Current Oncology

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Open AccessLetter

Trastuzumab in Metastatic Breast Cancer after Complete Remission: An Expensive Commitment for an Entire Life?

by Current Oncology Editorial Office

Curr. Oncol. 2017, 24(1), 76-77; https://doi.org/10.3747/co.24.3413 - 01 Feb 2017

Viewed by 331

Abstract

Metastatic breast cancer has consistently been considered an incurable disease. [...] Full article

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Open AccessLetter

Chemonaïveté in Inoperable Malignant Bowel Obstruction

by Saber Boutayeb, Ibrahim El Ghissassi, Hind Mrabti and Hassan Errihani

Curr. Oncol. 2017, 24(1), 75; https://doi.org/10.3747/co.24.3362 - 01 Feb 2017

Viewed by 335

Abstract

We are writing concerning the article titled “Metronomic chemotherapy with 5-fluorouracil and cisplatin for inoperable malignant bowel obstruction because of peritoneal dissemination from gastric cancer” recently published in your journal by Yang et al.[...]
Full article

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Open AccessMeeting Report

Moving Guidelines into Action: A Report from Cancer Care Ontario’s Event Let’s Get Moving: Exercise and Rehabilitation for Cancer Patients

by J.R. Tomasone, C. Zwaal, G. Kim, D. Yuen, J. Sussman, R. Segal and

Curr. Oncol. 2017, 24(1), 65-74; https://doi.org/10.3747/co.24.3422 - 01 Feb 2017

Cited by 17 | Viewed by 584

Abstract

The need for an improved understanding of the rehabilitation services landscape in Ontario and for promotion of Cancer Care Ontario’s newly developed Exercise for People with Cancer guideline brought Cancer Care Ontario’s Psychosocial Oncology and Survivorship Programs together to host a knowledge translation [...] Read more.

The need for an improved understanding of the rehabilitation services landscape in Ontario and for promotion of Cancer Care Ontario’s newly developed Exercise for People with Cancer guideline brought Cancer Care Ontario’s Psychosocial Oncology and Survivorship Programs together to host a knowledge translation and exchange event. The primary objectives of the event were to understand recommendations from Cancer Care Ontario’s new exercise guideline, to discuss key considerations and determine strategies for the implementation of the guideline recommendations, and to explore the current state and future directions of cancer rehabilitation in Ontario. The event was attended by 124 stakeholders, including clinicians, allied health care professionals, administrators, patients, community partners, and academics representing each of the 13 regional cancer programs in Ontario. Attendees participated in two small-group activities that focused on determining the best approach for implementing the guideline recommendations into practice and discussing current barriers and the future state of cancer rehabilitation in Ontario. The activities allowed for networking and collaboration between attendees. The event provided an opportunity for the Psychosocial Oncology and Survivorship Programs to learn about the types of goals and plans that could be feasible in implementing the guideline in each region, and about ways to prioritize gaps in access to rehabilitation services and the types of implementation strategies that might be used to address the gaps. Overall, attendees were highly satisfied with the event, and the findings are being used to help inform research and practice activities with respect to guideline implementation and rehabilitation practice. Full article

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Open AccessReview

Successful Treatment of Gastrointestinal Mucormycosis in an Adult with Acute LeukemiA: Case Report and Literature Review

by A. Alghamdi, A. Lutynski, M. Minden and C. Rotstein

Curr. Oncol. 2017, 24(1), 61-64; https://doi.org/10.3747/co.24.3522 - 01 Feb 2017

Cited by 10 | Viewed by 466

Abstract

Mucormycosis has emerged as an important cause of invasive fungal infection in patients with hematologic malignancies. Gastrointestinal mucormycosis is an unusual presentation of this invasive fungal infection, and it causes considerable morbidity and mortality. Such outcomes are due in part to a nonspecific [...] Read more.

Mucormycosis has emerged as an important cause of invasive fungal infection in patients with hematologic malignancies. Gastrointestinal mucormycosis is an unusual presentation of this invasive fungal infection, and it causes considerable morbidity and mortality. Such outcomes are due in part to a nonspecific presentation that results in delays in diagnosis and treatment. Successful treatment of gastrointestinal mucormycosis involves surgical debridement and appropriate antifungal therapy. Full article

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Open AccessReview

Nasopharyngeal Non-Intestinal-Type Adenocarcinoma: A Case Report and Updated Review of the Literature

by C. Jain, L. Caulley, K.I. Macdonald, B. Purgina, C.K. Lai, B. Esche and S. Johnson-Obaseki

Curr. Oncol. 2017, 24(1), 55-60; https://doi.org/10.3747/co.24.3299 - 01 Feb 2017

Cited by 3 | Viewed by 485

Abstract

Background: Non-intestinal-type adenocarcinoma is a malignancy traditionally found in the sinonasal cavity. To our knowledge, this case is the first reported of this rare condition originating in the nasopharynx. Case Presentation: A 67-year-old woman with nasopharyngeal non-intestinal-type adenocarcinoma, with an accompanying parapharyngeal mass [...] Read more.

