in women, they were lung (46%), colorectal (24%), breast (10%), nasopharyngeal (6%), and cervical (5%) cancers. Of the 216 referred patients, 82 (38%) had already undergone surgery, and 18 (8%) received chemoradiation or RT only, all given with curative intent. Among the surgical patients referred, 33 (40%) and 23 (28%) went on to receive adjuvant CT and adjuvant RT respectively. Among 116 patients referred for palliative care, 64 (55%) received CT, 76 (66%) received RT, 43 (37%) received both CT and RT, and 19 (16%) received neither treatment. Median all-stage overall survival was 10 months for patients with lung cancer [95% confidence interval: 6.1 to 13.9 months] and 37 months for patients with colorectal cancer [95% confidence interval: 14.8 to 59.2 months]. Conclusions: High uptake of palliative and adjuvant CT and RT was observed in the Inuit patients referred to TOHCC. Lung cancer was the most common cancer in referred Inuit men and women. The survival rates for Inuit lung cancer patients referred to TOHCC were comparable to those in the rest of Canada. Further research is required to understand reasons for non-referral of Canadian Inuit to TOHCC. Full article

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Open AccessArticle

Cost–Utility of Adjuvant Zoledronic Acid in Patients with Breast Cancer and Low Estrogen Levels

by N.W.D. Lamond, C. Skedgel, D. Rayson and T. Younis

Curr. Oncol. 2015, 22(4), 246-253; https://doi.org/10.3747/co.22.2383 - 01 Aug 2015

Cited by 1 | Viewed by 425

Abstract

Background: Adjuvant zoledronic acid (ZA) appears to improve disease-free survival (DFS) in women with early-stage breast cancer and low levels of estrogen (LLE) because of induced or natural menopause. Characterizing the cost–utility (CU) of this [...] Read more.

Background: Adjuvant zoledronic acid (ZA) appears to improve disease-free survival (DFS) in women with early-stage breast cancer and low levels of estrogen (LLE) because of induced or natural menopause. Characterizing the cost–utility (CU) of this therapy could help to determine its role in clinical practice. Methods: Using the perspective of the Canadian health care system, we examined the CU of adjuvant endocrine therapy with or without ZA in women with early-stage endocrine-sensitive breast cancer and LLE. A Markov model was used to compute the cumulative costs in Canadian dollars and the quality-adjusted life-years (QALYS) gained from each adjuvant strategy, discounted at a rate of 5% annually. The model incorporated the DFS and fracture benefits of adjuvant ZA. Probabilistic and one-way sensitivity analyses were conducted to examine key model parameters. Results: Compared with a no-ZA strategy, adjuvant ZA in the induced and natural menopause groups was associated with, respectively, $7,825 and $7,789 in incremental costs and 0.46 and 0.34 in QALY gains for CU ratios of $17,007 and $23,093 per QALY gained. In one-way sensitivity analyses, the results were most sensitive to changes in the ZA DFS benefit. Probabilistic sensitivity analysis suggested a 100% probability of adjuvant ZA being a cost-effective strategy at a threshold of $100,000 per QALY gained. Conclusions: Based on available data, adjuvant ZA appears to be a cost-effective strategy in women with endocrine-sensitive breast cancer and LLE, having cu ratios well below accepted thresholds. Full article

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Open AccessEditorial

Enhancing Access to Cancer Care for the Inuit

by P. Doering and C. DeGrasse

Curr. Oncol. 2015, 22(4), 244-245; https://doi.org/10.3747/co.22.2752 - 01 Aug 2015

Cited by 3 | Viewed by 484

Abstract

Of Canada’s Inuit, 49% reside in Nunavut [...] Full article

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Open AccessEditorial

Ready or Not? Lung Cancer Diagnosis in 2015

by K. Jao, C. Labbe and N.B. Leighl

Curr. Oncol. 2015, 22(4), 239-242; https://doi.org/10.3747/co.22.2647 - 01 Aug 2015

Cited by 2 | Viewed by 336

Abstract

Lung cancer remains a significant health issue in Canada, with more than 26,000 new cases reported in 2014 [...] Full article

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Open AccessArticle

Advance Care Planning: Identifying System-Specific Barriers and Facilitators

by N.A. Hagen, J. Howlett, N.C. Sharma, P. Biondo, J. Holroyd-Leduc, K. Fassbender and J. Simon

Curr. Oncol. 2015, 22(4), 237-245; https://doi.org/10.3747/co.22.2488 - 01 Aug 2015

Cited by 16 | Viewed by 914

Abstract

Background: Advance care planning (acp) is an important process in health care today. How to prospectively identify potential local barriers and facilitators to uptake of acp across a complex, multi-sector, publicly funded health care system and how to develop specific mitigating [...] Read more.

Background: Advance care planning (acp) is an important process in health care today. How to prospectively identify potential local barriers and facilitators to uptake of acp across a complex, multi-sector, publicly funded health care system and how to develop specific mitigating strategies have not been well characterized. Methods: We surveyed a convenience sample of clinical and administrative health care opinion leaders across the province of Alberta to characterize system-specific barriers and facilitators to uptake of acp. The survey was based on published literature about the barriers to and facilitators of acp and on the Michie Theoretical Domains Framework. Results: Of 88 surveys, 51 (58%) were returned. The survey identified system-specific barriers that could challenge uptake of acp. The factors were categorized into four main domains. Three examples of individual system-specific barriers were “insufficient public engagement and misunderstanding,” “conflict among different provincial health service initiatives,” and “lack of infrastructure.” Local system-specific barriers and facilitators were subsequently explored through a semi-structured informal discussion group involving key informants. The group identified approaches to mitigate specific barriers. Conclusions: Uptake of acp is a priority for many health care systems, but bringing about change in multi-sector health care systems is complex. Identifying system-specific barriers and facilitators to the uptake of innovation are important elements of successful knowledge translation. We developed and successfully used a simple and inexpensive process to identify local system-specific barriers and enablers to uptake of acp, and to identify specific mitigating strategies. Full article

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Open AccessCommentary

Is It Time to Offer BRCA1 and BRCA2 Testing to All Jewish Women?

by K.A. Metcalfe, A. Eisen, J. Lerner-Ellis and S.A. Narod

Curr. Oncol. 2015, 22(4), 233-236; https://doi.org/10.3747/co.22.2527 - 01 Aug 2015

Cited by 20 | Viewed by 421

Abstract

It was 2007 when Women’s College Hospital first began to test for BRCA1 and BRCA2 mutations among all Jewish women in Ontario [...] Full article

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Open AccessCommentary

Professionalism

by B.G. Lindeque

Curr. Oncol. 2015, 22(4), 232; https://doi.org/10.3747/co.22.2615 - 01 Aug 2015

Viewed by 492

Abstract

I have been reading medical literature since 1970. I started medical school in 1970 [...] Full article

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Open AccessEditorial

BRCA1/2 Population Screening: Embracing the Benefits

by S.E. Plon

Curr. Oncol. 2015, 22(4), 230-231; https://doi.org/10.3747/co.22.2660 - 01 Aug 2015

Cited by 8 | Viewed by 357

Abstract

Whether all adult Ashkenazi women should be offered population screening for recurrent [...] Full article

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Curr. Oncol., Volume 22, Issue 4 (August 2015) – 25 articles

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