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Current Oncology
Volume 30
Issue 8
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Curr. Oncol., Volume 30, Issue 8 (August 2023) – 51 articles

Cover Story (view full-size image): During COVID-19, exercise oncology programmes were forced to transition from in-person to online delivery. The purpose of this work was to understand participants’ experiences in both delivery modes by evaluating exercise facilitators and barriers, delivery mode preference, and experience with elements targeting behaviour change. Key differences in barriers and facilitators highlighted a more convenient experience online while participants reported a more socially supportive environment in-person. For future work that includes solely online delivery, focusing on building social support and a sense of community will be critical to optimising programme benefits. The results of this research will remain relevant as online exercise oncology programmes extend to reach more underserved populations of individuals living with and beyond cancer. View this paper
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12 pages, 699 KiB  
Article
Stereotactic Body Radiation Therapy for Spine Metastases—Findings from an Australian Population-Based Study
by Wee Loon Ong, Roger L. Milne, Farshad Foroudi and Jeremy L. Millar
Curr. Oncol. 2023, 30(8), 7777-7788; https://doi.org/10.3390/curroncol30080564 - 21 Aug 2023
Viewed by 1133
Abstract
Background: To evaluate the use of stereotactic body radiation therapy (SBRT) for spine metastases and the associated factors in Australia. Methods: The Victorian Radiotherapy Minimum Dataset, which captures all episodes of radiotherapy delivered in the state of Victoria, was accessed to evaluate the [...] Read more.
Background: To evaluate the use of stereotactic body radiation therapy (SBRT) for spine metastases and the associated factors in Australia. Methods: The Victorian Radiotherapy Minimum Dataset, which captures all episodes of radiotherapy delivered in the state of Victoria, was accessed to evaluate the patterns and trends of SBRT for spine metastases. The primary outcome was SBRT use and associated factors. Results: There were 6244 patients who received 8861 courses of radiotherapy for spine metastases between 2012 and 2017. Of these, 277 (3%) courses were SBRT, which increased from 0.4% in 2012 to 5% in 2017 (P-trend < 0.001). There was a higher proportion of SBRT use in patients with prostate cancer (6%) and melanoma (4%) compared to other cancers (2–3%) (p < 0.001). Patients from the highest socioeconomic quintiles (5%) were more likely to be treated with SBRT compared to patients from the lowest socioeconomic quintiles (3%) (p < 0.001). There was a higher proportion of SBRT use in private radiotherapy centres (6%) compared to public radiotherapy centres (1%) (p < 0.001). No spine SBRT was delivered in regional centres. In multivariate analyses, the year of treatment, age, primary cancers and radiotherapy centres were independently associated with SBRT use. Conclusion: This is the first Australian population-based study quantifying the increasing use of spine SBRT; however, the overall use of spine SBRT remains low. We anticipate an ongoing increase in spine SBRT, as spine SBRT gradually becomes the standard-of-care treatment for painful spine metastases. Full article
(This article belongs to the Special Issue Recent Advances in Stereotactic Body Radiation Therapy for Spinal Malignancies)
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4 pages, 200 KiB  
Editorial
Surgery for Non-Small Cell Lung Cancer in the Personalized Therapy Era
by Marco Chiappetta, Carolina Sassorossi and Giacomo Cusumano
Curr. Oncol. 2023, 30(8), 7773-7776; https://doi.org/10.3390/curroncol30080563 - 21 Aug 2023
Viewed by 1115
Abstract
Lung cancer remains one of the tumours with the highest incidence and the poorest
prognosis, with an estimated incidence of more than 220,000 cases with 135,000 cancerrelated
deaths annually in the United States [1,2].[...] Full article
(This article belongs to the Special Issue The Current Status of Lung Cancer Surgery)
20 pages, 6132 KiB  
Review
Cytology and Histology of Thyroid Nodules: Exploring Novel Insights in the Molecular Era for Enhanced Patient Management
by Beatrix Cochand-Priollet and Zahra Maleki
Curr. Oncol. 2023, 30(8), 7753-7772; https://doi.org/10.3390/curroncol30080562 - 21 Aug 2023
Viewed by 2663
Abstract
Significant advancements have been made over the past decade in our understanding of thyroid cancers, encompassing histomorphology, cytology, and ancillary techniques, particularly molecular tests. As a result, it is now feasible to put forth a comprehensive histo/cytomolecular approach to treating these tumors, thereby [...] Read more.
Significant advancements have been made over the past decade in our understanding of thyroid cancers, encompassing histomorphology, cytology, and ancillary techniques, particularly molecular tests. As a result, it is now feasible to put forth a comprehensive histo/cytomolecular approach to treating these tumors, thereby offering patients treatments that are precisely tailored to their unique circumstances. Full article
(This article belongs to the Special Issue Insights into Special Novelties in Thyroid Oncology Management)
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13 pages, 1845 KiB  
Article
NTCP Calculations of Five Different Irradiation Techniques for the Treatment of Thymoma
by Michalis Mazonakis, Stefanos Kachris, Maria Tolia and John Damilakis
Curr. Oncol. 2023, 30(8), 7740-7752; https://doi.org/10.3390/curroncol30080561 - 19 Aug 2023
Cited by 2 | Viewed by 1259
Abstract
This study provided normal tissue complication probability (NTCP) calculations from photon radiotherapy techniques in eleven patients with thymoma. Five plans were created for each participant using three-dimensional conformal radiotherapy (3D-CRT), five-field intensity modulated radiotherapy (5F-IMRT), seven-field IMRT (7F-IMRT), and volumetric modulated arc therapy [...] Read more.
This study provided normal tissue complication probability (NTCP) calculations from photon radiotherapy techniques in eleven patients with thymoma. Five plans were created for each participant using three-dimensional conformal radiotherapy (3D-CRT), five-field intensity modulated radiotherapy (5F-IMRT), seven-field IMRT (7F-IMRT), and volumetric modulated arc therapy with full arcs (FA-VMAT) and partial arcs (PA-VMAT). The target coverage, homogeneity index and conformation number for the planning target volume (PTV) and dosimetric parameters for the organs-at-risk (OARs) were taken from the fifty-five generated plans. The patient-specific NTCP of the lungs, heart and esophagus was calculated with an in-house software tool using differential dose-volume histograms and the equivalent uniform dose model. The PTV dose metrics from 3D-CRT were inferior to those from IMRT and VMAT plans. The dose constraints for the OARs were met in all treatment plans. The NTCP range of the lungs, heart and esophagus was 0.34–0.49%, 0.03–0.06% and 0.08–0.10%, respectively. The NTCPs of the heart for the incidence of peridarditis from IMRT and VMAT were significantly smaller than those from conformal treatment (p < 0.05). The 7F-IMRT was significantly superior to FA-VMAT in reducing the NTCP of the lungs and the risk of pneumonitis (p = 0.001). Similar superiority of 5F-IMRT over PA-VMAT for lung protection was found (p = 0.009). The presented results may be employed in the selection of the appropriate irradiation technique for restricting the complications in the adjacent OARs. Full article
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18 pages, 4140 KiB  
Article
Anemia, Iron Deficiency, and Iron Regulators in Pancreatic Ductal Adenocarcinoma Patients: A Comprehensive Analysis
by Malgorzata Osmola, Beata Gierej, Katarzyna Mleczko-Sanecka, Aneta Jończy, Olga Ciepiela, Leszek Kraj, Bogna Ziarkiewicz-Wróblewska and Grzegorz Władysław Basak
Curr. Oncol. 2023, 30(8), 7722-7739; https://doi.org/10.3390/curroncol30080560 - 18 Aug 2023
Viewed by 1720
Abstract
Anemia and iron deficiency (ID) are common complications in patients with pancreatic ductal adenocarcinoma (PDAC), but their underlying causes remain unclear. This study investigated the incidence and characteristics of anemia and micronutrient deficiencies in PDAC patients before initiating chemotherapy. A total of 103 [...] Read more.