Background: Non-intestinal-type adenocarcinoma is a malignancy traditionally found in the sinonasal cavity. To our knowledge, this case is the first reported of this rare condition originating in the nasopharynx. Case Presentation: A 67-year-old woman with nasopharyngeal non-intestinal-type adenocarcinoma, with an accompanying parapharyngeal mass received primary radiation treatment for both lesions. Her tumour subsequently persisted, with a concomitant conversion in pathology from a low- to a high-grade malignancy. Results: Non-intestinal-type and intestinal-type adenocarcinomas of the nasopharynx are extremely rare tumours and do not appear in the World Health Organization classification system. We review the pathophysiologic features of these malignancies and propose modifications to the current classification system. Conclusions: Non-intestinal-type adenocarcinoma should be included in the differential diagnosis of nasopharyngeal masses. In our experience, this tumour in this location showed a partial response to primary radiation but later converted from a low- to a high-grade adenocarcinoma. Full article

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Open AccessArticle

Updates from the 2016 American Society of Hematology Annual Meeting: Practice-Changing Studies in Untreated Follicular Lymphoma

by C. Owen, D. MacDonald, A. Aw and A. Christofides

Curr. Oncol. 2017, 24(1), 52-60; https://doi.org/10.3747/co.24.3586 - 01 Feb 2017

Viewed by 490

Abstract

The 2016 annual meeting of the American Society of Hematology took place in San Diego, California, 3–6 December. At the meeting, results from key studies on the first-line treatment of follicular lymphoma were presented. Of those studies, key oral presentations included two analyzing [...] Read more.

The 2016 annual meeting of the American Society of Hematology took place in San Diego, California, 3–6 December. At the meeting, results from key studies on the first-line treatment of follicular lymphoma were presented. Of those studies, key oral presentations included two analyzing data from the gallium study, which evaluated the efficacy and safety of obinutuzumab plus chemotherapy (G-chemo) compared with rituximab plus chemotherapy (R-chemo), followed, in responding patients with follicular lymphoma, by obinutuzumab or rituximab maintenance; results from the sabrina study, which evaluated the efficacy and safety of subcutaneous compared with intravenous rituximab; results of a cost-effectiveness analysis of first-line treatment with bendamustine and rituximab from a Canadian perspective; and results from the SAKK 35/10 study, which evaluated the safety and efficacy of rituximab plus lenalidomide compared with rituximab monotherapy. Our meeting report describes the foregoing studies and includes interviews with the Canadian investigators, plus commentaries by those investigators about the potential impact on Canadian practice. Full article

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Open AccessArticle

Examining the Medical Resource Utilization and Costs of Relapsed and Refractory Chronic Lymphocytic Leukemia in Ontario

by S. Hassan, S.J. Seung, M.C. Cheung, G. Fraser, B. Kuriakose, C. Trambitas and N. Mittmann

Curr. Oncol. 2017, 24(1), 50-54; https://doi.org/10.3747/co.24.3182 - 01 Feb 2017

Cited by 1 | Viewed by 604

Abstract

Purpose: The purpose of the present study was to collect medical resource utilization data and costs in Ontario for the management of patients with relapsed or refractory chronic lymphocytic lymphoma (cll) who have undergone at least 1 treatment course and have been stratified [...] Read more.

Purpose: The purpose of the present study was to collect medical resource utilization data and costs in Ontario for the management of patients with relapsed or refractory chronic lymphocytic lymphoma (cll) who have undergone at least 1 treatment course and have been stratified by Rai staging. Methods: This retrospective longitudinal cohort study, conducted by chart review, analyzed anonymized patient records from two cancer centres in Ontario. Comprehensive records of 86 patients meeting the inclusion criteria were used to obtain resource utilization, which, multiplied by unit costs, were used to determine overall and mean costs. Descriptive statistics are presented for patient demographics, medical resource utilization, and costing data. Results: The total cost for the cohort was $2.2 million over a mean follow-up period of 4.7 years. The mean total cost per patient (regardless of follow-up) was $25,736. In terms of Rai staging, overall mean costs were highest for stage iv patients. Almost 50% of the total cost was attributable to cll treatments, among which fludarabine-based treatments had the highest utilization. Conclusions: For this Canadian cll cohort, medical resource utilization and costs were determined to be $2.2 million, with cll treatments accounting for about half the cost. Costs generally increased with Rai stage. Full article

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Open AccessArticle

A Centrally Generated Primary Care Physician Audit Report Does Not Improve Colonoscopy Uptake After a Positive Result on a Fecal Occult Blood Test in Ontario’s Coloncancercheck Program

by D. Stock, L. Rabeneck, N.N. Baxter, L.F. Paszat, R. Sutradhar, L. Yun and J. Tinmouth

Curr. Oncol. 2017, 24(1), 47-51; https://doi.org/10.3747/co.24.3025 - 01 Feb 2017

Cited by 6 | Viewed by 597

Abstract

Background: Timely follow-up of fecal occult blood screening with colonoscopy is essential for achieving colorectal cancer mortality reduction. In the present study, we evaluated the effectiveness of centrally generated, physician-targeted audit and feedback to improve colonoscopy uptake after a positive fecal occult blood [...] Read more.

