Current Oncology

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Open AccessLetter

Response to: Second-Line Treatment of Non-Small-Cell Lung Cancer with Wild-Type EGFR Status. What Is the Best Approach?

by Ma Kim Anh, Goulnar Kasymjanova, Victor Cohen and Jason Agulnik

Curr. Oncol. 2016, 23(2), 160-161; https://doi.org/10.3747/co.23.2955 - 01 Apr 2016

Cited by 1 | Viewed by 332

Abstract

We thank Drs. Ibrahim Elghissassi, Saber Boutayeb, Hanane Inrhaoun, Hind Mrabti, and Hassan Errihani for their comments on our paper [...] Full article

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Open AccessLetter

Second-Line Treatment of Non-Small-Cell Lung Cancer with Wild-Type EGFR Status. What Is the Best Approach?

by Ibrahim Elghissassi, Saber Boutayeb, Hanane Inrhaoun, Hind Mrabti and Hassan Errihani

Curr. Oncol. 2016, 23(2), 158-159; https://doi.org/10.3747/co.23.2849 - 01 Apr 2016

Cited by 1 | Viewed by 326

Abstract

We read with great interest the article of Ma and colleagues titled “An exploratory comparative analysis of tyrosine kinase inhibitors or docetaxel in second-line treatment of EGFR wild-type non-small-cell lung cancer: a retrospective real-world practice review at a single tertiary care centre” [...] [...] Read more.

We read with great interest the article of Ma and colleagues titled “An exploratory comparative analysis of tyrosine kinase inhibitors or docetaxel in second-line treatment of EGFR wild-type non-small-cell lung cancer: a retrospective real-world practice review at a single tertiary care centre” [...] Full article

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Open AccessCase Report

Synchronous Metastatic Skull Base Chordoma to the Breast: Case Report and Literature Review

by S.I. Shakir, M. Pelmus, A. Florea, J.F. Boileau, M.C. Guiot, S. Di Maio and T.M. Muanza

Curr. Oncol. 2016, 23(2), 154-157; https://doi.org/10.3747/co.23.2896 - 01 Apr 2016

Cited by 4 | Viewed by 388

Abstract

Clinical Scenario: During routine staging work-up for a left breast mass, a 68-year-old woman complained of dysphagia and dysphonia. During further investigations, a left-sided lesion at the foramen magnum was observed on brain imaging. Both lesions were biopsied and showed a classical [...] Read more.

Clinical Scenario: During routine staging work-up for a left breast mass, a 68-year-old woman complained of dysphagia and dysphonia. During further investigations, a left-sided lesion at the foramen magnum was observed on brain imaging. Both lesions were biopsied and showed a classical chordoma. Management: The skull-base lesion and the breast lesion were surgically resected, and adjuvant radiotherapy was given. Summary: Chordoma is a rare primary central nervous system tumour that seldom metastasizes. The lung is the most common site of metastasis. Synchronous breast metastasis from a skull-base chordoma is very rare, and a safe management option includes a maximum resection followed by adjuvant radiotherapy. Full article

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Open AccessCase Report

Immunotherapy with Imiquimod and Interferon Alfa for Metastasized Merkel Cell Carcinoma

by R.U. Wahl, T. Braunschweig, A. Ghassemi and A. Rübben

Curr. Oncol. 2016, 23(2), 150-153; https://doi.org/10.3747/co.23.2878 - 01 Apr 2016

Cited by 10 | Viewed by 470

Abstract

Merkel cell carcinoma (MCC) is a highly aggressive neuroendocrine tumour of the skin. Remission rates are high with chemotherapy in patients with metastasis, but without any improvement in overall survival. We present the case of a 90-year-old woman with facial MCC [...] Read more.

Merkel cell carcinoma (MCC) is a highly aggressive neuroendocrine tumour of the skin. Remission rates are high with chemotherapy in patients with metastasis, but without any improvement in overall survival. We present the case of a 90-year-old woman with facial MCC. After radiation and surgery, the MCC recurred with widespread cutaneous and regional lymph node metastases. The metastases were treated with weekly intralesional injections of 1–2×10⁶ IU interferon alfa-2a, accompanied by topical imiquimod 5% cream 3 times weekly. After partial regression, subcutaneous pegylated interferon alfa-2b was added at a dose of 30 μg weekly, which was then increased to 50 μg weekly. At 4 months after the start of immunotherapy, all cutaneous metastases and the intralesionally treated lymph node metastases receded. Interruption or reduction of systemic interferon application resulted in locoregional relapses that were successfully treated with surgery or intralesional interferon injections. The patient remains alive 30 months after initiation of immunotherapy, suggesting that locally metastasized MCC might be able to be controlled with local and systemic immunotherapy. Full article

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Open AccessShort Communication

But other than Mesothelioma? An Estimate of the Proportion of Work-Related Cancers in Quebec

by F. Labrèche, P. Duguay, A. Boucher and R. Arcand

Curr. Oncol. 2016, 23(2), 144-149; https://doi.org/10.3747/co.23.2812 - 01 Apr 2016

Cited by 4 | Viewed by 608

Abstract

Background: More than 30 exposures in the workplace are proven carcinogens. In the present study, we aimed to estimate the burden of occupational cancer in Quebec so as to increase awareness among stakeholders and to prioritize research activities. Methods: Work-attributable fractions—that [...] Read more.