Anemia and iron deficiency (ID) are common complications in patients with pancreatic ductal adenocarcinoma (PDAC), but their underlying causes remain unclear. This study investigated the incidence and characteristics of anemia and micronutrient deficiencies in PDAC patients before initiating chemotherapy. A total of 103 PDAC patients were included, comprising 67 in the palliative and 36 in the adjuvant groups. The overall incidence of anemia was 42.7% (n = 44), with comparable rates in both groups. Normocytic and normochromic anemia were predominant, with mild and moderate cases observed in 32% and 10.7% of the cohort, respectively. ID was evident in 51.4% of patients, with absolute ID more frequent in the adjuvant than in the palliative group (19.4% vs. 13.4%). Functional ID occurred more often in the palliative than in the adjuvant group (41.8% vs. 25%). Vitamin B12 and folate deficiency occurred in <5% (n = 5) of patients. Furthermore, 8.7% (n = 9) of patients had chronic kidney disease and anemia. To elucidate mechanisms of iron deficiency, the study explored the expression of iron regulators (hepcidin (HEP), ferroportin (FPN), and ZIP14 protein) and mitochondrial mass in PDAC tissue with immunohistochemical (IHC) staining and Perl’s Prussian blue to detect iron deposits on available tumor samples (n = 56). ZIP14 expression was significantly higher in less advanced tumors (p = 0.01) and correlated with mitochondrial mass (p < 0.001), potentially indicating its role in local iron homeostasis. However, no significant impact of tissue iron regulators on patient survival was observed. Perl’s Prussian blue staining revealed iron deposits within macrophages, but not in pancreatic duct cells. Furthermore, the GEPIA database was used to compare mRNA expression of iron regulators (HEP, FPN, and ZIP14) and other genes encoding iron transport and storage, including Transferrin Receptor Protein 1 (TfR1) and both ferritin chain subunits (FTH and FTL), in PDAC and normal pancreatic samples. FPN, TfR1, FTH, and FTL showed higher expression in tumor tissues, indicating increased iron usage by cancer. ZIP14 expression was higher in the pancreas than in PDAC and was correlated with FPN expression. The study highlights the importance of baseline iron status assessment in managing PDAC patients due to the high incidence of anemia and iron deficiency. Furthermore, ZIP14, in addition to HEP and FPN, may play a crucial role in local iron homeostasis in PDAC patients, providing valuable insights into the underlying mechanisms of iron dysregulation. Full article
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9 pages, 510 KiB  
Communication
Real-World Analysis of Durvalumab after Chemoradiation in Stage III Non-Small-Cell Lung Cancer
by Beatrice T. B. Preti, Michael S. Sanatani, Daniel Breadner, Suganija Lakkunarajah, Carolyn Scott, Caroline Esmonde-White, Eric McArthur, George Rodrigues, Mitali Chaudhary, Adam Mutsaers, Robin Sachdeva and Mark D. Vincent
Curr. Oncol. 2023, 30(8), 7713-7721; https://doi.org/10.3390/curroncol30080559 - 18 Aug 2023
Viewed by 1578
Abstract
The 2017 PACIFIC trial heralded the incorporation of routine adjuvant durvalumab following curative-intent chemoradiation for stage III non-small-cell lung cancer (NSCLC). However, carefully selected clinical trial populations can differ significantly from real-world populations, which can have implications on treatment toxicities and outcomes, making [...] Read more.
The 2017 PACIFIC trial heralded the incorporation of routine adjuvant durvalumab following curative-intent chemoradiation for stage III non-small-cell lung cancer (NSCLC). However, carefully selected clinical trial populations can differ significantly from real-world populations, which can have implications on treatment toxicities and outcomes, making it difficult to accurately counsel patients. Consequently, we performed a real-world, retrospective analysis of outcomes and toxicities in 118 patients with stage III NSCLC treated with durvalumab after platinum-based chemoradiotherapy. The data were collected from patients who underwent treatment at a single, tertiary-level Canadian cancer centre from May 2018 to October 2020. The variables collected included patient demographics, treatment specifics, progression-free survival, overall survival, and immune-related adverse events (IRAE) from durvalumab. Descriptive statistics were used for toxicity analysis, and progression-free survival and overall survival estimates were calculated using the Kaplan–Meier method. The statistical analyses indicated a 64.4% (n = 76) toxicity rate, with a 21% (n = 25) toxicity rate of grade 3+ IRAEs. The most common documented IRAEs were pneumonitis (n = 44; 40%), followed by rash (n = 20; 18%) and thyroid dysfunction (n = 17; 15%). FEV1 and DLCO were not found to be associated predictors of pneumonitis toxicity. The median PFS and OS were estimated to be >1.7 years and >2.7 years, respectively. Full article
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7 pages, 403 KiB  
Communication
Impact of Oncology Drug Review Times on Public Funding Recommendations
by Marya Hussain, Chelsea Wong, Eddy Taguedong, Saurav Verma, Md Mahsin, Safiya Karim, Richard Lee-Ying and Doreen A. Ezeife
Curr. Oncol. 2023, 30(8), 7706-7712; https://doi.org/10.3390/curroncol30080558 - 18 Aug 2023
Cited by 1 | Viewed by 1197
Abstract
New oncology drugs undergo detailed review prior to public funding in a single-payer healthcare system. The aim of this study was to assess how cancer drug review times impact funding recommendations. Drugs reviewed by the pan-Canadian Oncology Drug Review (pCODR) between the years [...] Read more.
New oncology drugs undergo detailed review prior to public funding in a single-payer healthcare system. The aim of this study was to assess how cancer drug review times impact funding recommendations. Drugs reviewed by the pan-Canadian Oncology Drug Review (pCODR) between the years 2012 and 2020 were included. Data were collected including Health Canada approval dates, initial and final funding recommendations, treatment intent, drug class, clinical indications, and incremental cost-effectiveness ratios (ICER). Univariable and multivariable analyses were used to determine the association between funding recommendations and review times. Of the 164 applications submitted, 130 received a positive final recommendation. Median time from Health Canada (HC) approval to final recommendation was longer for drugs indicated for the treatment of gastrointestinal (GI) and lung cancer compared to breast, genitourinary (GU), and other tumours (205 vs. 198 vs. 111 vs. 129 vs. 181 days, respectively; Kruskal–Wallis p = 0.0312). Drugs with longer review times were more likely to receive a negative pCODR recommendation, even when adjusting for tumour type, drug class, and intent of therapy (157 vs. 298 days; Wilcoxon p = 0.0003, OR 1.002 95% CI [1.000–1.004].). There was no association between funding recommendation and tumour type or class of drug. The exploration of factors associated with variance in review times will be important in ensuring timely patient access to cancer drugs. Full article
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14 pages, 1108 KiB  
Article
Age-Specific Trends of Invasive Cervical Cancer Incidence in British Columbia, Canada, 1971–2017
by Nivedha Raveinthiranathan, Jonathan Simkin, Robine Donken, Gina Ogilvie, Laurie Smith, Dirk Van Niekerk, Marette Lee and Ryan R. Woods
Curr. Oncol. 2023, 30(8), 7692-7705; https://doi.org/10.3390/curroncol30080557 - 18 Aug 2023
Viewed by 1283
Abstract
This study examined invasive cervical cancer (ICC) incidence trends in British Columbia (BC) by age and stage-at-diagnosis relative to World Health Organization ICC elimination targets (4 per 100,000 persons). Incident ICC cases (1971–2017) were obtained from the BC Cancer Registry. Annual age-standardized incidence [...] Read more.