Background: Timely follow-up of fecal occult blood screening with colonoscopy is essential for achieving colorectal cancer mortality reduction. In the present study, we evaluated the effectiveness of centrally generated, physician-targeted audit and feedback to improve colonoscopy uptake after a positive fecal occult blood test (fobt) result within Ontario’s population-wide ColonCancerCheck Program. Methods: This prospective cohort study used data sets from Ontario’s ColonCancerCheck Program (2008–2011) that were linked to provincial administrative health databases. Cox proportional hazards regression was used to estimate the effect of centralized, physician-targeted audit and feedback on colonoscopy uptake in an Ontario-wide fobt-positive cohort. Results: A mailed physician audit and feedback report identifying individuals outstanding for colonoscopy for 3 or more months after a positive fobt result did not increase the likelihood of colonoscopy uptake (hazard ratio: 0.95; 95% confidence interval: 0.79 to 1.13). Duration of positive fobt status was strongly inversely associated with the hazard of follow-up colonoscopy (p for linear trend: <0.001). Conclusions: In a large population-wide setting, centralized tracking in the form of physician-targeted mailed audit and feedback reports does not improve colonoscopy uptake for screening participants with a positive fobt result outstanding for 3 or more months. Mailed physician-targeted screening audit and feedback reports alone are unlikely to improve compliance with follow-up colonoscopy in Ontario. Other interventions such as physician audits or automatic referrals, demonstrated to be effective in other jurisdictions, might be warranted. Full article

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Open AccessArticle

Guideline for Radiotherapy with Curative Intent in Patients with Early-Stage Medically Inoperable Non-Small-Cell Lung Cancer

by C.B. Falkson, E.T. Vella, E. Yu, M. El-Mallah, R. Mackenzie, P.M. Ellis and Y.C. Ung

Curr. Oncol. 2017, 24(1), 44-49; https://doi.org/10.3747/co.24.3358 - 01 Feb 2017

Cited by 18 | Viewed by 724

Abstract

Objectives: For this guideline, we investigated the effectiveness of radiotherapy with curative intent in medically inoperable patients with early-stage non-small-cell lung cancer (nsclc). Methods: The guideline was developed by Cancer Care Ontario’s Program in Evidence-Based Care and by the Lung Cancer Disease Site [...] Read more.

Objectives: For this guideline, we investigated the effectiveness of radiotherapy with curative intent in medically inoperable patients with early-stage non-small-cell lung cancer (nsclc). Methods: The guideline was developed by Cancer Care Ontario’s Program in Evidence-Based Care and by the Lung Cancer Disease Site Group through a systematic review of mainly retrospective studies, expert consensus, and formal internal and external reviews. Recommendations: 1. Stereotactic body radiation therapy (sbrt) with curative intent is an option that should be considered for patients with early-stage, node-negative, medically inoperable nsclc. Qualifying Statements (1) Because of the high dose per fraction, the planning process and treatment delivery for sbrt require the use of advanced technology to maintain an appropriate level of safety. Consistent patient positioning and 4-dimensional analysis of tumour and critical structure motion during simulation and treatment delivery are essential. (2) Preliminary results for proton-beam therapy have been promising, but the technique requires further clinical study. 2. Recommended fractionation schemes for sbrt should result in a biologically effective dose of 100 or greater by the linear quadric model, choosing an α/β value of 10 [bed10(LQ) ≥ 100]. Qualifying Statements (1) Because of the increased risk of treatment-related adverse events associated with centrally located tumours, consideration of tumour size and proximity to critical central structures is required when determining the dose and fractionation. (2) Examples of dose–fractionation schemes used in the included studies have been provided. (3) Based on the current evidence and the opinion of the authors, radiation doses at bed10(LQ) greater than 146 might significantly increase toxicity and should be avoided. (4) Determination of the radiation bed by the linear quadratic model has limitations for the extreme hypofractionated schemes used in sbrt. Full article

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Open AccessArticle

Exercise for People with Cancer: A Clinical Practice Guideline

by R. Segal, C. Zwaal, E. Green, J.R. Tomasone, A. Loblaw, T. Petrella and the Exercise for People with Cancer Guideline Development Group

Curr. Oncol. 2017, 24(1), 40-46; https://doi.org/10.3747/co.24.3376 - 01 Feb 2017

Cited by 184 | Viewed by 4059

Abstract

Background: Development of this guideline was undertaken by the Exercise for People with Cancer Guideline Development Group, a group organized by Cancer Care Ontario’s Program in Evidence-Based Care (pebc). The purpose of the guideline was to provide guidance for clinicians with respect to [...] Read more.