Background: More than 30 exposures in the workplace are proven carcinogens. In the present study, we aimed to estimate the burden of occupational cancer in Quebec so as to increase awareness among stakeholders and to prioritize research activities. Methods: Work-attributable fractions—that is, the proportions of cancers attributable to work—as published in Finland and the United Kingdom were applied to Quebec 2002–2006 cancer incidence and mortality data to estimate the number of work-related cases for 28 cancer sites. Results: Overall, 6.0% of incident cancers (men: 9.1%; women: 2.7%) and 7.6% of cancer deaths (men: 11.8%; women: 2.8%) could be attributable to work, resulting annually in an average of 2160 new cancer diagnoses and 1190 cancer deaths in Quebec. Incident cancers of the lung, prostate, skin, bladder, and (female) breast were the most numerous; cancer sites resulting in more deaths were lung, (female) breast, and pleura. During the same period, compensation statistics reported annual averages of 94.3 incident cancers and 61.9 cancer deaths, mostly involving mesothelioma (64% of compensated incident cancers) and lung cancer (30% of compensated incident cancers). Conclusions: Increased recognition of workplace cancers by all stakeholders, from workers and employers to treating physicians, will foster appropriate preventive measures for safer workplaces. Full article

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Open AccessArticle

Collaborative Case Conferences in Rectal Cancer: Case Series in a Tertiary Care Centre

by C. Eskicioglu, S. Forbes, S. Tsai, V. Francescutti, A. Coates, V. Grubac, R. Sonnadara and M. Simunovic

Curr. Oncol. 2016, 23(2), 138-143; https://doi.org/10.3747/co.23.2894 - 01 Apr 2016

Cited by 1 | Viewed by 478

Abstract

Background: In many hospitals, resource barriers preclude the use of preoperative multidisciplinary cancer conferences (MCCS) for consecutive patients with cancer. Collaborative cancer conferences (CCCS) are modified MCCS that might overcome such barriers. Methods: We established a CCC [...] Read more.

Background: In many hospitals, resource barriers preclude the use of preoperative multidisciplinary cancer conferences (MCCS) for consecutive patients with cancer. Collaborative cancer conferences (CCCS) are modified MCCS that might overcome such barriers. Methods: We established a CCC at an academic tertiary care centre to review preoperative plans for patients with rectal cancer. Attendees included only surgeons who perform colorectal cancer procedures and a radiologist with expertise in cross-sectional imaging. Individual reviews began with the primary surgeon presenting the case information and initial treatment recommendations. Cross-sectional images were then reviewed, the case was discussed, and consensus on CCC-treatment recommendations was achieved. Outcomes for the present study were changes in treatment recommendations defined as “major” (that is, redirection of patient to preoperative radiation from straight-to-surgery or uncertain plan, or redirection of the patient to straight-to-surgery from preoperative radiation or plan uncertain) or as “minor” (that is, referral to a multidisciplinary cancer clinic, request additional tests, change type of neoadjuvant therapy, change type of surgery). Chart reviews provided relevant patient, tumour, and treatment information. Results: Between September 2011 and September 2012, 101 rectal cancer patients were discussed at a CCC. Of the 35 management plans (34.7%) that were changed as a result, 8 had major changes, and 27 had minor changes. Available patient and tumour factors did not predict for a change in treatment recommendation. Conclusions: Preoperative CCCS at a tertiary-care centre changed treatment recommendations for one third of patients with rectal cancer. Given that no specific factor predicted for a treatment plan change, it is likely prudent that all rectal cancer patients undergo some form of collaborative review. Full article

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Open AccessArticle

Involved-Field Irradiation in Definitive Chemoradiotherapy for T4 Squamous Cell Carcinoma of the Esophagus

by M. Li, F. Zhao, X. Zhang, F. Shi, H. Zhu, A. Han, Y. Zhang, L. Kong and J. Yu

Curr. Oncol. 2016, 23(2), 131-137; https://doi.org/10.3747/co.23.2846 - 01 Apr 2016

Cited by 14 | Viewed by 510

Abstract

Objectives: Definitive concurrent chemoradiotherapy (CCRT) is currently a therapeutic option for locally advanced esophageal cancer. However, clinical practice differs with respect to the target volume for irradiation. The purpose of the present study was to analyze failure patterns and survival, [...] Read more.