This study examined invasive cervical cancer (ICC) incidence trends in British Columbia (BC) by age and stage-at-diagnosis relative to World Health Organization ICC elimination targets (4 per 100,000 persons). Incident ICC cases (1971–2017) were obtained from the BC Cancer Registry. Annual age-standardized incidence rates (ASIRs) per 100,000 persons were generated using the direct method. ASIRs were examined among all ages 15+ years and eight age groups using Joinpoint Regression with the Canadian 2011 standard population. Standardized rate ratios (SRRs) compared stage II–IV (late) versus stage I (early) ASIRs by age (2010–2017). ICC ASIRs did not reach the elimination target. ASIRs declined from 18.88 to 7.08 per 100,000 persons (1971–2017). Stronger declines were observed among ages 45+ years, with the largest decline among ages 70–79 years (AAPC = −3.2%, 95% CI = −3.9% to −2.6%). Among ages 25–69 years, varying levels of attenuation in declining trends and stabilization were observed since the 1980s. SRRs indicated higher rates of late-stage ICC among ages 55+ years (SRR−55–69 years = 1.34, 95% CI = 1.08–1.71). Overall, ICC incidence declined in BC since 1971 but did not reach the elimination target. The pace of decline varied across age groups and increased with age. Continued efforts are needed to progress cervical cancer elimination among all age groups. Full article
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20 pages, 1155 KiB  
Opinion
Clinical Considerations for the Integration of Adjuvant Olaparib into Practice for Early Breast Cancer: A Canadian Perspective
by Jan-Willem Henning, Jean-François Boileau, Larissa Peck and Tom McFarlane
Curr. Oncol. 2023, 30(8), 7672-7691; https://doi.org/10.3390/curroncol30080556 - 17 Aug 2023
Viewed by 2596
Abstract
With the recent Health Canada approval of olaparib for high-risk, HER2-negative early breast cancer, physicians are now facing the practical challenges of integrating olaparib into current management of triple-negative breast cancer (TNBC) and HR-positive, HER2-negative (HR+/HER2−) early breast cancer. This review provides perspectives [...] Read more.
With the recent Health Canada approval of olaparib for high-risk, HER2-negative early breast cancer, physicians are now facing the practical challenges of integrating olaparib into current management of triple-negative breast cancer (TNBC) and HR-positive, HER2-negative (HR+/HER2−) early breast cancer. This review provides perspectives on some of the challenges related to identification of olaparib candidates, with a focus on the latest guidance for germline BRCA testing and considerations regarding high-risk disease definitions. Updated treatment pathways are explored for both disease states, including other adjuvant treatment options such as pembrolizumab, capecitabine, and abemaciclib. Gaps in the current literature regarding the sequential or combined use of these adjuvant therapies are noted and future, potentially informative, studies are briefly examined. Full article
(This article belongs to the Collection New Insights into Breast Cancer Diagnosis and Treatment)
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18 pages, 930 KiB  
Systematic Review
Cost Drivers and Financial Burden for Cancer-Affected Families in China: A Systematic Review
by Yufei Jia, Weixi Jiang, Bolu Yang, Shenglan Tang and Qian Long
Curr. Oncol. 2023, 30(8), 7654-7671; https://doi.org/10.3390/curroncol30080555 - 16 Aug 2023
Cited by 2 | Viewed by 1610
Abstract
This systematic review examined cancer care costs, the financial burden for patients, and their economic coping strategies in mainland China. We included 38 quantitative studies that reported out-of-pocket payment for cancer care and patients’ coping strategies in English or Chinese (PROSPERO: CRD42021273989). We [...] Read more.
This systematic review examined cancer care costs, the financial burden for patients, and their economic coping strategies in mainland China. We included 38 quantitative studies that reported out-of-pocket payment for cancer care and patients’ coping strategies in English or Chinese (PROSPERO: CRD42021273989). We searched PubMed, Embase, Ovid, Web of Science, Cochrane, CNKI, and Wanfang Data from 1 January 2009 to 10 August 2022. We referred to the standards for reporting observational studies to assess the methodological quality and transparent reporting of the included studies and reported the costs narratively. Annual mean medical costs (including inpatient and outpatient costs and fees for self-purchasing drugs) ranged from USD 7421 to USD 10,297 per patient. One study investigated medical costs for 5 years and indicated that inpatient costs accounted for 51.6% of the total medical costs, followed by self-purchasing drugs (43.9%). Annual medical costs as a percentage of annual household income ranged from 36.0% to 63.1% with a metaproportion of 51.0%. The common coping strategies included borrowing money and reduction of household expenses and expenses from basic health services. Costs of inpatient care and self-purchasing drugs are major drivers of medical costs for cancer care, and many affected households shoulder a very heavy financial burden. Full article
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16 pages, 3786 KiB  
Review
Novel Cellular and Immunotherapy: Toxicities and Perioperative Implications
by Alessandro De Camilli and Gregory Fischer
Curr. Oncol. 2023, 30(8), 7638-7653; https://doi.org/10.3390/curroncol30080554 - 16 Aug 2023
Viewed by 1337
Abstract
Targeted cellular and immunotherapies have welcomed a new chapter in multi-modal cancer therapy. These agents harness our innate immune system and destroy malignant cells in a precise way as compared with “legacy” chemotherapeutic agents that largely rely on abolishing cell division. New therapies [...] Read more.
Targeted cellular and immunotherapies have welcomed a new chapter in multi-modal cancer therapy. These agents harness our innate immune system and destroy malignant cells in a precise way as compared with “legacy” chemotherapeutic agents that largely rely on abolishing cell division. New therapies can augment the T-cell recognition of tumor antigens and effectively prevent tumor cells from their historically successful ability to evade immune recognition. These novel agents cause acute and chronic toxicities to a variety of organ systems (enteritis, pneumonitis, hypophysitis, and hepatitis), and this may masquerade as other chronic illnesses or paraneoplastic effects. As the perioperative footprint of cancer patients increases, it is essential that perioperative providers—anesthesiologists, surgeons, nurse anesthetists, and inpatient hospital medicine providers—be up to date on the physiologic mechanisms that underlie these new therapies as well as their acute and subacute toxicity profiles. Immunotherapy toxicity can significantly impact perioperative morbidity as well as influence perioperative management, such as prophylaxis for adrenal insufficiency, preoperative pulmonary assessment, and screening for thyroid dysfunction, among others. Full article
(This article belongs to the Collection Editorial Board Members’ Collection Series: Contemporary Perioperative Concepts in Cancer Surgery)
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11 pages, 1389 KiB  
Article
Trainee Evaluations of Preparedness for Clinical Trials in Medical Oncology—A National Questionnaire
by Michela Febbraro, Ghazaleh Kazemi, Rosalyn Juergens and Gregory R. Pond
Curr. Oncol. 2023, 30(8), 7627-7637; https://doi.org/10.3390/curroncol30080553 - 15 Aug 2023
Viewed by 1084
Abstract
Background: A standardized approach to the education of clinical trial investigators across Canadian medical oncology (MO) subspecialty training does not exist. With training programs transitioning to competency-based medical education (CBME), studies assessing education practices and competence are paramount to enhancing trainee education. This [...] Read more.