Background: Development of this guideline was undertaken by the Exercise for People with Cancer Guideline Development Group, a group organized by Cancer Care Ontario’s Program in Evidence-Based Care (pebc). The purpose of the guideline was to provide guidance for clinicians with respect to exercise for patients living with cancer, focusing on the benefits of specific types of exercise, recommendations about screening requirements for new referrals, and safety concerns. Methods: Consistent with the pebc’s standardized approach, a systematic search was conducted for existing guidelines, and systematic literature searches were performed in medline and embase for both systematic reviews and primary literature. Content and methodology experts performed an internal review, which was followed by an external review by targeted experts and intended users. Results: The search identified three guidelines, eighteen systematic reviews, and twenty-nine randomized controlled trials with relevance to the topic. The present guideline provides recommendations for the duration, frequency, and intensity of exercise appropriate for people living with cancer. It also provides recommendations for pre-exercise assessment, safety concerns, and delivery models. Conclusions: There is sufficient evidence to show that exercise provides benefits in quality of life and muscular and aerobic fitness for people with cancer both during and after treatment, and that it does not cause harm. The present guideline is intended to support the Canadian Society for Exercise Physiology’s Canadian physical activity guidelines. The recommendations are intended for clinicians and institutions treating cancer patients in Ontario, and for policymakers and program planners involved in the delivery of exercise programs for cancer patients. Full article

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Open AccessArticle

Lymph Node Evaluation for Colon Cancer in Routine Clinical Practice: A Population-Based Study

by J.C. Del Paggio, S. Nanji, X. Wei, P.H. MacDonald and C.M. Booth

Curr. Oncol. 2017, 24(1), 35-43; https://doi.org/10.3747/co.24.3210 - 01 Feb 2017

Cited by 11 | Viewed by 518

Abstract

Background: Guidelines recommend that 12 or more lymph nodes (lns) be evaluated during surgical resection of colon cancer. Here, we report ln yield and its association with survival in routine practice. Methods: Electronic records of treatment were linked to the population-based Ontario Cancer [...] Read more.

Background: Guidelines recommend that 12 or more lymph nodes (lns) be evaluated during surgical resection of colon cancer. Here, we report ln yield and its association with survival in routine practice. Methods: Electronic records of treatment were linked to the population-based Ontario Cancer Registry to identify all patients with colon cancer treated during 2002–2008. The study population (n = 5508) included a 25% random sample of patients with stage ii or iii disease. Modified Poisson regression was used to identify factors associated with ln yield; Cox models were used to explore the association between ln yield and overall (os) and cancer-specific survival (css). Results: During 2002–2008, median ln yield increased to 17 from 11 nodes (p < 0.001), and the proportion of patients with 12 or more nodes evaluated increased to 86% from 45% (p < 0.001). Lymph node positivity did not change over time (to 53% from 54%, p = 0.357). Greater ln yield was associated with younger age (p < 0.001), less comorbidity (p = 0.004), higher socioeconomic status (p = 0.001), right-sided tumours (p < 0.001), and higher hospital volume (p < 0.001). In adjusted analyses, a ln yield of less than 12 nodes was associated with inferior os and css for stages ii and iii disease [stage ii os hazard ratio (hr): 1.36; 95% confidence interval (ci): 1.19 to 1.56; stage ii css hr: 1.52; 95% ci: 1.26 to 1.83; and stage iii os hr: 1.45; 95% ci: 1.30 to 1.61; stage iii css hr: 1.54; 95% ci: 1.36 to 1.75]. Conclusions: Despite a temporal increase in ln yield, the proportion of cases with ln positivity has not changed. Lymph node yield is associated with survival in patients with stages ii and iii colon cancer. The association between ln yield and survival is unlikely to be a result of stage migration. Full article

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Open AccessReview

A Canadian Perspective on the Subcutaneous Administration of Rituximab in Non-Hodgkin Lymphoma

by D. MacDonald, T. Crosbie, A. Christofides, W. Assaily and J. Wiernikowski

Curr. Oncol. 2017, 24(1), 33-39; https://doi.org/10.3747/co.24.3470 - 01 Feb 2017

Cited by 8 | Viewed by 625

Abstract

Rituximab is widely used for the treatment of non-Hodgkin lymphoma, being a key component in most therapeutic regimens. Administration of the intravenous (IV) formulation is lengthy and places a significant burden on health care resources and patient quality of life. A subcutaneous (sc) [...] Read more.