Objectives: Definitive concurrent chemoradiotherapy (CCRT) is currently a therapeutic option for locally advanced esophageal cancer. However, clinical practice differs with respect to the target volume for irradiation. The purpose of the present study was to analyze failure patterns and survival, and to determine the feasibility of using involved-field irradiation (IFI) with concurrent chemotherapy for T4 squamous cell carcinoma (SCC) of the esophagus. Methods: Between January 2003 and January 2013, 56 patients with clinical T4M0 SCC of the esophagus received CCRT using IFI. The radiation field included the primary tumour and clinically involved lymph nodes. Target volumes and sites of failure were analyzed, as were treatment-related toxicity and survival time. Results: In this 56-patient cohort, 13 patients (23.2%) achieved a complete response, and 21 (37.5%) achieved a partial response, for a total response rate of 60.7%. The major toxicities experienced were leucocytopenia and esophagitis, with 14 patients (25.0%) experiencing grade 3 toxicities. At a median follow-up of 34 months, 48 patients (85.7%) had experienced failure: 39 (69.6%) in-field, 7 (12.5%) elective nodal, and 19 (33.9%) distant. Only 1 patient (1.8%) experienced isolated elective nodal failure. The 1-, 2-, and 3-year survival rates were 39.3%, 21.4%, and 12.5% respectively. Conclusions: For patients with T4M0 SCC of the esophagus, definitive CCRT using IFI resulted in an acceptable rate of isolated elective nodal failure and an overall survival comparable to that achieved with elective nodal irradiation. A limited radiation therapy target volume, including only clinically involved lesions, would therefore be a feasible choice for this patient subgroup. Full article

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Open AccessMeeting Report

Report on a Delphi Process and Workshop to Improve Accrual to Cancer Clinical Trials

by J.A.H. Bell, L.G. Balneaves, M.T. Kelly and H. Richardson

Curr. Oncol. 2016, 23(2), 125-130; https://doi.org/10.3747/co.23.3110 - 01 Apr 2016

Cited by 3 | Viewed by 502

Abstract

Cancer clinical trials (ccts) are essential for furthering knowledge and developing effective interventions to improve the lives of people living with cancer in Canada. Randomized controlled trials are particularly important for developing evidence-based health care interventions. To produce robust and relevant [...] Read more.

Cancer clinical trials (ccts) are essential for furthering knowledge and developing effective interventions to improve the lives of people living with cancer in Canada. Randomized controlled trials are particularly important for developing evidence-based health care interventions. To produce robust and relevant research conclusions, timely and sufficient accrual to ccts is essential. The present report delivers the key recommendations emerging from a workshop meeting, Improve Accrual to Cancer Clinical Trials, that was hosted by the Canadian Cancer Trials Group and funded by the Canadian Institutes of Health Research. The meeting, which took place in Toronto, Ontario, in April 2012 before the Canadian Cancer Trials Group annual spring meeting, brought together key stakeholders from across Canada to explore creative strategies for improving accrual to ccts. The objectives of the workshop were to provide an opportunity for knowledge exchange with respect to the research evidence and the ethics theory related to cct accrual and to promote discussion of best practices and policies related to enhancing cct access and accrual in Canada. The workshop provided the foundation for establishing new interdisciplinary research collaborations to overcome the identified barriers to cct participation in Canada. Meeting participants also supported the development of evidence-based policies and practices to make trials more accessible to Canadians living with cancer. Full article

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Open AccessArticle

Hematogones: A Sensitive Prognostic Factor for Chinese Adult Patients with Acute Myeloid Leukemia

by L. Li, R. Fu, T. Zhang, X. Xie, J. Liu, J. Tao, J. Song, H. Liu, W. Zhang, W. Lu and Z. Shao

Curr. Oncol. 2016, 23(2), 123-130; https://doi.org/10.3747/co.23.2877 - 01 Apr 2016

Cited by 4 | Viewed by 596

Abstract

Background: Hematogones (HGS) are normal B-lymphocyte precursors that increase in some hematologic diseases. Many studies indicate that HGS might be a favourable prognostic factor. We thus considered it important to determine whether HGS are also a prognostic factor for Chinese [...] Read more.

Background: Hematogones (HGS) are normal B-lymphocyte precursors that increase in some hematologic diseases. Many studies indicate that HGS might be a favourable prognostic factor. We thus considered it important to determine whether HGS are also a prognostic factor for Chinese adult patients with acute myeloid leukemia (AML) and whether the HG-positive and HG-negative groups show any serologic or phenotypic differences. Methods: Chinese adult AML patients (n = 177) who were all initially HG-negative underwent standard chemotherapy and were thereafter divided into HG-positive and HG-negative groups according to HGlevels in bone marrow during their first remission. Results: The follow-up study confirmed that survival duration (both leukemia-free and overall) was significantly greater in the HG-positive group than in the HG-negative group and was accompanied by a lower relapse rate. A retrospective study of patient characteristics at the time of first diagnosis revealed some differences between the HG-positive and the HG-negative groups, including elevations in white blood cells, lactate dehydrogenase, and β₂-microglobulin in the HG-negative group. Retrospective phenotypic analysis revealed a significantly lower proportion of abnormal chromosome karyotype and CD34 expression in HG-positive patients. Finally, we evaluated whether additional intensive chemotherapy after standard chemotherapy could further increase HGS. Conclusions: The present work verified the validity of HGS as a prognostic factor for Chinese adult patients with AML. Compared with HG-negative patients, HG-positive patients not only experienced longer survival and a lower relapse rate, but they also had some serologic and phenotypic characteristics that are all considered indicators of better outcome. Additional intensive chemotherapy could further increase the level of HGS, which might imply better clinical results. Full article