Background: A standardized approach to the education of clinical trial investigators across Canadian medical oncology (MO) subspecialty training does not exist. With training programs transitioning to competency-based medical education (CBME), studies assessing education practices and competence are paramount to enhancing trainee education. This study aimed to determine whether current education practices in MO subspecialty training programs in Canada prepare trainees for participating in clinical trials as an investigator. Methods: From November 2021 to February 2022 a national, bilingual, online questionnaire to understand trainee experiences with self-perceived competence, preparedness, and willingness to participate in clinical trials as investigators was conducted. MO trainees, fellows, and new-to-practice physicians who completed an MO subspecialty training program in Canada were included. Results: A total of 41 responses were received (response rate: 15%). Formal training in how to participate in clinical trials as an investigator was reported by 73% of respondents. At the end of training, 65% of respondents rated competence in clinical trials as fair/poor and 74% rated preparedness in conducting clinical trials as fair/poor. Correlation analysis determined that in-clinic teaching in clinical trials trended toward improved self-evaluations of competence and preparedness (p > 0.05). Conclusion: This is the first study in Canada to assess competencies in any residency training program since the establishment of CBME. Training in conducting clinical trials is highly variable across MO programs in Canada, with most trainees finding current practices not translating into self-perceived competence and preparedness. Further assessment into how to produce competent clinical trial investigators is warranted. Full article
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7 pages, 1500 KiB  
Case Report
Bilateral Renal Auto-Transplantation for Retroperitoneal Sarcomas: Is It Underutilized?
by Tyler P. Robinson, Daniel P. Milgrom, Santosh Nagaraju, William C. Goggins, Kannan P. Samy and Leonidas G. Koniaris
Curr. Oncol. 2023, 30(8), 7620-7626; https://doi.org/10.3390/curroncol30080552 - 14 Aug 2023
Viewed by 1233
Abstract
Sarcomas are a rare tumor of mesenchymal origin. The liposarcoma is the most common sarcoma of the retroperitoneum. Liposarcomas are typically low grade, and present at an advanced stage and a large size. We report a case of a large retroperitoneal liposarcoma, approximately [...] Read more.
Sarcomas are a rare tumor of mesenchymal origin. The liposarcoma is the most common sarcoma of the retroperitoneum. Liposarcomas are typically low grade, and present at an advanced stage and a large size. We report a case of a large retroperitoneal liposarcoma, approximately 50 kg, encasing both kidneys, which was managed via a two-stage resection and staged renal auto-transplantation into the intra-peritoneal pelvis. The patient maintained normal renal function throughout, and remains disease free two years post-resection. Renal auto-transplantation with pelvic placement may facilitate improved margin-free resection. Renal relocation may allow the use of curative-intent ablative therapies such as radiofrequency ablation and radiation in cases of retroperitoneal recurrence. Full article
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12 pages, 271 KiB  
Article
Exploring the Use of a Digital Platform for Cancer Patients to Report Their Demographics, Disease and Therapy Characteristics, Age, and Educational Disparities: An Early-Stage Feasibility Study
by Dimitra Galiti, Helena Linardou, Sofia Agelaki, Athanasios Karampeazis, Nikolaos Tsoukalas, Amanda Psyrri, Michalis Karamouzis, Konstantinos N. Syrigos, Alexandros Ardavanis, Ilias Athanasiadis, Eleni Arvanitou, Stavroula Sgourou, Anastasia Mala, Christos Vallilas and Ioannis Boukovinas
Curr. Oncol. 2023, 30(8), 7608-7619; https://doi.org/10.3390/curroncol30080551 - 12 Aug 2023
Cited by 1 | Viewed by 1573
Abstract
Introduction: The increasing burden of cancer, the development of novel therapies, and the COVID-19 pandemic have made cancer care more complex. Digital innovation was then pushed toward developing platforms to facilitate access to cancer care. Age, education, and other disparities were, however, shown [...] Read more.
Introduction: The increasing burden of cancer, the development of novel therapies, and the COVID-19 pandemic have made cancer care more complex. Digital innovation was then pushed toward developing platforms to facilitate access to cancer care. Age, education, and other disparities were, however, shown to limit the use of the digital health innovation. The aim of this early-stage feasibility study was to assess whether Greek cancer patients would register at CureCancer and self-report their demographics, disease and therapy characteristics, and socioeconomic issues. The study was organized by the Hellenic Society of Medical Oncology. Methods: Patients from nine cancer centers were invited to register on the CureCancer platform and complete an anonymous questionnaire on demographics, disease and therapy characteristics, and socioeconomic issues. Patients were also encouraged to upload, in a secure area for them, their medical files and share them with their physicians. They were then asked to comment on their experience of registration and how easy it was to upload their medical files. Results: Of the 159 patients enrolled, 144 (90.56%) registered, and 114 of those (79.16%) completed the questionnaire, suggesting that the study is feasible. Users’ median age was 54.5 years, and 86.8% of them were university and high school graduates. Most patients (79.8%) reported their specific type of cancer diagnosis, and all reported their therapy characteristics. Breast and lung cancers were the most common. A total of 87 patients (76.3%) reported being on active cancer therapy, 46 (40.4%) had metastatic disease, and 51 (44.7%) received supportive care medications. Eighty-one (71.05%) patients received prior cancer therapies, and twenty-seven recalled prior supportive care medications. All patients reported visiting non-oncology Health Care Professionals during the study. Nineteen of 72 (26.39%) patients who worked prior to cancer diagnosis changed work status; 49 (42.98) patients had children under 24 years; and 16 (14%) patients lived alone. Nine (7.9%) patients were members of patient associations. Registration was “much/very much” easy for 98 (86.0%) patients, while 67 (58.8%) had difficulties uploading their files. Patients commented on the well-organized data access, improved communication, feeling safe, medication adherence, interventions from a distance, and saving time and money. Over 80% of patients “preferred the digital way”. Discussion: A total of 114 patients succeeded in registering on the digital platform and reporting their demographics, disease and therapy characteristics, and socioeconomic issues. Age and educational disparities were disclosed and highlighted the need for educational programs to help older people and people of lower education use digital innovation. Health care policy measures would support patients’ financial burden associated with work changes, living alone, and children under 24 years old at school or college. Policy actions would motivate patients to increase their participation in patient associations. According to the evidence DEFINED framework, the number of patients, and the focus on enrollment, engagement, and user experience, the study fulfills actionability level criterion 1. Full article
27 pages, 287 KiB  
Conference Report
Abstracts of the 2023 Canadian Association of Medical Oncologists Annual Scientific Meeting
by Alexi Campbell, Sharlene Gill, Desiree Hao, Erin Powell, Stephanie Snow, Zachary Veitch and Stephen Welch
Curr. Oncol. 2023, 30(8), 7581-7607; https://doi.org/10.3390/curroncol30080550 - 11 Aug 2023
Viewed by 1236
Abstract
On behalf of the Canadian Association of Medical Oncologists, we are pleased to present the abstracts of the 2023 Annual Scientific Meeting. The CAMO Annual Scientific Meeting (ASM) took place on 27 April 2023 in an in-person event in Toronto, ON. Thirty-two (32) [...] Read more.
On behalf of the Canadian Association of Medical Oncologists, we are pleased to present the abstracts of the 2023 Annual Scientific Meeting. The CAMO Annual Scientific Meeting (ASM) took place on 27 April 2023 in an in-person event in Toronto, ON. Thirty-two (32) abstracts were selected for presentation as oral presentations, in-person poster presentations, and virtual poster presentations. Awards for the top four (4) abstracts were presented during the ASM; they have been marked as “Award Recipient”. We congratulate all presenters on their research work and contribution. Full article
15 pages, 307 KiB  
Review
An Overview of Pancreatic Neuroendocrine Tumors and an Update on Endoscopic Techniques for Their Management
by Osama O. Elkelany, Fred G. Karaisz, Benjamin Davies and Somashekar G. Krishna
Curr. Oncol. 2023, 30(8), 7566-7580; https://doi.org/10.3390/curroncol30080549 - 11 Aug 2023
Cited by 3 | Viewed by 1281
Abstract
The growing importance of advanced endoscopy in the diagnosis and treatment of pancreatic neuroendocrine neoplasms (PanNETs) necessitates a comprehensive understanding of various biochemical markers, genetic testing methods, radiological techniques, and treatment approaches that encompass multiple disciplines within and beyond gastrointestinal oncology. This review [...] Read more.