Rituximab is widely used for the treatment of non-Hodgkin lymphoma, being a key component in most therapeutic regimens. Administration of the intravenous (IV) formulation is lengthy and places a significant burden on health care resources and patient quality of life. A subcutaneous (sc) formulation that provides a fixed dose of rituximab is being examined in a number of studies. Results indicate that the pharmacokinetics are noninferior and response rates are comparable to those obtained with the IV formulation. Moreover, the sc formulation is preferred by patients and health care providers and reduces administration and chair time. Additional advantages include a lesser potential for dosing errors, shorter preparation time, reduced drug wastage, and fewer infusion-related reactions. Despite the success of the sc formulation, correct administration is needed to reduce administration-related reactions. By using a careful procedure, the sc formulation can be given safely and effectively, potentially reducing the burden on health care resources and improving quality of life for patients. Full article

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Open AccessArticle

Does Adjuvant Radiation Therapy Benefit Women with Small Mammography-Detected Breast Cancers?

by K. Jerzak, N. Dudalski, K. Pritchard, P. Sun and S.A. Narod

Curr. Oncol. 2017, 24(1), 28-32; https://doi.org/10.3747/co.24.3089 - 01 Feb 2017

Viewed by 409

Abstract

Background: Women with small nonpalpable breast tumours have an excellent prognosis. The benefit of radiotherapy in this group of low-risk women is unknown. Methods: A cohort of 1595 women with stages i–iii invasive breast cancer treated with breast-conserving surgery were followed for local [...] Read more.

Background: Women with small nonpalpable breast tumours have an excellent prognosis. The benefit of radiotherapy in this group of low-risk women is unknown. Methods: A cohort of 1595 women with stages i–iii invasive breast cancer treated with breast-conserving surgery were followed for local recurrence. Using t-tests, baseline demographic data and tumour characteristics were compared for the women who had palpable (n = 1023) and mammography-detected (n = 572) breast cancers. The 15-year actuarial risk of local recurrence was estimated using a Kaplan–Meier method, stratified for adjuvant radiation therapy (yes or no), tumour palpability (palpable or not), and tumour size (≤1 cm or >1 cm). Hazard ratios (hrs) and 95% confidence intervals (95% cis) were calculated using a multivariate Cox regression model. Results were considered statistically significant if 2-tailed p values were less than 0.05. Results: Among women with a nonpalpable tumour, the 15-year actuarial rates of local recurrence were, respectively, 13.9% and 18.3% for those treated and not treated with adjuvant radiation therapy (hr: 0.65; 95%ci: 0.40 to 1.06; p = 0.08). Among women with small nonpalpable breast cancers (≤1.0 cm), the rates were 14.6% and 13.4% respectively (p = 0.67). The absolute reduction in 15-year local recurrence was 11.0% for women with palpable tumours. Conclusions: Our results suggest that women with small (<1 cm) screen-detected nonpalpable breast cancers likely derive little benefit from adjuvant radiotherapy; however, an adequately powered randomized trial would be required to make definitive conclusions. Full article

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Open AccessArticle

Pre- and Post-Surgery Treatments in Rectal Cancer: A Long-Term Single-Centre Experience

by H. Ozyurt, A.S. Ozden, Z. Ozgen, C. Gemici and G. Yaprak

Curr. Oncol. 2017, 24(1), 24-34; https://doi.org/10.3747/co.24.3229 - 01 Feb 2017

Cited by 5 | Viewed by 515

Abstract

Background: Our study evaluated long-term survival outcomes in rectal cancer patients treated with preoperative radiotherapy, and the impact on survival of concomitant and postoperative adjuvant chemotherapy (ctx), among other prognostic factors. Methods: The study included 196 patients [median age: 58 years (range: 20–86 [...] Read more.