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Open AccessShort Communication

A First Look at Relative Survival by Stage for Colorectal and Lung Cancers in Canada

by J. Chadder, R. Dewar, L. Shack, D. Nishri, J. Niu and G. Lockwood

Curr. Oncol. 2016, 23(2), 119-124; https://doi.org/10.3747/co.23.3096 - 01 Apr 2016

Cited by 4 | Viewed by 419

Abstract

Monitoring and reporting on cancer survival provides a mechanism for understanding the effectiveness of Canada’s cancer care system. Although 5-year relative survival for colorectal cancer and lung cancer has been previously reported, only recently has pan-Canadian relative survival by stage been analyzed using [...] Read more.

Monitoring and reporting on cancer survival provides a mechanism for understanding the effectiveness of Canada’s cancer care system. Although 5-year relative survival for colorectal cancer and lung cancer has been previously reported, only recently has pan-Canadian relative survival by stage been analyzed using comprehensive registry data. This article presents a first look at 2-year relative survival by stage for colorectal and lung cancer across 9 provinces. As expected, 2-year age-standardized relative survival ratios (arsrs) for colorectal cancer and lung cancer were higher when the cancer was diagnosed at an earlier stage. The arsrs for stage i colorectal cancer ranged from 92.2% in Nova Scotia [95% confidence interval (ci): 88.6% to 95.1%] to 98.4% in British Columbia (95% ci: 96.2% to 99.3%); for stage iv, they ranged from 24.3% in Prince Edward Island (95% ci: 15.2% to 34.4%) to 38.8% in New Brunswick (95% ci: 33.3% to 44.2%). The arsrs for stage i lung cancer ranged from 66.5% in Prince Edward Island (95% ci: 54.5% to 76.5%) to 84.8% in Ontario (95% ci: 83.5% to 86.0%). By contrast, arsrs for stage iv lung cancer ranged from 7.6% in Manitoba (95% ci: 5.8% to 9.7%) to 13.2% in British Columbia (95% ci: 11.8% to 14.6%). The available stage data are too recent to allow for meaningful comparisons between provinces, but over time, analyzing relative survival by stage can provide further insight into the known differences in 5-year relative survival. As the data mature, they will enable an assessment of the extent to which interprovincial differences in relative survival are influenced by differences in stage distribution or treatment effectiveness (or both), permitting targeted measures to improve population health outcomes to be implemented. Full article

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Open AccessArticle

A Retrospective Study on the Role of Diabetes and Metformin in Colorectal Cancer Disease Survival

by R. Ramjeesingh, C. Orr, C.S. Bricks, W.M. Hopman and N. Hammad

Curr. Oncol. 2016, 23(2), 116-122; https://doi.org/10.3747/co.23.2809 - 01 Apr 2016

Cited by 29 | Viewed by 869

Abstract

Background: Recent studies have suggested an effect of metformin on mortality for patients with both diabetes and colorectal cancer (CRC). However, the literature is contradictory, with both positive and negative effects being identified. We set out to determine the effect [...] Read more.

Background: Recent studies have suggested an effect of metformin on mortality for patients with both diabetes and colorectal cancer (CRC). However, the literature is contradictory, with both positive and negative effects being identified. We set out to determine the effect of metformin with respect to prognosis in CRC patients. Methods: After a retrospective chart review of CRC patients treated at the Cancer Centre of Southeastern Ontario, Kaplan–Meier analyses and Cox proportional hazards regression models were used to compare overall survival (os) in patients with and without diabetes. Results: We identified 1304 CRC patients treated at the centre. No significant differences between the diabetic and nondiabetic groups were observed with respect to tumour pathology, extent of metastatic disease, time or toxicity of chemotherapy, and the os rate (1-year os: 85.6% vs. 86.4%, p = 0.695; 2-year os: 73.6% vs. 77.0%, p = 0.265). In subgroup analysis, diabetic patients taking metformin survived significantly longer than their counterparts taking other diabetes treatments (os for the metformin group: 91% at 1 year; 80.5% at 2 years; os for the group taking other treatments, including diet control: 80.6% at 1 year, 67.4% at 2 years). Multivariate analysis suggests that patients with diabetes taking treatments other than metformin experience worse survival (p = 0.025). Conclusions: Our results suggest that CRC patients with diabetes, excluding those taking metformin, might have a worse CRC prognosis. Taking metformin appears to have a positive association with prognosis. The protective nature of metformin needs further evaluation in prospective analyses. Full article

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Open AccessArticle

Follow-Up for Cervical Cancer: A Program in Evidence-Based Care Systematic Review and Clinical Practice Guideline Update

by L. Elit, E.B. Kennedy, A. Fyles and U. Metser

Curr. Oncol. 2016, 23(2), 109-118; https://doi.org/10.3747/co.23.2742 - 01 Apr 2016

Cited by 20 | Viewed by 1010

Abstract

Background: In 2009, the Program in Evidence-based Care (pebc) of Cancer Care Ontario published a guideline on the follow-up of cervical cancer. In 2014, the pebc undertook an update of the systematic review and clinical practice guideline for women in [...] Read more.