The growing importance of advanced endoscopy in the diagnosis and treatment of pancreatic neuroendocrine neoplasms (PanNETs) necessitates a comprehensive understanding of various biochemical markers, genetic testing methods, radiological techniques, and treatment approaches that encompass multiple disciplines within and beyond gastrointestinal oncology. This review aims to highlight key aspects of these topics, with a specific focus on emerging EUS-guided procedures for the management of PanNETs. Full article
13 pages, 779 KiB  
Article
Validation of the Canadian Version of the Shame and Stigma Scale for Head and Neck Cancer Patients
by Irene Bobevski, David W. Kissane, Justin Desroches, Avina De Simone and Melissa Henry
Curr. Oncol. 2023, 30(8), 7553-7565; https://doi.org/10.3390/curroncol30080548 - 11 Aug 2023
Viewed by 1101
Abstract
Cancers of the head and neck and their treatment can cause disfigurement and loss of functioning, with a profound negative impact on the person’s self-image and psychosocial wellbeing. This can lead to experiences of shame and stigma, which are important targets for psychosocial [...] Read more.
Cancers of the head and neck and their treatment can cause disfigurement and loss of functioning, with a profound negative impact on the person’s self-image and psychosocial wellbeing. This can lead to experiences of shame and stigma, which are important targets for psychosocial interventions. Accurate measurement and identification of these problems enables clinicians to offer appropriate interventions and monitor patients’ progress. This study aimed to validate the Canadian version of the Shame and Stigma Scale (SSS) among French- and English-speaking head and neck cancer patients. Data from 254 patients from two major Canadian hospitals were analysed. The existing four-factor structure of the SSS was supported, with the following subscales: Shame with Appearance, Sense of Stigma, Regret, and Social/Speech Concerns. The Canadian SSS showed adequate convergent and divergent validity and test–retest reliability. Rasch analysis suggested scale improvement by removing two misfitting items and two items with differential functioning between French- and English-speaking patients. The final 16-item scale version was an adequate fit with the Rasch model. The SSS provides more accurate measures for people with high levels of shame and stigma, and thus has utility in identifying patients with more severe symptoms who may be in need of psychosocial interventions. Full article
(This article belongs to the Special Issue Psychosocial Effects of Head and Neck Cancer)
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11 pages, 3238 KiB  
Article
Non-Professional Phagocytosis Increases in Melanoma Cells and Tissues with Increasing E-Cadherin Expression
by Luzie Helene Unseld, Laura S. Hildebrand, Florian Putz, Maike Büttner-Herold, Christoph Daniel, Rainer Fietkau and Luitpold Valentin Distel
Curr. Oncol. 2023, 30(8), 7542-7552; https://doi.org/10.3390/curroncol30080547 - 11 Aug 2023
Viewed by 1291
Abstract
Non-professional phagocytosis in cancer has been increasingly studied in recent decades. In malignant melanoma metastasis, cell-in-cell structures have been described as a sign of cell cannibalism. To date, only low rates of cell-in-cell structures have been described in patients with malignant melanoma. To [...] Read more.
Non-professional phagocytosis in cancer has been increasingly studied in recent decades. In malignant melanoma metastasis, cell-in-cell structures have been described as a sign of cell cannibalism. To date, only low rates of cell-in-cell structures have been described in patients with malignant melanoma. To investigate these findings further, we examined twelve primary melanoma cell lines in both adherent and suspended co-incubation for evidence of engulfment. In addition, 88 malignant melanoma biopsies and 16 healthy tissue samples were evaluated. E-cadherin levels were determined in the cell lines and tissues. All primary melanoma cell lines were capable of phagocytosis, and phagocytosis increased when cells were in suspension during co-incubation. Cell-in-cell structures were also detected in most of the tissue samples. Early T stages and increasingly advanced N and M stages have correspondingly lower rates of cell-in-cell structures. Non-professional phagocytosis was also present in normal skin tissue. Non-professional phagocytosis appears to be a ubiquitous mechanism in malignant melanoma. The absence of phagocytosis in metastases may be one reason for the high rate of metastasis in malignant melanoma. Full article
(This article belongs to the Section Dermato-Oncology)
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10 pages, 585 KiB  
Article
Exploring Patients’ Perspectives on Late Complications after Colorectal and Anal Cancer Treatment: A Qualitative Study
by Birthe Thing Oggesen, Marie Louise Sjødin Hamberg, Thordis Thomsen and Jacob Rosenberg
Curr. Oncol. 2023, 30(8), 7532-7541; https://doi.org/10.3390/curroncol30080546 - 10 Aug 2023
Viewed by 1315
Abstract
Background: Patients often experience late complications following treatment for colorectal and anal cancer. Although several measurement tools exist to classify the severity of these symptoms, little is known about how patients personally experience and adapt to these complications. This study aimed to investigate [...] Read more.
Background: Patients often experience late complications following treatment for colorectal and anal cancer. Although several measurement tools exist to classify the severity of these symptoms, little is known about how patients personally experience and adapt to these complications. This study aimed to investigate patients’ experiences and coping strategies in relation to these symptoms. Methods: We conducted an explorative qualitative interview study to gather data. Results: Our findings revealed two main categories: How patients react after treatment for colorectal and anal cancer, and Experienced symptoms. Additionally, we identified four sub-categories: the period after discharge, coping strategies, stool symptoms, and other symptoms. Patients commonly feel abandoned once their surgical and oncological treatments are completed. It is typical for patients to turn to the internet for guidance on managing late complications, despite being aware that evidence-based options are limited. Stool-related issues significantly impact patients’ personal and professional lives, requiring constant preparedness for accidents, the use of diapers, and the need for extra clothing at all times. Furthermore, patients experience additional troublesome symptoms such as urinary incontinence, fatigue, pain, and sexual dysfunction, which further affect their daily lives. Conclusions: Patients experience multiple problems after colorectal cancer surgery, and this warrants more focused attention. Full article
(This article belongs to the Section Surgical Oncology)
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12 pages, 264 KiB  
Review
Locoregional Treatment for Early-Stage Breast Cancer: Current Status and Future Perspectives
by Sayeh Lavasani, Erin Healy and Kari Kansal
Curr. Oncol. 2023, 30(8), 7520-7531; https://doi.org/10.3390/curroncol30080545 - 10 Aug 2023
Viewed by 1459
Abstract
Background: The locoregional recurrence of breast cancer has been reduced due to the multidisciplinary approach of breast surgery, systemic therapy and radiation. Early detection and better surgical techniques contribute to an improvement in breast cancer outcomes. Purpose of Review: The purpose of this [...] Read more.
Background: The locoregional recurrence of breast cancer has been reduced due to the multidisciplinary approach of breast surgery, systemic therapy and radiation. Early detection and better surgical techniques contribute to an improvement in breast cancer outcomes. Purpose of Review: The purpose of this review is to have an overview and summary of the current evidence behind the current approaches to the locoregional treatment of breast cancer and to discuss its future direction. Summary: With improved surgical techniques and the use of a more effective neoadjuvant systemic therapy, including checkpoint inhibitors and dual HER2-directed therapies that lead to a higher frequency of pathologic complete responses and advances in adjuvant radiation therapy, breast cancer patients are experiencing better locoregional control and reduced local and systemic recurrence. De-escalation in surgery has not only improved the quality of life in the majority of breast cancer patients, but also maintained the low risk of recurrence. There are ongoing clinical trials to optimize radiation therapy in breast cancer. More modern radiation technologies are evolving to improve the patient outcome and reduce radiation toxicities. Full article
(This article belongs to the Section Breast Cancer)
12 pages, 1097 KiB  
Article
Small Bowel Neuroendocrine Tumors—10-Year Experience of the Ottawa Hospital (TOH)
by Abdulhameed Alfagih, Abdulaziz AlJassim, Nasser Alqahtani, Michael Vickers, Rachel Goodwin and Timothy Asmis
Curr. Oncol. 2023, 30(8), 7508-7519; https://doi.org/10.3390/curroncol30080544 - 09 Aug 2023
Cited by 1 | Viewed by 1444
Abstract
(1) Aim: The prevalence and incidence of small bowel NETs have increased significantly over the past two decades. This study aims to report the 10-year experience of SB-NET management at a regional cancer center in Canada. (2) Materials and methods: We conducted a [...] Read more.