Background: Our study evaluated long-term survival outcomes in rectal cancer patients treated with preoperative radiotherapy, and the impact on survival of concomitant and postoperative adjuvant chemotherapy (ctx), among other prognostic factors. Methods: The study included 196 patients [median age: 58 years (range: 20–86 years); 63.0% men] with locally advanced rectal carcinoma and, in some cases, resectable liver metastasis. Rates of distant metastasis and local recurrence and of 5-year distant metastasis-free survival (dmfs) and overall survival (os) were determined. Results: The 5-year os rate was 57.0%, with a median duration of 81.5 months (95% confidence interval: 73.7 months to 89.4 months), and the 5-year dmfs rate was 54.1%, with a median duration of 68.4 months (95% confidence interval: 40.4 months to 96.4 months). Prognostic factors for higher os and dmfs rates were downstaging (p = 0.013 and p = 0.005 respectively), radiotherapy dose (50 Gy vs. 56 Gy or 45–46 Gy, both p = 0.002), and concomitant ctx use (p = 0.004 and p = 0.001) and type (5-fluorouracil–leucovorin–folinic acid vs. tegafur–folinic acid, p = 0.034 and p = 0.043). Adjuvant ctx after neoadjuvant long-term concomitant chemoradiotherapy (ccrt) and surgery was associated with better 5-year os rates for postoperative T0–T3 disease (p = 0.003) and disease at all lymph node stages (p = 0.001). Conclusions: Our findings revealed a favourable survival outcome with long-term fractionated irradiation and concomitant 5-fluorouracil–based ctx, achieving 5-year os and dmfs rates of 57.0% and 54.1% respectively. Preoperative administration of radiotherapy (50 Gy) and postoperative adjuvant ctx were associated with a significant survival benefit. Radiation doses above 50 Gy and the interval between ccrt and surgery had no significant effect on survival. Full article

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Open AccessArticle

The Hospital at Home Program: No Place Like Home

by M. Lippert, S. Semmens, L. Tacey, T. Rent, K. Defoe, M. Bucsis, T. Shykula, J. Crysdale, V. Lewis, D. Strother and L. Lafay-Cousin

Curr. Oncol. 2017, 24(1), 23-27; https://doi.org/10.3747/co.24.3326 - 01 Feb 2017

Cited by 28 | Viewed by 1405

Abstract

Background: The treatment of children with cancer is associated with significant burden for the entire family. Frequent clinic visits and extended hospital stays can negatively affect quality of life for children and their families. Methods: Here, we describe the development of a Hospital [...] Read more.

Background: The treatment of children with cancer is associated with significant burden for the entire family. Frequent clinic visits and extended hospital stays can negatively affect quality of life for children and their families. Methods: Here, we describe the development of a Hospital at Home program (H@H) that delivers therapy to pediatric hematology, oncology, and blood and marrow transplant (bmt) patients in their homes. The services provided include short infusions of chemotherapy, supportive-care interventions, antibiotics, post-chemotherapy hydration, and teaching. Results: From 2013 to 2015, the H@H program served 136 patients, making 1701 home visits, for patients mainly between the ages of 1 and 4 years. Referrals came from oncology in 82% of cases, from hematology in 11%, and from bmt in 7%. Since inception of the program, no adverse events have been reported. Family surveys suggested less disruption in daily routines and appreciation of specialized care by hematology and oncology nurses. Staff surveys highlighted a perceived benefit of H@H in contributing to early discharge of patients by supporting out-of-hospital monitoring and teaching. Conclusions: The development of a H@H program dedicated to the pediatric hematology, oncology, or bmt patient appears feasible. Our pilot program offers a potential contribution to improvement in patient quality of life and in cost–benefit for parents and the health care system. Full article

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Open AccessArticle

Rate of Egfr Mutation Testing for Patients with Nonsquamous Non-Small-Cell Lung Cancer with Implementation of Reflex Testing by Pathologists

by P.K. Cheema, S. Raphael, R. El-Maraghi, J. Li, R. McClure, L. Zibdawi, A. Chan, J.C. Victor, A. Dolley and A. Dziarmaga

Curr. Oncol. 2017, 24(1), 16-22; https://doi.org/10.3747/co.24.3266 - 01 Feb 2017

Cited by 23 | Viewed by 828

Abstract

Background: Testing for mutation of the EGFR (epidermal growth factor receptor) gene is a standard of care for patients with advanced nonsquamous non-small-cell lung cancer (nsclc). To improve timely access to EGFR results, a few centres implemented reflex testing, defined as a request [...] Read more.

Background: Testing for mutation of the EGFR (epidermal growth factor receptor) gene is a standard of care for patients with advanced nonsquamous non-small-cell lung cancer (nsclc). To improve timely access to EGFR results, a few centres implemented reflex testing, defined as a request for EGFR testing by the pathologist at the time of a nonsquamous nsclc diagnosis. We evaluated the impact of reflex testing on EGFR testing rates. Methods: A retrospective observational review of the Web-based AstraZeneca Canada EGFR Database from 1 April 2010 to 31 March 2014 found centres within Ontario that had requested EGFR testing through the database and that had implemented reflex testing (with at least 2 years’ worth of data, including the pre- and post-implementation period). Results: The 7 included centres had requested EGFR tests for 2214 patients. The proportion of pathologists requesting EGFR tests increased after implementation of reflex testing (53% vs. 4%); conversely, the proportion of medical oncologists requesting tests decreased (46% vs. 95%, p < 0.001). After implementation of reflex testing, the mean number of patients having EGFR testing per centre per month increased significantly [12.6 vs. 4.9 (range: 4.5–14.9), p < 0.001]. Before reflex testing, EGFR testing rates showed a significant monthly increase over time (1.37 more tests per month; 95% confidence interval: 1.19 to 1.55 tests; p < 0.001). That trend could not account for the observed increase with reflex testing, because an immediate increase in EGFR test requests was observed with the introduction of reflex testing (p = 0.003), and the overall trend was sustained throughout the post–reflex testing period (p < 0.001). Conclusions: Reflex EGFR testing for patients with nonsquamous nsclc was successfully implemented at multiple centres and was associated with an increase in EGFR testing. Full article