Background: In 2009, the Program in Evidence-based Care (pebc) of Cancer Care Ontario published a guideline on the follow-up of cervical cancer. In 2014, the pebc undertook an update of the systematic review and clinical practice guideline for women in this target population. Methods: The literature from 2007 to August 2014 was searched using medline and embase [extended to 2000 for studies of human papillomavirus (hpv) dna testing]. Outcomes of interest were measures of survival, diagnostic accuracy, and quality of life. A working group evaluated the need for changes to the earlier guidelines and incorporated comments and feedback from internal and external reviewers. Results: One systematic review and six individual studies were included. The working group concluded that the new evidence did not warrant changes to the 2009 recommendations, although hpv dna testing was added as a potentially more sensitive method of detecting recurrence in patients treated with radiotherapy. Comments from internal and external reviewers were incorporated. Recommendations Summary: Follow-up care after primary treatment should be conducted and coordinated by a physician experienced in the surveillance of cancer patients. A reasonable follow-up strategy involves visits every 3–4 months within the first 2 years, and every 6–12 months during years 3–5. Visits should include a patient history and complete physical examination, with elicitation of relevant symptoms. Vaginal vault cytology examination should not be performed more frequently than annually. Combined positron-emission tomography and computed tomography, other imaging, and biomarker evaluation are not advocated; hpv dna testing could be useful as a method of detection of recurrence after radiotherapy. General recommendations for follow-up after 5 years are also provided. Full article

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Open AccessArticle

Costs of Cervical Cancer Treatment: Population-Based Estimates from Ontario

by C. Pendrith, A. Thind, G.S. Zaric and S. Sarma

Curr. Oncol. 2016, 23(2), 109-115; https://doi.org/10.3747/co.23.2598 - 01 Apr 2016

Cited by 16 | Viewed by 809

Abstract

Objectives: The objectives of the present study were to estimate the overall and specific medical care costs associated with cervical cancer in the first 5 years after diagnosis in Ontario. Methods: Incident cases of invasive cervical cancer during 2007–2010 were identified [...] Read more.

Objectives: The objectives of the present study were to estimate the overall and specific medical care costs associated with cervical cancer in the first 5 years after diagnosis in Ontario. Methods: Incident cases of invasive cervical cancer during 2007–2010 were identified from the Ontario Cancer Registry and linked to administrative databases held at the Institute for Clinical Evaluative Sciences. Mean costs in 2010 Canadian dollars were estimated using the arithmetic mean and estimators that adjust for censored data. Results: Mean age of the patients in the study cohort (779 cases) was 49.3 years. The mean overall medical care cost was $39,187 [standard error (se): $1,327] in the 1st year after diagnosis. Costs in year 1 ranged from $34,648 (se: $1,275) for those who survived at least 1 year to $69,142 (se: $4,818) for those who died from cervical cancer within 1 year. At 5 years after diagnosis, the mean overall unadjusted cost was $63,131 (se: $3,131), and the cost adjusted for censoring was $68,745 (se: $2,963). Inpatient hospitalizations and cancer-related care were the two largest components of cancer treatment costs. Conclusions: We found that the estimated mean costs that did not account for censoring were consistently undervalued, highlighting the importance of estimates based on censoring-adjusted costs in cervical cancer. Our results are reliable for estimating the economic burden of cervical cancer and the cost-effectiveness of cervical cancer prevention strategies. Full article

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Open AccessArticle

Formal Evaluation of PYNK: Breast Cancer Program for Young Women—The Patient Perspective

by L. Cohen, J. Hamer, C. Helwig, K. Fergus, A. Kiss, R. Mandel, B. Dawson, A. Landsberg, K. Shein, N. Kay and E. Warner

Curr. Oncol. 2016, 23(2), 102-108; https://doi.org/10.3747/co.23.2773 - 01 Apr 2016

Cited by 23 | Viewed by 696

Abstract

Purpose: The aim of the present study was to assess patient satisfaction with PYNK: Breast Cancer Program for Young Women so as to determine how the program might be improved and to provide feedback to donors. Methods: All PYNK patients [...] Read more.

Purpose: The aim of the present study was to assess patient satisfaction with PYNK: Breast Cancer Program for Young Women so as to determine how the program might be improved and to provide feedback to donors. Methods: All PYNK patients who had consented to have their information entered in our database and who supplied us with their e-mail address were invited to complete a 58-item online questionnaire consisting of multiple choice and open-ended questions. Domains included demographics, provision of written and spoken information, support, infertility risk, research awareness, attitudes toward discharge, and general feedback. Results: Of 120 PYNK patients approached, 61 (51%) participated. More than 90% were satisfied or very satisfied with the timing, usefulness, and clarity of spoken and written information given, and 69% found the service and support provided by the nurse navigator to be the most helpful component of the program. Of those who had received systemic therapy, 93% recalled a health care provider initiating a discussion of the risk of treatment-related infertility, and 67% were referred to a fertility clinic. On the negative side, 11%–27% were unaware of various services provided by pynk, and 11% were unaware of PYNK’s ongoing research. One third of patients were unhappy or ambivalent about the prospect of discharge from the program. Conclusions: Patient satisfaction with this novel program for young women with breast cancer is high. This study highlights the critical role that the nurse navigator plays in patient support and dissemination of information. In contrast to other reported surveys of young cancer patients, PYNK patients are routinely given the opportunity to undergo fertility preservation. Full article