(1) Aim: The prevalence and incidence of small bowel NETs have increased significantly over the past two decades. This study aims to report the 10-year experience of SB-NET management at a regional cancer center in Canada. (2) Materials and methods: We conducted a retrospective study of the clinical and pathological data of patients diagnosed with biopsy-proven SB-NET at The Ottawa Hospital (TOH), Ottawa, Canada between 2011 and 2021. We report the clinicopathological characteristics of these patients, as well as their outcomes data, including survival rates. (3) Results: Between 2011 and 2021, a total of 177 SB-NET cases were identified with 51% (n = 91) of cases being males. The most common sites of the tumors were the ileum 53% (n = 94), followed by the duodenum 9% (n = 16) and jejunum 7% (n = 12). Approximately 24% (n = 42) of the patients had symptoms for over six months prior to diagnosis and 18% (n = 32) had functioning SB-NET during the course of the disease. The majority of patients had locally advanced or metastatic disease at the time of presentation with stage III, and stage IV representing 42% (n = 75), and 41% (n = 73) respectively. The majority of patients 84% (n = 148) had well-differentiated histology. One hundred twenty patients underwent surgical resection of the primary tumor including 28 patients (16%) with limited metastatic disease. A total of 21 patients (18%) had recurrence after curative surgery. A total of 62 patients (35%) received first-line somatostatin analog (SSA) therapy for unresectable disease and seven patients had PRRT after progression on SSA. Five years OS was 100%, 91%, 97%, and 73% for stages I, II, III, and IV respectively. In univariate analysis, carcinoid symptoms, T stage, and differentiation were significant predictors for worse overall survival, but not RFS. (4) Conclusions: Compared to published historical controls, our study suggests improvement in the 5-year survival rate of SB-NETs over the last 10 years. Full article
(This article belongs to the Section Gastrointestinal Oncology)
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9 pages, 1061 KiB  
Article
Beyond PACIFIC: Real-World Outcomes of Adjuvant Durvalumab According to Treatment Received and PD-L1 Expression
by Marie-Hélène Denault, Jamie Feng, Shelley Kuang, Aria Shokoohi, Bonnie Leung, Mitchell Liu, Eric Berthelet, Janessa Laskin, Sophie Sun, Tina Zhang, Cheryl Ho and Barbara Melosky
Curr. Oncol. 2023, 30(8), 7499-7507; https://doi.org/10.3390/curroncol30080543 - 08 Aug 2023
Cited by 1 | Viewed by 1661
Abstract
Adjuvant durvalumab after chemoradiotherapy (CRT) is the standard of care for unresectable stage III non-small cell lung cancer (NSCLC). A post hoc exploratory analysis of PACIFIC revealed no OS benefit in the PD-L1 < 1% subgroup. This retrospective analysis assesses the real-world impact [...] Read more.
Adjuvant durvalumab after chemoradiotherapy (CRT) is the standard of care for unresectable stage III non-small cell lung cancer (NSCLC). A post hoc exploratory analysis of PACIFIC revealed no OS benefit in the PD-L1 < 1% subgroup. This retrospective analysis assesses the real-world impact of durvalumab on OS according to PD-L1 tumor proportion score (TPS). Patients with stage III, unresectable NSCLC treated by CRT, with available PD-L1 TPS, from 1 March 2018 to 31 December 2020, at BC Cancer, British Columbia, Canada were included. Patients were divided into two groups, CRT + durvalumab and CRT alone. OS and PFS were analyzed in the PD-L1 ≥ 1% and <1% subgroups. A total of 134 patients were included in the CRT + durvalumab group and 117, in the CRT alone group. Median OS was 35.9 months in the CRT + durvalumab group and 27.4 months in the CRT alone group [HR 0.59 (95% CI 0.42–0.83), p = 0.003]. Durvalumab improved OS in the PD-L1 ≥ 1% [HR 0.53 (95% CI 0.34–0.81), p = 0.003, n = 175], but not in the <1% subgroup [HR 0.79 (95% CI 0.44–1.42), p = 0.4, n = 76]. This retrospective study demonstrates a statistically significant improvement in OS associated with durvalumab after CRT in PD-L1 ≥ 1%, but not PD-L1 < 1% NSCLC. Variables not accounted for may have biased the survival analysis. A prospective study would bring more insight. Full article
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10 pages, 1655 KiB  
Article
Axillary Management in Breast Cancer Patients Undergoing Upfront Surgery: Results from a Nationwide Survey on Behalf of the Clinical Oncology Breast Cancer Group (COBCG) and the Breast Cancer Study Group of the Italian Association of Radiotherapy and Clinical Oncology (AIRO)
by Fiorenza De Rose, Riccardo Ray Colciago, Sara Lucidi, Eliana La Rocca, Agnese Prisco, Elisabetta Bonzano, Bruno Meduri, Maria Carmen De Santis, Samantha Dicuonzo, Nadia Pasinetti, Isabella Palumbo, Icro Meattini and Pierfrancesco Franco
Curr. Oncol. 2023, 30(8), 7489-7498; https://doi.org/10.3390/curroncol30080542 - 08 Aug 2023
Viewed by 1873
Abstract
Background: We assessed the current practice concerning the axillary management of breast cancer (BC) patients undergoing upfront surgery among radiation oncologists (ROs) practising in Italy. Methods: An online survey via SurveyMonkey (including 21 questions) was distributed amongst ROs in Italy through personal contacts [...] Read more.
Background: We assessed the current practice concerning the axillary management of breast cancer (BC) patients undergoing upfront surgery among radiation oncologists (ROs) practising in Italy. Methods: An online survey via SurveyMonkey (including 21 questions) was distributed amongst ROs in Italy through personal contacts and the Italian Association for Radiotherapy and Clinical Oncology (AIRO) network from August to September 2022. We particularly focused on the emerging omission of axillary lymph node dissection (ALND) in the presence of 1–2 sentinel node-positive patients and the consequent change in the role of regional nodal irradiation (RNI). Results: A total of 101/195 (51% response rate) Italian Radiotherapy Cancer Care Centres answered the survey. With respect to patients with 1–2 sentinel node-positive, the relative proportion of respondents that offer patients ALND a) always, b) only in selected cases, and c) never was 37.6%, 60.4%, and 2.0%, respectively, with no significant geographical (North vs. Centre–South Italy; p = 0.92) or institutional (Academic vs. non-Academic; p = 0.49) differences. Radiation therapy indications varied widely in patients who did not undergo ALND. Among these, about a third of the respondents (17/56, 30.4%) stated that RNI was constantly performed. On the other hand, half of the respondents offered RNI in selected cases, stating that an unfavourable biologic tumour profile and extracapsular nodal extension were considered drivers of their decision. Conclusions: Results of the present survey show the variability of axillary management offered in clinical practice for BC patients undergoing conserving surgery upfront in Italy. Analysis of these attitudes may trigger the modification of some clinical approaches through multidisciplinary collaboration and create the background for future clinical investigations. Full article
(This article belongs to the Section Breast Cancer)
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11 pages, 1084 KiB  
Review
Phosphaturic Mesenchymal Tumors with or without Phosphate Metabolism Derangements
by Andrea Montanari, Maria Giulia Pirini, Ludovica Lotrecchiano, Lorenzo Di Prinzio and Guido Zavatta
Curr. Oncol. 2023, 30(8), 7478-7488; https://doi.org/10.3390/curroncol30080541 - 08 Aug 2023
Cited by 3 | Viewed by 1508
Abstract
Phosphaturic mesenchymal tumors (PMT) are rare neoplasms, which can give rise to a multifaceted syndrome, otherwise called tumor-induced osteomalacia (TIO). Localizing these tumors is crucial to obtain a cure for the phosphate metabolism derangement, which is often the main cause leading the patient [...] Read more.
