Current Oncology

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Open AccessCommentary

Use of Cannabinoids in Cancer Care: Palliative Care

by S.K. Aggarwal

Curr. Oncol. 2016, 23(s1), 33-36; https://doi.org/10.3747/co.23.2962 - 01 Mar 2016

Cited by 21 | Viewed by 1022

All too often neglected, maximal quality improvement in the setting of life-limiting illness and noxious symptomatology is a worthy medical, public health, and humanitarian goal [...] Full article

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Open AccessArticle

Anticancer Mechanisms of Cannabinoids

by G. Velasco, C. Sánchez and M. Guzmán

Curr. Oncol. 2016, 23(s1), 23-32; https://doi.org/10.3747/co.23.3080 - 01 Mar 2016

Cited by 184 | Viewed by 3771

Abstract

In addition to the well-known palliative effects of cannabinoids on some cancer-associated symptoms, a large body of evidence shows that these molecules can decrease tumour growth in animal models of cancer. They do so by modulating key cell signalling pathways involved in the [...] Read more.

In addition to the well-known palliative effects of cannabinoids on some cancer-associated symptoms, a large body of evidence shows that these molecules can decrease tumour growth in animal models of cancer. They do so by modulating key cell signalling pathways involved in the control of cancer cell proliferation and survival. In addition, cannabinoids inhibit angiogenesis and decrease metastasis in various tumour types in laboratory animals. In this review, we discuss the current understanding of cannabinoids as antitumour agents, focusing on recent discoveries about their molecular mechanisms of action, including resistance mechanisms and opportunities for their use in combination therapy. Those observations have already contributed to the foundation for the development of the first clinical studies that will analyze the safety and potential clinical benefit of cannabinoids as anticancer agents. Full article

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Open AccessArticle

In Vitro and In Vivo Efficacy of Non-Psychoactive Cannabidiol in Neuroblastoma

by T. Fisher, H. Golan, G. Schiby, S. PriChen, R. Smoum, I. Moshe, N. Peshes-Yaloz, A. Castiel, D. Waldman, R. Gallily, R. Mechoulam and A. Toren

Curr. Oncol. 2016, 23(s1), 15-22; https://doi.org/10.3747/co.23.2893 - 01 Mar 2016

Cited by 51 | Viewed by 2441

Abstract

Background: Neuroblastoma (NBL) is one of the most common solid cancers in children. Prognosis in advanced NBL is still poor despite aggressive multimodality therapy. Furthermore, survivors experience severe long-term multi-organ sequelae. Hence, the identification of new therapeutic strategies is of [...] Read more.

Background: Neuroblastoma (NBL) is one of the most common solid cancers in children. Prognosis in advanced NBL is still poor despite aggressive multimodality therapy. Furthermore, survivors experience severe long-term multi-organ sequelae. Hence, the identification of new therapeutic strategies is of utmost importance. Cannabinoids and their derivatives have been used for years in folk medicine and later in the field of palliative care. Recently, they were found to show pharmacologic activity in cancer, including cytostatic, apoptotic, and antiangiogenic effects. Methods: We investigated, in vitro and in vivo, the anti-NBL effect of the most active compounds in Cannabis, Δ⁹-tetrahydrocannabinol (THC) and cannabidiol (CBD). We set out to experimentally determine the effects of those compounds on viability, invasiveness, cell cycle distribution, and programmed cell death in human NBL SK-N-SH cells. Results: Both compounds have antitumourigenic activity in vitro and impeded the growth of tumour xenografts in vivo. Of the two cannabinoids tested, CBD was the more active. Treatment with CBD reduced the viability and invasiveness of treated tumour cells in vitro and induced apoptosis (as demonstrated by morphology changes, sub-G1 cell accumulation, and annexin V assay). Moreover, CBD elicited an increase in activated caspase 3 in treated cells and tumour xenografts. Conclusions: Our results demonstrate the antitumourigenic action of CBD on NBL cells. Because CBD is a nonpsychoactive cannabinoid that appears to be devoid of side effects, our results support its exploitation as an effective anticancer drug in the management of NBL. Full article

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Open AccessArticle

Integrating Cannabis into Clinical Cancer Care

by D.I. Abrams

Curr. Oncol. 2016, 23(s1), 8-14; https://doi.org/10.3747/co.23.3099 - 01 Mar 2016

Cited by 86 | Viewed by 4459

Abstract

Cannabis species have been used as medicine for thousands of years; only since the 1940s has the plant not been widely available for medical use. However, an increasing number of jurisdictions are making it possible for patients to obtain the botanical for medicinal [...] Read more.