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Open AccessArticle

Canadian Recommendations for the Management of Breakthrough Cancer Pain

by P. Daeninck, B. Gagnon, R. Gallagher, J.D. Henderson, Y. Shir, C. Zimmermann and B. Lapointe

Curr. Oncol. 2016, 23(2), 96-108; https://doi.org/10.3747/co.23.2865 - 01 Apr 2016

Cited by 32 | Viewed by 2178

Abstract

Breakthrough cancer pain (BTCP) represents an important element in the spectrum of cancer pain management. Because most BTCP episodes peak in intensity within a few minutes, speed of medication onset is crucial for proper control. In Canada, several current provincial guidelines [...] Read more.

Breakthrough cancer pain (BTCP) represents an important element in the spectrum of cancer pain management. Because most BTCP episodes peak in intensity within a few minutes, speed of medication onset is crucial for proper control. In Canada, several current provincial guidelines for the management of cancer pain include a brief discussion about the treatment of BTCP; however, there are no uniform national recommendations for the management of BTCP. That lack, accompanied by unequal access to pain medication across the country, contributes to both regional and provincial variability in the management of BTCP. Currently, immediate-release oral opioids are the treatment of choice for BTCP. This approach might not always offer optimal speed for onset of action and duration to match the rapid nature of an episode of BTCP. Novel transmucosal fentanyl formulations might be more appropriate for some types of BTCP, but limited access to such drugs hinders their use. In addition, the recognition of BTCP and its proper assessment, which are crucial steps toward appropriate treatment selection, remain challenging for many health care professionals. To facilitate appropriate management of BTCP, a group of prominent Canadian specialists in palliative care, oncology, and anesthesiology convened to develop a set of recommendations and suggestions to assist Canadian health care providers in the treatment of BTCP and the alleviation of the suffering and discomfort experienced by adult cancer patients. Full article

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Open AccessArticle

Expression of APPL1 Is Correlated with Clinicopathologic Characteristics and Poor prognosis in Patients with Gastric Cancer

by J.S. Zhai, J.G. Song, C.H. Zhu, K. Wu, Y. Yao and N. Li

Curr. Oncol. 2016, 23(2), 95-101; https://doi.org/10.3747/co.23.2775 - 01 Apr 2016

Cited by 7 | Viewed by 493

Abstract

Background: Although APPL1 is overexpressed in many cancers, its status in gastric cancer (GC) is not known. In the present study, we used relevant pathologic and clinical data to investigate APPL1 expression in patients with GC. Methods: In [...] Read more.

Background: Although APPL1 is overexpressed in many cancers, its status in gastric cancer (GC) is not known. In the present study, we used relevant pathologic and clinical data to investigate APPL1 expression in patients with GC. Methods: In 47 GC and 27 non-GC surgical specimens, immunohistochemistry was used to detect the expression of APPL1, and reverse-transcriptase polymerase chain reaction (RT-PCR) was used to detect messenger RNA (mRNA). A scatterplot visualized the relationship between survival time and mRNA expression in GC patients. The log-rank test and other survival statistics were used to determine the association of APPL1 expression with the pathologic features of the cancer and clinical outcomes. Results: In GC, APPL1 was expressed in 28 of 47 specimens (59.6%), and in non-GC, it was expressed in 7 of 23 specimens (30.4%, p < 0.05). The expression of mRNA in GC was 0.82 [95% confidence interval (CI): 0.78 to 0.86], and in non-GC, it was 0.73 (95% CI: 0.69 to 0.77; p < 0.05). Immunohistochemistry demonstrated that, in GC, APPL1 expression was correlated with depth of infiltration (p = 0.005), lymph node metastasis (p = 0.017), and TNM stage (p = 0.022), but not with pathologic type (p = 0.41). Testing by RT-PCR demonstrated that, in GC, APPL1 mRNA expression was correlated with depth of infiltration (p = 0.042), lymph node metastasis (p = 0.031), and TNM stage (p = 0.04), but again, not with pathologic type (p = 0.98). The correlation coefficient between survival time and mRNA expression was −0.83 (p < 0.01). Overexpression of APPL1 protein (hazard ratio: 3.88; 95% CI: 1.07 to 14.09) and mRNA (hazard ratio: 4.23; 95% CI: 3.09 to 15.11) was a risk factor for death in patients with GC. Conclusions: Expression of APPL1 is increased in GC. Overexpression is prognostic for a lethal outcome. Full article

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Open AccessArticle

Duration of Trastuzumab in Patients with HER2-Positive Metastatic Breast Cancer in Prolonged Remission

by R. Haq and P. Gulasingam

Curr. Oncol. 2016, 23(2), 91-95; https://doi.org/10.3747/co.23.2743 - 01 Apr 2016

Cited by 14 | Viewed by 714

Abstract

Background: Outcomes in metastatic breast cancer (MBC) positive for HER2 (human epidermal growth factor receptor 2) are generally unfavourable. Trastuzumab has revolutionized the prognosis of HER2-positive mbc. Some HER2-positive mbc patients go into prolonged remission, and a few [...] Read more.