Phosphaturic mesenchymal tumors (PMT) are rare neoplasms, which can give rise to a multifaceted syndrome, otherwise called tumor-induced osteomalacia (TIO). Localizing these tumors is crucial to obtain a cure for the phosphate metabolism derangement, which is often the main cause leading the patient to seek medical help, because of invalidating physical and neuromuscular symptoms. A proportion of these tumors is completely silent and may grow unnoticed, unless they become large enough to produce pain or discomfort. FGF-23 can be produced by several benign or malignant PMTs. The phosphate metabolism, radiology and histology of these rare tumors must be collectively assessed by a multidisciplinary team aimed at curing the disease locally and improving patients’ quality of life. This narrative review, authored by multiple specialists of a tertiary care hospital center, will describe endocrine, radiological and histological features of these tumors, as well as present surgical and interventional strategies to manage PMTs. Full article
(This article belongs to the Special Issue Bone and Soft Tissue Tumors: Clinical Features, Imaging and Treatment)
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28 pages, 819 KiB  
Review
Immunotherapy during the Immediate Perioperative Period: A Promising Approach against Metastatic Disease
by Elad Sandbank, Anabel Eckerling, Adam Margalit, Liat Sorski and Shamgar Ben-Eliyahu
Curr. Oncol. 2023, 30(8), 7450-7477; https://doi.org/10.3390/curroncol30080540 - 07 Aug 2023
Cited by 1 | Viewed by 2058
Abstract
Tumor excision is a necessary life-saving procedure in most solid cancers. However, surgery and the days before and following it, known as the immediate perioperative period (IPP), entail numerous prometastatic processes, including the suppression of antimetastatic immunity and direct stimulation of minimal residual [...] Read more.
Tumor excision is a necessary life-saving procedure in most solid cancers. However, surgery and the days before and following it, known as the immediate perioperative period (IPP), entail numerous prometastatic processes, including the suppression of antimetastatic immunity and direct stimulation of minimal residual disease (MRD). Thus, the IPP is pivotal in determining long-term cancer outcomes, presenting a short window of opportunity to circumvent perioperative risk factors by employing several therapeutic approaches, including immunotherapy. Nevertheless, immunotherapy is rarely examined or implemented during this short timeframe, due to both established and hypothetical contraindications to surgery. Herein, we analyze how various aspects of the IPP promote immunosuppression and progression of MRD, and how potential IPP application of immunotherapy may interact with these deleterious processes. We discuss the feasibility and safety of different immunotherapies during the IPP with a focus on the latest approaches of immune checkpoint inhibition. Last, we address the few past and ongoing clinical trials that exploit the IPP timeframe for anticancer immunotherapy. Accordingly, we suggest that several specific immunotherapies can be safely and successfully applied during the IPP, alone or with supporting interventions, which may improve patients’ resistance to MRD and overall survival. Full article
(This article belongs to the Collection Editorial Board Members’ Collection Series: Contemporary Perioperative Concepts in Cancer Surgery)
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11 pages, 6719 KiB  
Case Report
Percutaneous Radiofrequency Ablation of Thyroid Carcinomas Ineligible for Surgery, in the Elderly
by Pierre Yves Marcy, Marc Tassart, Jean-Guillaume Marchand, Juliette Thariat, Alain Bizeau and Edouard Ghanassia
Curr. Oncol. 2023, 30(8), 7439-7449; https://doi.org/10.3390/curroncol30080539 - 06 Aug 2023
Cited by 3 | Viewed by 1655
Abstract
Thirty to 50% of differentiated thyroid carcinomas include papillary thyroid microcarcinomas (mPTC). Most of these tumors remain clinically silent, have a bright prognosis and a disease-specific mortality <1%. Surgery has been recommended as first line-treatment by current guidelines, the standard treatment being lobectomy. [...] Read more.
Thirty to 50% of differentiated thyroid carcinomas include papillary thyroid microcarcinomas (mPTC). Most of these tumors remain clinically silent, have a bright prognosis and a disease-specific mortality <1%. Surgery has been recommended as first line-treatment by current guidelines, the standard treatment being lobectomy. However, surgery has some drawbacks, including potential recurrent laryngeal nerve paralysis, hypothyroidism, hypoparathyroidism, in -patient basis hospital stay, lifelong medication, scarring of the neck, and general anesthesia related risks. Moreover, elderly patients who present severe comorbidities, could be ineligible for surgery, and others may refuse invasive surgery. Another option supported by the American Thyroid Association is active surveillance. This option can be considered as unattractive and difficult to accept by European patients, as there is a 2–6% risk of disease progression. Percutaneous image-guided thermal ablation has been successfully applied in the treatment of liver and lung tumors in the 1990s and 2000s; and has recently been proposed as an alternative to surgery in patients presenting with thyroid diseases. This minimally invasive treatment has similar efficacy, fewer complications, better quality of life and cosmetic outcomes than surgery. We report herein two cases of radiofrequency ablation of mPTC and T2 PTC in elderly patients who were ineligible for surgery. Full article
(This article belongs to the Section Head and Neck Oncology)
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14 pages, 306 KiB  
Review
The Oncology Clinical Nurse Specialist: A Rapid Review of Implementation Models and Barriers around the World
by Ori Kapra, Noam Asna, Mazal Amoyal, Osnat Bashkin and Keren Dopelt
Curr. Oncol. 2023, 30(8), 7425-7438; https://doi.org/10.3390/curroncol30080538 - 05 Aug 2023
Viewed by 2492
Abstract
The role of a clinical nurse specialist in oncology varies greatly between healthcare systems, and implementing this healthcare role with its multifaceted and co-existing responsibilities may prove challenging. While already integrated into healthcare systems and services in several European countries, Asia, Canada, and [...] Read more.