Cannabis species have been used as medicine for thousands of years; only since the 1940s has the plant not been widely available for medical use. However, an increasing number of jurisdictions are making it possible for patients to obtain the botanical for medicinal use. For the cancer patient, cannabis has a number of potential benefits, especially in the management of symptoms. Cannabis is useful in combatting anorexia, chemotherapy-induced nausea and vomiting, pain, insomnia, and depression. Cannabis might be less potent than other available antiemetics, but for some patients, it is the only agent that works, and it is the only antiemetic that also increases appetite. Inhaled cannabis is more effective than placebo in ameliorating peripheral neuropathy in a number of conditions, and it could prove useful in chemotherapy-induced neuropathy. A pharmacokinetic interaction study of vaporized cannabis in patients with chronic pain on stable doses of sustained-release opioids demonstrated no clinically significant change in plasma opiates, while suggesting the possibility of synergistic analgesia. Aside from symptom management, an increasing body of in vitro and animal-model studies supports a possible direct anticancer effect of cannabinoids by way of a number of different mechanisms involving apoptosis, angiogenesis, and inhibition of metastasis. Despite an absence of clinical trials, abundant anecdotal reports that describe patients having remarkable responses to cannabis as an anticancer agent, especially when taken as a high-potency orally ingested concentrate, are circulating. Human studies should be conducted to address critical questions related to the foregoing effects. Full article

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Open AccessEditorial

Why I Chose to Use Cannabis

by L. Perrier

Curr. Oncol. 2016, 23(s1), 7; https://doi.org/10.3747/co.23.3104 - 01 Mar 2016

Cited by 1 | Viewed by 344

Abstract

I just learned that my ovarian cancer is back and that I need to start chemotherapy [...]
Full article

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Open AccessEditorial

Cannabis and Cancer: Toward a New Understanding

by M.A. Ware

Curr. Oncol. 2016, 23(s1), 5-6; https://doi.org/10.3747/co.23.3185 - 01 Mar 2016

Cited by 3 | Viewed by 357

Abstract

The treatment of cancer, [...] Full article

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Open AccessArticle

Cost Trajectories for Cancer Patients

by W.P. Wodchis, E. Arthurs, A.I. Khan, S. Gandhi, M. MacKinnon and J. Sussman

Curr. Oncol. 2016, 23(s1), 64-75; https://doi.org/10.3747/co.23.2995 - 01 Feb 2016

Cited by 19 | Viewed by 672

Abstract

Background: Health care spending is known to be highly skewed, with a small subset of the population consuming a disproportionate amount of health care resources. Patients with cancer are high-cost users because of high incremental health care costs for treatment and the growing [...] Read more.

Background: Health care spending is known to be highly skewed, with a small subset of the population consuming a disproportionate amount of health care resources. Patients with cancer are high-cost users because of high incremental health care costs for treatment and the growing prevalence of cancer. The objectives of the present study included characterizing cancer-patient trajectories by cost, and identifying the patient and health system characteristics associated with high health system costs after cancer treatment. Methods: This retrospective cohort study identified Ontario adults newly diagnosed with cancer between 1 April 2009 and 30 September 2010. Costs of health care use before, during, and after cancer episodes were used to develop trajectories of care. Descriptive analyses examined differences between the trajectories in terms of clinical and health system characteristics, and a logistic regression approach identified predictors of being a high-cost user after a cancer episode. Results: Ten trajectories were developed based on whether patients were high- or low-cost users before and after their cancer episode. The most common trajectory represented patients who were low-cost in the year before cancer, survived treatment, and continued to be low-cost in the year after cancer (31.4%); stage ii cancer of the male genital system was the most common diagnosis within that trajectory. Regression analyses identified increases in age and in multimorbidity and low continuity of care as the strongest predictors of high-cost status after cancer. Conclusions: Findings highlight an opportunity to proactively identify patients who might transition to high-cost status after cancer treatment and to remediate that transition. Full article