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Open AccessArticle

Is There a Sex Effect in Colon Cancer? Disease Characteristics, Management, and Outcomes in Routine Clinical Practice

by J.S. Quirt, S. Nanji, X. Wei, J.A. Flemming and C.M. Booth

Curr. Oncol. 2017, 24(1), 15-23; https://doi.org/10.3747/co.24.3410 - 01 Feb 2017

Cited by 23 | Viewed by 927

Abstract

Introduction: The incidence of colon cancer varies by sex. Whether women and men show differences in extent of disease, treatment, and outcomes is not well described. We used a large population-based cohort to evaluate sex differences in colon cancer. Methods: Using the Ontario [...] Read more.

Introduction: The incidence of colon cancer varies by sex. Whether women and men show differences in extent of disease, treatment, and outcomes is not well described. We used a large population-based cohort to evaluate sex differences in colon cancer. Methods: Using the Ontario Cancer Registry, all cases of colon cancer treated with surgery in Ontario during 2002–2008 were identified. Electronic records of treatment identified use of surgery and adjuvant chemotherapy. Pathology reports for a random 25% sample of all cases were obtained, and disease characteristics, treatment, and outcomes in women and men were compared. A Cox proportional hazards model was used to identify factors associated with overall (os) and cancer-specific survival (css). Results: The study population included 7249 patients who underwent resection of colon cancer; 49% (n = 3556) were women. Stage of disease and histologic grade did not vary by sex. Compared with men, women were more likely to have right-sided disease (55% vs. 44%, p ≤ 0.001). Surgical procedure and lymph node yield did not differ by sex. Adjuvant chemotherapy was delivered to 18% of patients with stage ii and 64% of patients with stage iii disease; when adjusted for patient- and disease-related factors, use of adjuvant chemotherapy was similar for women and men [relative risk: 0.99; 95% confidence interval (ci): 0.94 to 1.03]. Adjusted analyses demonstrated that os [hazard ratio (hr): 0.80; 95% ci: 0.75 to 0.86] and css (hr: 0.82; 95% ci: 0.76 to 0.90) were superior for women compared with men. Conclusions: Long-term survival after colon cancer is significantly better for women than for men, which is not explained by any substantial differences in extent of disease or treatment delivered. Full article

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Open AccessArticle

Listening through Narratives: Using a Narrative Approach When Discussing Fertility Preservation Options with Young Cancer Patients

by S.I.G. Roher, J. Gibson, B.E. Gibson and A.A. Gupta

Curr. Oncol. 2017, 24(1), 10-15; https://doi.org/10.3747/co.24.3419 - 01 Feb 2017

Cited by 5 | Viewed by 804

Abstract

Despite clinical practice guideline recommendations mandating that fertility preservation be discussed with young cancer patients, many providers fail to initiate such discussions with adolescents. Researchers and clinicians often focus on system-level changes to improve access to fertility preservation for adolescents and young adults [...] Read more.

Despite clinical practice guideline recommendations mandating that fertility preservation be discussed with young cancer patients, many providers fail to initiate such discussions with adolescents. Researchers and clinicians often focus on system-level changes to improve access to fertility preservation for adolescents and young adults in Canada. However, little of the available information considers the way in which health care providers approach those discussions. Research has shown that, even when fertility preservation options are broached with adolescents, survivors often report dissatisfaction with those conversations, thus raising additional concerns about their content and quality. Here, we consider how a narrative approach—and the Frank narrative typology in particular—could improve the quality of such conversations by helping providers to more accurately and thoughtfully respond to the needs of adolescent patients when discussing the possibility of fertility preservation. Based on findings from a qualitative research project, we provide concrete suggestions for how to more sensitively approach fertility preservation conversations with male adolescent cancer patients and survivors. Full article

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Open AccessEditorial

Exercise Guidelines for Cancer Survivors: Are Fitness and Quality-of-life Benefits Enough to Change Practice?

by K.S. Courneya

Curr. Oncol. 2017, 24(1), 8-9; https://doi.org/10.3747/co.24.3545 - 01 Feb 2017

Cited by 16 | Viewed by 428

Abstract

Since the mid-1980s, exercise has been tested as an intervention strategy to help cancer patients prepare for treatments, cope with treatments, and recover after treatments. [...] Full article