The role of a clinical nurse specialist in oncology varies greatly between healthcare systems, and implementing this healthcare role with its multifaceted and co-existing responsibilities may prove challenging. While already integrated into healthcare systems and services in several European countries, Asia, Canada, and the United States, other countries are just beginning to develop clinical nursing specialties. The current study aims to provide healthcare policymakers with up-to-date evidence that focuses on the diverse modes of oncology clinical nurse specialist role implementation across several healthcare systems and pertinent implementation challenges as described in the literature. A rapid evidence assessment was carried out in order to provide policymakers with a rigorous review in a condensed timescale. Initially, only items in the English language were included, and “grey literature” was excluded. We searched PubMed between 1 January 2022 and 28 February 2022 and two independent scholars reviewed items. Based on 64 papers, both non-scientific and papers that met the initial criteria of the rapid review, we describe the modes of implementation of the oncology clinical nurse specialist in the United States, Canada, United Kingdom, Japan, Brazil and Australia. Barriers to implementation include conflicts around role boundaries, skepticism and lack of organizational support, as well as fears that oncology clinical nurse specialists will “encroach” on doctors’ powers. In contrast, an oncology clinical nurse specialist is found to be universally more accessible to patients and their families and can help physicians deal with difficult workloads, among other advantages. Conclusions: This role offers a myriad of gains for cancer patients, oncology physicians, and the healthcare system. The literature demonstrates that it is a necessary role, albeit one that brings specific implementation challenges. Full article
(This article belongs to the Section Palliative and Supportive Care)
13 pages, 1764 KiB  
Article
Mean Heart Dose Prediction Using Parameters of Single-Slice Computed Tomography and Body Mass Index: Machine Learning Approach for Radiotherapy of Left-Sided Breast Cancer of Asian Patients
by Wlla E. Al-Hammad, Masahiro Kuroda, Ryo Kamizaki, Nouha Tekiki, Hinata Ishizaka, Kazuhiro Kuroda, Kohei Sugimoto, Masataka Oita, Yoshinori Tanabe, Majd Barham, Irfan Sugianto, Yudai Shimizu, Yuki Nakamitsu and Junichi Asaumi
Curr. Oncol. 2023, 30(8), 7412-7424; https://doi.org/10.3390/curroncol30080537 - 04 Aug 2023
Viewed by 1990
Abstract
Deep inspiration breath-hold (DIBH) is an excellent technique to reduce the incidental radiation received by the heart during radiotherapy in patients with breast cancer. However, DIBH is costly and time-consuming for patients and radiotherapy staff. In Asian countries, the use of DIBH is [...] Read more.
Deep inspiration breath-hold (DIBH) is an excellent technique to reduce the incidental radiation received by the heart during radiotherapy in patients with breast cancer. However, DIBH is costly and time-consuming for patients and radiotherapy staff. In Asian countries, the use of DIBH is restricted due to the limited number of patients with a high mean heart dose (MHD) and the shortage of radiotherapy personnel and equipment compared to that in the USA. This study aimed to develop, evaluate, and compare the performance of ten machine learning algorithms for predicting MHD using a patient’s body mass index and single-slice CT parameters to identify patients who may not require DIBH. Machine learning models were built and tested using a dataset containing 207 patients with left-sided breast cancer who were treated with field-in-field radiotherapy with free breathing. The average MHD was 251 cGy. Stratified repeated four-fold cross-validation was used to build models using 165 training data. The models were compared internally using their average performance metrics: F2 score, AUC, recall, accuracy, Cohen’s kappa, and Matthews correlation coefficient. The final performance evaluation for each model was further externally analyzed using 42 unseen test data. The performance of each model was evaluated as a binary classifier by setting the cut-off value of MHD ≥ 300 cGy. The deep neural network (DNN) achieved the highest F2 score (78.9%). Most models successfully classified all patients with high MHD as true positive. This study indicates that the ten models, especially the DNN, might have the potential to identify patients who may not require DIBH. Full article
(This article belongs to the Topic Innovative Radiation Therapies)
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14 pages, 270 KiB  
Review
Do Cancer Genetics Impact Treatment Decision Making? Immunotherapy and Beyond in the Management of Advanced and Metastatic Urothelial Carcinoma
by Gavin Hui, Dimitrios Stefanoudakis, Yuliya Zektser, Dayna Jill Isaacs, Christopher Hannigan, Allan J. Pantuck and Alexandra Drakaki
Curr. Oncol. 2023, 30(8), 7398-7411; https://doi.org/10.3390/curroncol30080536 - 04 Aug 2023
Cited by 1 | Viewed by 1919
Abstract
Bladder cancer is one of the most commonly diagnosed genitourinary malignancies. For many years, the primary treatment for metastatic urothelial cancer (mUC) was predicated on the use of platinum-based chemotherapy. More recently, immune checkpoint inhibitors (ICIs) were approved by regulatory agencies such as [...] Read more.
Bladder cancer is one of the most commonly diagnosed genitourinary malignancies. For many years, the primary treatment for metastatic urothelial cancer (mUC) was predicated on the use of platinum-based chemotherapy. More recently, immune checkpoint inhibitors (ICIs) were approved by regulatory agencies such as the US FDA for use in both the first- and second-line settings. This review outlines the approved ICIs for mUC in the second-line setting and as an alternative to chemotherapy in the first-line setting, as well as the novel agents that have also been incorporated into the treatment of this malignancy. Single-agent ICIs are often used in second-line settings in mUC, and there are three drugs currently approved for those who progress after receiving platinum-based chemotherapy. In the first-line setting, the preferred treatment regimen remains cisplatin-based chemotherapy. However, single-agent ICI can be an alternative first-line treatment for those who are not candidates for cisplatin-based therapy. There are also clinical trials adding ICIs to chemotherapy as combination regimens. However, treatment for mUC has now expanded even beyond immunotherapy. Newer targeted agents such as erdafitinib, a fibroblast growth factor receptor inhibitor, and two antibody–drug conjugates, enfortumab vedotin and sacituzumab govitecan, have been recently approved. As new drug agents are discovered, it will be important to assess both the treatment outcomes as well as the effects on patients’ quality of life. Furthermore, integrating genetic and molecular information can help guide treatment decisions as next-generation sequencing is more commonly acquired during the evaluation of newly diagnosed patients with advanced and metastatic cancer. Full article
(This article belongs to the Special Issue Current Advances in Clinical Genomics and Treatment of Urothelial Carcinoma)
14 pages, 564 KiB  
Article
A Multi-Centre Randomized Study Comparing Two Standard of Care Chemotherapy Regimens for Lower-Risk HER2-Positive Breast Cancer
by Ricardo Fernandes, Terry L. Ng, Mashari Jemaan Alzahrani, Jacques Raphael, Phillip Blanchette, Morgan Black, Carol Stober, Gregory R. Pond, David Cella, Lisa Vandermeer, Mohammed Ibrahim and Mark Clemons
Curr. Oncol. 2023, 30(8), 7384-7397; https://doi.org/10.3390/curroncol30080535 - 04 Aug 2023
Cited by 2 | Viewed by 2088
Abstract
Background: Neither paclitaxel plus trastuzumab (P-H) nor docetaxel-cyclophosphamide plus trastuzumab (TC-H) have been prospectively compared in HER2-positive early-stage breast cancer (EBC). A randomized trial was performed to assess the feasibility of a larger study. Methods: Lower-risk HER2-positive EBC patients were randomized to either [...] Read more.
Background: Neither paclitaxel plus trastuzumab (P-H) nor docetaxel-cyclophosphamide plus trastuzumab (TC-H) have been prospectively compared in HER2-positive early-stage breast cancer (EBC). A randomized trial was performed to assess the feasibility of a larger study. Methods: Lower-risk HER2-positive EBC patients were randomized to either P-H or TC-H treatment arms. The co-primary feasibility outcomes were: ≥75% patient acceptability rate, active trial participation of ≥50% of medical oncologists, ≥75% and ≥90% treatment completion, and receipt rate of planned cycles of chemotherapy, respectively. Secondary outcomes: Febrile neutropenia (FN) rate, treatment-related hospitalizations, health-related quality of life (HR-QoL) questionnaires. Analyses were performed by per protocol and intention-to-treat. Results: Between May 2019 and March 2021, 49 of 52 patients agreed to study participation (94% acceptability rate). Fifteen (65%) of 23 medical oncologists approached patients. Rates of FN were higher (8.3% vs. 0%) in the TC-H vs. P-H arm. Median (IQR) changes in scores from baseline in FACT-Taxane Trial Outcome Index at 24 weeks were −4 (−10, −1) vs. −6.5 (−15, −2) for TC-H and P-H arms, respectively. Conclusions: A randomized trial comparing P-H and TC-H was feasible. Expansion to a larger trial would be feasible to explore patient-reported outcomes of these adjuvant HER2 chemotherapy regimens. Full article
(This article belongs to the Section Breast Cancer)
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