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Open AccessArticle

Using the Cancer Risk Management Model to Evaluate the Health and Economic Impacts of Cytology Compared with Human Papillomavirus DNA Testing for Primary Cervical Cancer Screening in Canada

by C. Popadiuk, C.L. Gauvreau, M. Bhavsar, C. Nadeau, K. Asakawa, W.M. Flanagan, M.C. Wolfson, A.J. Coldman, S. Memon, N. Fitzgerald, J. Lacombe and A.B. Miller

Curr. Oncol. 2016, 23(s1), 56-63; https://doi.org/10.3747/co.23.2991 - 01 Feb 2016

Cited by 10 | Viewed by 567

Abstract

Background: In Canada, discussion about changing from cytology to human papillomavirus (HPV) DNA testing for primary screening in cervical cancer is ongoing. However, the Canadian Task Force on Preventive Health Care has not yet made a recommendation, concluding that the evidence [...] Read more.

Background: In Canada, discussion about changing from cytology to human papillomavirus (HPV) DNA testing for primary screening in cervical cancer is ongoing. However, the Canadian Task Force on Preventive Health Care has not yet made a recommendation, concluding that the evidence is insufficient. Methods: We used the cervical cancer and HPV transmission models of the Cancer Risk Management Model to study the health and economic outcomes of primary cytology compared with HPV DNA testing in 14 screening scenarios with varying screening modalities and intervals. Projected cervical cancer cases, deaths, colposcopies, screens, costs, and incremental cost-effectiveness were evaluated. We performed sensitivity analyses for HPV DNA test costs. Results: Compared with triennial cytology from age 25, 5-yearly HPV DNA screening alone from age 30 resulted in equivalent incident cases and deaths, but 55% (82,000) fewer colposcopies and 43% (1,195,000) fewer screens. At HPV DNA screening intervals of 3 years, whether alone or in an age-based sequence with cytology, screening costs are greater, but at intervals of more than 5 years, they are lower. Scenarios on the cost-effectiveness frontier were HPV DNA testing alone every 10, 7.5, 5, or 3 years, and triennial cytology starting at age 21 or 25 when combined with HPV DNA testing every 3 years. Conclusions: Changing from cytology to HPV DNA testing as the primary screening test for cervical cancer would be an acceptable strategy in Canada with respect to incidence, mortality, screening and diagnostic test volumes. Full article

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Open AccessArticle

Cost Implications of Unwarranted Imaging for Distant Metastasis in Women with Early-Stage Breast Cancer in Ontario

by K. Thavorn, Z. Wang, D. Fergusson, S. van Katwyk, A. Arnaout and M. Clemons

Curr. Oncol. 2016, 23(s1), 52-55; https://doi.org/10.3747/co.23.2977 - 01 Feb 2016

Cited by 8 | Viewed by 389

Abstract

Introduction: Despite the publication of multiple evidence-based guidelines recommending against routine imaging for distant metastasis in patients with early-stage (I/II) breast cancer, such imaging is frequently performed. The present retrospective cohort study was conducted to estimate the cost of [...] Read more.