Background: Outcomes in metastatic breast cancer (MBC) positive for HER2 (human epidermal growth factor receptor 2) are generally unfavourable. Trastuzumab has revolutionized the prognosis of HER2-positive mbc. Some HER2-positive mbc patients go into prolonged remission, and a few patients remain in remission even after discontinuation of trastuzumab, suggesting the possibility of a cure. In our practice, 4 HER2-positive mbc patients treated with chemotherapy and trastuzumab have remained in remission on maintenance therapy for 5 years or more. Of those 4 patients, 2 have continued in remission after discontinuation of trastuzumab for more than 1 year. The objective of the present paper was therefore to address the duration of trastuzumab therapy in HER2-positive mbc patients in prolonged remission. Methods: We conducted a literature review of the duration of trastuzumab in HER2-positive mbc patients in remission. We also conducted an online survey of oncologists in Ontario to determine their treatment practices in HER2-positive mbc patients. Results: The literature search found no specific evidence about the optimal duration of trastuzumab maintenance therapy in HER2-positive mbc in prolonged remission. However, retrospective studies suggest predictive markers of good prognosis in patients in complete remission taking maintenance trastuzumab. Identifying those markers could lead to more personalized treatment. Our survey of oncologists about their treatment practices in HER2-positive mbc patients revealed that 82.93% of respondents (n = 34) follow the currently available guidelines. Conclusions: With the emergence of patients in prolonged remission, duration of trastuzumab in HER2-positive mbc has become an important and relevant clinical question worldwide. Collaborative efforts are needed for the further study of this topic. Full article

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Open AccessArticle

MicroRNA Expression Profiling of Sputum for the Detection of Early and Locally Advanced Non-Small-Cell Lung Cancer: A Prospective Case–Control Study

by R. Razzak, E.L.R. Bédard, J.O. Kim, S. Gazala, L. Guo, S. Ghosh, A. Joy, T. Nijjar, E. Wong and W.H. Roa

Curr. Oncol. 2016, 23(2), 86-94; https://doi.org/10.3747/co.23.2830 - 01 Apr 2016

Cited by 32 | Viewed by 622

Abstract

Background: Non-small-cell lung cancer (NSCLC) is associated with very poor overall survival because 70% of patients present with locally advanced or metastatic disease at the time of diagnosis. MicroRNAS (miRNAS) are a class of short, noncoding RNA [...] Read more.

Background: Non-small-cell lung cancer (NSCLC) is associated with very poor overall survival because 70% of patients present with locally advanced or metastatic disease at the time of diagnosis. MicroRNAS (miRNAS) are a class of short, noncoding RNA molecules whose presence in samples of biologic fluids such as sputum has demonstrated promise as a potential means of detecting NSCLC. We investigated the stage-specific NSCLC detection potential of an efficient panel of 3 miRNAS (MIR-21, MIR-210, MIR-372) using a single sputum sample. Methods: A single spontaneously expectorated sputum sample was prospectively collected from 21 early NSCLC (≤stage II) patients, 22 advanced NSCLC (≥stage III) patients, and 10 control subjects. MiRNA expression profiles were determined by quantitative real-time polymerase chain reaction and were analyzed by unsupervised hierarchical cluster analysis. Results: Mean tumour size (±95% confidence interval) in the early and advanced NSCLC patients was 3.3 cm ± 0.9 cm and 4.8 cm ± 0.7 cm respectively. Adenocarcinoma constituted 61.9% of the early and 45.5% of the advanced NSCLC cases respectively. In comparing the early NSCLC group with the control group, the miRNA panel yielded a diagnostic sensitivity of 67% and a specificity of 90.0%. For the advanced NSCLC group, the miRNA panel detected NSCLC with a sensitivity and specificity of 64% and 100% respectively. Conclusions: A sputum MIR-21, MIR-210, and MIR-372 expression profile might provide a sensitive and highly specific means for detecting NSCLC. Sputum miRNA analysis demonstrates promise as a potential complementary screening tool. Full article

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Open AccessCommentary

Accrual of Adolescents and Young Adults with Cancer to Clinical Trials

by A.E. Hay, C. Rae, G.A. Fraser, R.M. Meyer, L.S. Abbott, S. Bevan, M.L. McBride, G.D.E. Cuvelier, S. McKillop and R.D. Barr

Curr. Oncol. 2016, 23(2), 81-85; https://doi.org/10.3747/co.23.2925 - 01 Apr 2016

Cited by 19 | Viewed by 498

Abstract

Cancer is the most common disease-related cause of death in 15- to 29-year-olds in Canada [...]
Full article

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Open AccessArticle

Identification of Performance Indicators across a Network of Clinical Cancer Programs

by S.R. Khare, G. Batist and G. Bartlett

Curr. Oncol. 2016, 23(2), 81-90; https://doi.org/10.3747/co.23.2789 - 01 Apr 2016

Cited by 17 | Viewed by 659

Abstract

Background: Cancer quality indicators have previously been described for a single tumour site or a single treatment modality, or according to distinct data sources. Our objective was to identify cancer quality indicators across all treatment modalities specific to breast, prostate, colorectal, and [...] Read more.