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Open AccessEditorial

Introducing Dr. Matthew Seftel

by M. Chasen

Curr. Oncol. 2017, 24(1), 7; https://doi.org/10.3747/co.24.3642 - 01 Feb 2017

Viewed by 458

Abstract

It is with much pride that I welcome Dr. Matthew Seftel to the editorial staff of Current Oncology. [...] Full article

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Open AccessArticle

Economic Evaluation of Brentuximab Vedotin for Persistent Hodgkin Lymphoma

by V. Babashov, M.A. Begen, J. Mangel and G.S. Zaric

Curr. Oncol. 2017, 24(1), 6-14; https://doi.org/10.3747/co.24.3369 - 01 Feb 2017

Cited by 7 | Viewed by 842

Abstract

Background: We conducted a cost-effectiveness analysis of brentuximab vedotin for the treatment of relapsed and refractory Hodgkin lymphoma (hl) in the post–autologous stem-cell transplantation (asct) failure period, from the perspective of the Canadian health care payer. Methods: We developed a decision-analytic model to [...] Read more.

Background: We conducted a cost-effectiveness analysis of brentuximab vedotin for the treatment of relapsed and refractory Hodgkin lymphoma (hl) in the post–autologous stem-cell transplantation (asct) failure period, from the perspective of the Canadian health care payer. Methods: We developed a decision-analytic model to simulate lifetime costs and benefits of brentuximab vedotin compared with best supportive care for the treatment of patients with hl after failure of asct. Administrative data from Ontario were used to set the model parameters. Results: In the base case, treatment with brentuximab vedotin resulted in incremental quality-adjusted life-years (qalys) of 0.544 and an incremental cost of $89,366 per patient, corresponding to an incremental cost-effectiveness ratio (icer) of $164,248 per qaly gained. The icer was sensitive to the cost of brentuximab vedotin, the hazard ratio used to assess the efficacy of brentuximab vedotin treatment, and health state utilities. Conclusions: In light of the available information, brentuximab vedotin has an icer exceeding $100,000 per qaly gained, which is a level often classified as having “weak evidence for adoption and appropriate utilization” in Canada. However, it is worth noting that provincial cancer agencies take into account not only the costs and associated icer, but also other factors such as a lack of alternative treatment options and the clinical benefits of expensive cancer drugs. Pricing arrangements should be negotiated, and risk-sharing agreements or patient access schemes should be explored. Full article

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Open AccessArticle

The Effect of Acupuncture on Chemotherapy-Associated Gastrointestinal Symptoms in Gastric Cancer

by J. Zhou, L. Fang, W.Y. Wu, F. He, X.L. Zhang, X. Zhou and Z.J. Xiong

Curr. Oncol. 2017, 24(1), 1-5; https://doi.org/10.3747/co.24.3296 - 01 Feb 2017

Cited by 26 | Viewed by 1059

Abstract

Background: Gastrointestinal (gi) symptoms are the most notable side effects of chemotherapeutic drugs; such symptoms are currently treated with drugs. In the present study, we investigated the effect of acupuncture on gi symptoms induced by chemotherapy in patients with advanced gastric cancer. Methods: [...] Read more.

Background: Gastrointestinal (gi) symptoms are the most notable side effects of chemotherapeutic drugs; such symptoms are currently treated with drugs. In the present study, we investigated the effect of acupuncture on gi symptoms induced by chemotherapy in patients with advanced gastric cancer. Methods: A cohort of 56 patients was randomly divided into an experimental group and a control group. All patients received combination chemotherapy with oxaliplatin–paclitaxel. Patients in the experimental group received 30 minutes of acupuncture therapy daily for 2 weeks. The frequency and duration of nausea, vomiting, abdominal pain, and diarrhea, the average days and costs of hospitalization, and quality-of-life scores were compared between the groups. Results: Nausea was sustained for 32 ± 5 minutes and 11 ± 3 minutes daily in the control and experimental groups respectively (p < 0.05). On average, vomiting occurred 2 ± 1 times daily in the experimental group and 4 ± 1 times daily in the control group (p < 0.05). Abdominal pain persisted for 7 ± 2 minutes and 16 ± 5 minutes daily in the experimental and control groups respectively (p < 0.05). On average, diarrhea occurred 1 ± 1 times daily in the experimental group and 3 ± 1 times daily in the control group (p < 0.05). The average quality-of-life score was higher in the experimental group than in the control group (p < 0.05). No adverse events were observed for the patients receiving acupuncture. Conclusions: Acupuncture, a safe technique, could significantly reduce gi symptoms induced by chemotherapy and enhance quality of life in patients with advanced gastric cancer. Full article

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Curr. Oncol., Volume 24, Issue 1 (February 2017) – 22 articles

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