Introduction: Despite the publication of multiple evidence-based guidelines recommending against routine imaging for distant metastasis in patients with early-stage (I/II) breast cancer, such imaging is frequently performed. The present retrospective cohort study was conducted to estimate the cost of unnecessary imaging tests in women with stage I and II breast cancer diagnosed between 1 January 2007 and 31 December 2012 in Ontario. Methods: We obtained patient-level demographic and tumour data from a large provincial dataset. The total cost of unwarranted imaging tests (in 2015 Canadian dollars) was considered to be equal to the sum of imaging costs incurred between 2007 and 2012 and was stratified by disease stage, imaging modality, and body site. Results: Of the 26,547 identified patients with early-stage breast cancer, 22,811 (85.9%) underwent at least 1 imaging test, with an average of 3.7 tests per patient (3.2 for stage I patients and 4.0 for stage II patients) over 5 years. At least 1 imaging test was performed in 79.6% of stage I and 92.7% of stage II patients. During a 5-year period, the cost of unwarranted imaging in patients with early-stage breast cancer ranged from CA$4,418,139 to CA$6,865,856, depending on guideline recommendations. Conclusions: Our study highlights the substantial cost of excess imaging that could be saved and re-allocated to patient care if evidence-based guidelines are followed. Future studies should assess strategies to ensure that evidence-based guidelines are followed and to increase awareness of the cost implications of nonadherence to guidelines. Full article

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Open AccessArticle

Temporal Association between Home Nursing and Hospital Costs at End of Life in Three Provinces

by H. Seow, R. Pataky, B. Lawson, E.M. O’Leary, R. Sutradhar, K. Fassbender, K. McGrail, L. Barbera, F. Burge, S.J. Peacock and J.S. Hoch

Curr. Oncol. 2016, 23(s1), 42-51; https://doi.org/10.3747/co.23.2971 - 01 Feb 2016

Cited by 11 | Viewed by 434

Abstract

Background: Research has demonstrated that increases in palliative homecare nursing are associated with a reduction in the rate of subsequent hospitalizations. However, little evidence is available about the cost-savings potential of palliative nursing when accounting for both increased nursing costs and potentially reduced [...] Read more.

Background: Research has demonstrated that increases in palliative homecare nursing are associated with a reduction in the rate of subsequent hospitalizations. However, little evidence is available about the cost-savings potential of palliative nursing when accounting for both increased nursing costs and potentially reduced hospital costs. Methods: Our retrospective cohort study included cancer decedents from British Columbia, Ontario, and Nova Scotia who received any palliative nursing in the last 6 months of life. A Poisson regression analysis was used to determine the association of increased nursing costs (in 2-week blocks) on the relative average hospital costs in the subsequent 2-week block and on the overall total cost (hospital costs plus nursing costs in the preceding 2-week block). Results: The cohort included 58,022 cancer decedents. Results of the analysis for the last month of life showed an association between increased nursing costs and decreased relative hospital costs in comparisons with a reference group (>0 to 1 hour nursing in the block): the maximum decrease was 55% for Ontario, 31% for British Columbia, and 38% for Nova Scotia. Also, increased nursing costs in the last month were almost always associated with lower total costs in comparison with the reference. For example, cost savings per person-block ranged from $376 (>10 nursing hours) to $1,124 (>4 to 6 nursing hours) in British Columbia. Conclusions: In the last month of life, increased palliative nursing costs (compared with costs for >0 to 1 hour of nursing in the block) were associated with lower relative hospital costs and a lower total cost in a subsequent block. Our research suggests a cost-savings potential associated with increased community-based palliative nursing. Full article

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Open AccessArticle

Population-Based Trends in Systemic Therapy Use and Cost for Cancer Patients in the Last Year of Life

by R.E. Pataky, W.Y. Cheung, C. de Oliveira, K.E. Bremner, K.K.W. Chan, J.S. Hoch, M.D. Krahn and S.J. Peacock

Curr. Oncol. 2016, 23(s1), 32-41; https://doi.org/10.3747/co.23.2946 - 01 Feb 2016

Cited by 17 | Viewed by 546

Abstract

Background: The use of systemic therapy near the end of life can expose cancer patients to severe toxicity for minimal survival gain and comes with a high cost. Early palliative care is recommended, but there is evidence that aggressive care remains common. To [...] Read more.