Background: Cancer quality indicators have previously been described for a single tumour site or a single treatment modality, or according to distinct data sources. Our objective was to identify cancer quality indicators across all treatment modalities specific to breast, prostate, colorectal, and lung cancer. Methods: Candidate indicators for each tumour site were extracted from the relevant literature and rated in a modified Delphi approach by multidisciplinary groups of expert clinicians from 3 clinical cancer programs. All rating rounds were conducted by e-mail, except for one that was conducted as a face-to-face expert panel meeting, thus modifying the original Delphi technique. Four high-level indicators were chosen for immediate data collection. A list of confounding variables was also constructed in a separate literature review. Results: A total of 156 candidate indicators were identified for breast cancer, 68 for colorectal cancer, 40 for lung cancer, and 43 for prostate cancer. Iterative rounds of ratings led to a final list of 20 evidence- and consensus-based indicators each for colorectal and lung cancer, and 19 each for breast and prostate cancer. Approximately 30 clinicians participated in the selection of the breast, lung, and prostate indicators; approximately 50 clinicians participated in the selection of the colorectal indicators. Conclusions: The modified Delphi approach that incorporates an in-person meeting of expert clinicians is an effective and efficient method for performance indicator selection and offers the added benefit of optimal clinician engagement. The finalized indicator lists for each tumour site, together with salient confounding variables, can be directly adopted (or adapted) for deployment within a performance improvement program. Full article

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Open AccessArticle

Research Output and the Public Health Burden of Cancer: Is There Any Relationship?

by F.M. Patafio, S.C. Brooks, X. Wei, Y. Peng, J. Biagi and C.M. Booth

Curr. Oncol. 2016, 23(2), 75-80; https://doi.org/10.3747/co.23.2935 - 01 Apr 2016

Cited by 14 | Viewed by 740

Abstract

Purpose: The relative distribution of research output across cancer sites is not well described. Here, we evaluate whether the volume of published research is proportional to the public health burden of individual cancers. We also explore whether research output is proportional to research [...] Read more.

Purpose: The relative distribution of research output across cancer sites is not well described. Here, we evaluate whether the volume of published research is proportional to the public health burden of individual cancers. We also explore whether research output is proportional to research funding. Methods: Statistics from the Canadian and American cancer societies were used to identify the top ten causes of cancer death in 2013. All journal articles and clinical trials published in 2013 by Canadian or U.S. authors for those cancers were identified. Total research funding in Canada by cancer site was obtained from the Canadian Cancer Research Alliance. Descriptive statistics and Pearson correlation coefficients were used to describe the relationship between research output, cancer mortality, and research funding. Results: We identified 19,361 publications and 2661 clinical trials. The proportion of publications and clinical trials was substantially lower than the proportion of deaths for lung (41% deaths, 15% publications, 16% clinical trials), colorectal (14%, 7%, 6%), pancreatic (10%, 7%, 5%), and gastroesophageal (7%, 5%, 3%) cancers. Conversely, research output was substantially greater than the proportion of deaths for breast cancer (10% deaths, 29% publications, 30% clinical trials) and prostate cancer (8%, 15%, 17%). We observed a stronger correlation between research output and funding (publications r = 0.894, p < 0.001; clinical trials r = 0.923, p < 0.001) than between research output and cancer mortality (r = 0.363, p = 0.303; r = 0.340, p = 0.337). Conclusions: Research output is not well correlated with the public health burden of individual cancers, but is correlated with the relative level of research funding. Full article

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Open AccessCommentary

Training the Trainer: Five Practical Considerations for Your First Five Years in Practice

by C. Jacobs, A.A. Joy, M. Clemons, S. Mazzarello and M. Fralick

Curr. Oncol. 2016, 23(2), 71-73; https://doi.org/10.3747/co.23.2959 - 01 Apr 2016

Cited by 7 | Viewed by 393

Abstract

Congratulations, you’ve made it! After years of studying, subspecialist training, and rounds of interviews, you have a staff position [...] Full article

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Open AccessEditorial

Guideposts for Quests in the Realm of Oncology Careers

by S. Snow and T. Younis

Curr. Oncol. 2016, 23(2), 69; https://doi.org/10.3747/co.23.3127 - 01 Apr 2016

Viewed by 344

Abstract

Oncology is a small world in Canada, but the practice each individual undertakes is unique. [...] Full article

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Curr. Oncol., Volume 23, Issue 2 (April 2016) – 23 articles

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