Background: The use of systemic therapy near the end of life can expose cancer patients to severe toxicity for minimal survival gain and comes with a high cost. Early palliative care is recommended, but there is evidence that aggressive care remains common. To better understand those patterns, the present study set out to describe trends in systemic therapy use and cost for cancer patients in the last year of life. Methods: Using the BC Cancer Registry, a retrospective population-based cohort of cancer decedents (2002–2007) was identified and linked to systemic therapy records. The outcomes of interest were any systemic therapy use and total systemic therapy costs during the last year of life. Multiple logistic regression (systemic therapy use) and generalized linear regression (costs) were conducted, adjusting for age, sex, and survival. Subgroup analyses were performed for patients with primary colorectal, lung, prostate, or breast cancer. Results: From 2002 to 2007, use of systemic therapy in the last 12–4 months of life increased by 21% (95% CI: 10% to 33%); no significant change in use in the last 3 months of life was observed. Costs for both periods increased over time, by 48% (95% CI: 36% to 63%) and by 33% (95% CI: 19% to 49%) respectively. The trends varied across cancer sites, with the greatest increases being observed for lung and colorectal cancer patients. Conclusions: The use and costs of systemic therapy have generally been increasing, putting pressure on health care providers and payers, but the quality-of-life implications for patients must be better understood. Full article

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Open AccessArticle

Cost-Effectiveness Analysis of Whole-Mount Pathology Processing for Patients with Early Breast Cancer Undergoing Breast Conservation

by N.J. Look Hong, G.M. Clarke, M.J. Yaffe and C.M.B. Holloway

Curr. Oncol. 2016, 23(s1), 23-31; https://doi.org/10.3747/co.23.2917 - 01 Feb 2016

Cited by 11 | Viewed by 494

Abstract

Background: Obtaining accurate histopathologic detail for breast lumpectomy specimens is challenging because of sampling and loss of three-dimensional conformational features with conventional processing. The whole-mount (WM) technique is a novel method of serial pathologic sectioning designed to optimize cross-sectional visualization [...] Read more.

Background: Obtaining accurate histopathologic detail for breast lumpectomy specimens is challenging because of sampling and loss of three-dimensional conformational features with conventional processing. The whole-mount (WM) technique is a novel method of serial pathologic sectioning designed to optimize cross-sectional visualization of resected specimens and determination of margin status. Methods: Using a Markov chain cohort simulation cost-effectiveness model, we compared conventional processing with WM technique for breast lumpectomies. Cost-effectiveness was evaluated from the perspective of the Canadian health care system and compared using incremental cost-effectiveness ratios (ICERs) for cost per quality-adjusted life–year (QALY) over a 10-year time horizon. Deterministic and probabilistic sensitivity analyses were performed to test the robustness of the model with willingness-to-pay (WTP) thresholds of $0–$100,000. Costs are reported in adjusted 2014 Canadian dollars, discounted at a rate of 3%. Results: Compared with conventional processing, WM processing is more costly ($19,989 vs. $18,427) but generates 0.03 more QALYs over 10 years. The ICER is $45,414, indicating that this additional amount is required for each additional QALY obtained. The model was robust to all variance in parameters, with the prevalence of positive margins accounting for most of the model’s variability. Conclusions: After a WTP threshold of $45,414, WM processing becomes cost-effective and ultimately generates fewer recurrences and marginally more QALYs over time. Excellent baseline outcomes for the current treatment of breast cancer mean that incremental differences in survival are small. However, the overall benefit of the WM technique should be considered in the context of achieving improved accuracy and not just enhancements in clinical effectiveness. Full article

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Open AccessArticle

Cost and Resource Utilization in Cervical Cancer Management: A Real-World Retrospective Cost Analysis

by I. Cromwell, Z. Ferreira, L. Smith, K. van der Hoek, G. Ogilvie, A. Coldman and S.J. Peacock

Curr. Oncol. 2016, 23(s1), 14-22; https://doi.org/10.3747/co.23.2914 - 01 Feb 2016

Cited by 7 | Viewed by 633

Abstract

Objectives: We set out to assess the health care resource utilization and cost of cervical cancer from the perspective of a single-payer health care system. Methods: Retrospective observational data for women diagnosed with cervical cancer in British Columbia between 2004 and [...] Read more.

Objectives: We set out to assess the health care resource utilization and cost of cervical cancer from the perspective of a single-payer health care system. Methods: Retrospective observational data for women diagnosed with cervical cancer in British Columbia between 2004 and 2009 were analyzed to calculate patient-level resource utilization patterns from diagnosis to death or 5-year discharge. Domains of resource use within the scope of this cost analysis were chemotherapy, radiotherapy, and brachytherapy administered by the BC Cancer Agency; resource utilization related to hospitalization and outpatient visits as recorded by the B.C. Ministry of Health; medically required services billed under the B.C. Medical Services Plan; and prescriptions dispensed under British Columbia’s health insurance programs. Unit costs were applied to radiotherapy and brachytherapy, producing per-patient costs. Results: The mean cost per case of treating cervical cancer in British Columbia was $19,153 (standard error: $3,484). Inpatient hospitalizations, at 35%, represented the largest proportion of the total cost (95% confidence interval: 32.9% to 36.9%). Costs were compared for subgroups of the total cohort. Conclusions: As health care systems change the way they manage, screen for, and prevent cervical cancer, cost-effectiveness evaluations of the overall approach will require up-to-date data for resource utilization and costs. We provide information suitable for such a purpose and also identify factors that influence costs. Full article

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Open AccessArticle

Estimation of Drug Cost Avoidance and Pathology Cost Avoidance through Participation in NCIC Clinical Trials Group Phase III Clinical Trials in Canada

by P.A. Tang, A.E. Hay, C.J. O’Callaghan, N. Mittmann, C.R. Chambers, J.L. Pater and N.B. Leighl

Curr. Oncol. 2016, 23(s1), 7-13; https://doi.org/10.3747/co.23.2861 - 01 Feb 2016

Cited by 16 | Viewed by 612

Abstract

Background: Cost avoidance occurs when, because of provision of a drug therapy [drug cost avoidance (DCA)] or a pathology test [pathology cost avoidance (PCA)] during trial participation, health care payers need not pay for standard treatments or testing. [...] Read more.

Background: Cost avoidance occurs when, because of provision of a drug therapy [drug cost avoidance (DCA)] or a pathology test [pathology cost avoidance (PCA)] during trial participation, health care payers need not pay for standard treatments or testing. The aim of our study was to estimate the total DCA and PCA for Canadian patients enrolled in relevant phase III trials conducted by the NCIC Clinical Trials Group. Methods: Phase III trials that had completed accrual and resulted in DCA or PCA were identified. The PCA was calculated based on the number of patients screened and the test cost. The DCA was estimated based on patients randomized, the protocol dosing regimen, drug cost, median dose intensity, and median duration of therapy. Costs are presented in Canadian dollars. No adjustment was made for inflation. Results: From 1999 to 2011, 4 trials (1479 patients) resulted in PCA and 17 trials (3195 patients) resulted in DCA. The total PCA was estimated at $4,194,849, which included testing for KRAS ($141,058), microsatellite instability ($18,600), and 21-gene recurrence score ($4,035,191). The total DCA was estimated at $27,952,512, of which targeted therapy constituted 43% (five trials). The combined PCA and DCA was $32,147,361. Conclusions: Over the study period, trials conducted by the NCIC Clinical Trials Group resulted in total cost avoidance (PCA and DCA) of approximately $7518 per patient. Although not all trials lead to cost avoidance, such savings should be taken account when the financial impact of conducting clinical research is being considered. Full article

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Open AccessEditorial

Importance of Cost Estimates and Cost Studies

by N. Mittmann and C. de Oliveira

Curr. Oncol. 2016, 23(s1), 6; https://doi.org/10.3747/co.23.3154 - 01 Feb 2016

Cited by 5 | Viewed by 475

Abstract

Canada has a distinctive health care system, [...] Full article

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Open AccessEditorial

Original Canadian Cancer Costing Research for Cancer Control Sustainability, Quality, and Value

by Heather Bryant

Curr. Oncol. 2016, 23(s1), 5; https://doi.org/10.3747/co.23.3163 - 01 Feb 2016

Viewed by 313

Abstract

Given the acute shortage of Canada-specific cancer health economics evidence, [...] Full article

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Curr. Oncol., Volume 23, Issue s1 (February 2016) – 16 articles

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