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Current Oncology is published by MDPI from Volume 28 Issue 1 (2021). Previous articles were published by another publisher in Open Access under a CC-BY (or CC-BY-NC-ND) licence, and they are hosted by MDPI on mdpi.com as a courtesy and upon agreement with Multimed Inc..

Curr. Oncol., Volume 24, Issue 3 (June 2017) – 23 articles

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771 KiB  
Case Report
Carcinoma Ex Pleomorphic Adenoma: Case Report and Options for Systemic Therapy
by N. Chooback, Y. Shen, M. Jones, K. Kasaian, M. Martin, T. Ng, T. Thomson, M. Marra, J. Laskin and Cheryl Ho
Curr. Oncol. 2017, 24(3), 251-254; https://0-doi-org.brum.beds.ac.uk/10.3747/co.24.3588 - 01 Jun 2017
Cited by 10 | Viewed by 662
Abstract
The most common benign salivary tumour is a pleomorphic adenoma. Transformation to malignancy, carcinoma ex pleomorphic adenoma (CXPA), occurs in 6% of cases. Management focuses on surgical resection and radiotherapy; however, rare cases require systemic management. We present the case of [...] Read more.
The most common benign salivary tumour is a pleomorphic adenoma. Transformation to malignancy, carcinoma ex pleomorphic adenoma (CXPA), occurs in 6% of cases. Management focuses on surgical resection and radiotherapy; however, rare cases require systemic management. We present the case of a 60-year-old woman with a CXPA of the left parotid gland who required systemic therapy for locally recurrent disease. Treatment options were guided by the literature concerning malignant salivary gland tumour and by whole-genome and transcriptome sequencing of the tumour. The patient received multiple systemic agents during the course of her disease, with cyclophosphamide–doxorubicin–cisplatin providing the best control (partial response). Genomeand transcriptome-directed therapy, including sorafenib and vismodegib, were utilized with limited clinical benefit. Malignant transformation in CXPA is a complex process, and therapy directed at a single tumour pathway might not be sufficient to control disease. Full article
3499 KiB  
Case Report
Molecular Progression in Unusual Recurrent Non-Pediatric Intracranial Clear Cell Meningioma
by B. Domingo-Arrué, Rosario Gil-Benso, J. Megías, L. Navarro, T. San-Miguel, L. Muñoz-Hidalgo, C. López-Ginés and M. Cerdá-Nicolás
Curr. Oncol. 2017, 24(3), 244-250; https://0-doi-org.brum.beds.ac.uk/10.3747/co.24.3509 - 01 Jun 2017
Cited by 2 | Viewed by 393
Abstract
We report a case of a recurrent clear cell meningioma (CCM) in the frontal lobe of the brain of a 67-year-old man. The patient developed three recurrences: at 3, 10, and 12 years after his initial surgery. Histopathology observations revealed a [...] Read more.
We report a case of a recurrent clear cell meningioma (CCM) in the frontal lobe of the brain of a 67-year-old man. The patient developed three recurrences: at 3, 10, and 12 years after his initial surgery. Histopathology observations revealed a grade 2 CCM with positivity for vimentin and epithelial membrane antigen. Expression of E-cadherin was positive only in the primary tumour and in the first available recurrence. Fluorescence in situ hybridization analyses demonstrated 1p and 14q deletions within the last recurrence. Multiplex ligation-dependent probe amplification studies revealed a heterozygous partial NF2 gene deletion, which progressed to total loss in the last recurrence. The last recurrence showed homozygous deletions in CDKN2A and CDKN2B. The RASSF1 gene was hypermethylated during tumour evolution. In this report, we show the genetic alterations of a primary ccm and its recurrences to elucidate their relationships with the changes involved in the progression of this rare neoplasm. Full article
828 KiB  
Article
Effect of Non-Alcoholic Liver Disease on Recurrence Rate and Liver Regeneration after Liver Resection for Colorectal Liver Metastases
by N. W. Molla, M. M. Hassanain, Z. Fadel, L. M. Boucher, A. Madkhali, R. M. Altahan, E. A. Alrijraji, E. B. Simoneau, H. Alamri, A. Salman, Z. Gao and Peter P. Metrakos
Curr. Oncol. 2017, 24(3), 233-243; https://0-doi-org.brum.beds.ac.uk/10.3747/co.24.3133 - 01 Jun 2017
Cited by 13 | Viewed by 707
Abstract
Background: Resection of metastases is the only potential cure for patients with liver metastasis from colorectal cancer (CRC-LM). But despite an improved overall 5-year survival, the recurrence rate is still as high as 60%. Non-alcoholic fatty liver disease (NAFLD) [...] Read more.
Background: Resection of metastases is the only potential cure for patients with liver metastasis from colorectal cancer (CRC-LM). But despite an improved overall 5-year survival, the recurrence rate is still as high as 60%. Non-alcoholic fatty liver disease (NAFLD) can decrease the liver’s capacity to regenerate after resection and might also affect cancer recurrence, potentially by elevating transforming growth factor β, levels of specific metalloproteinases, and oxidative stress. The objective of the present work was to determine the effect of the histologic features of nafld on cancer recurrence and liver regeneration. Methods: This retrospective analysis considered 60 patients who underwent an R0 hepatectomy for CRC-LM. Volumetric analysis of the liver was calculated using axial view, portovenous phase, 2.5 mm thickness, multiphasic computed tomography images taken before and after surgery. The histologic features of NAFLD (steatosis, inflammation, and ballooning) were scored using the nafld activity score, and the degree of fibrosis was determined. Results: The hepatic recurrence rate was 38.33%. Median overall survival duration was 56 months. Median disease-free survival duration was 14 months, and median hepatic disease-free survival duration was 56 months. Multivariate analysis revealed significant correlations of hepatic disease-free survival with hepatocyte ballooning (p = 0.0009), lesion diameter (p = 0.014), and synchronous disease (p = 0.006). Univariate and multivariate analyses did not reveal any correlation with degree of steatosis or recurrence rate. Conclusions: This study reveals an important potential negative effect of hepatocyte ballooning on hepatic disease-free survival. Full article
359 KiB  
Article
Patterns of Failure in Anaplastic and Differentiated Thyroid Carcinoma Treated with Intensity-Modulated Radiotherapy
by H. Vulpe, J. Y. Y. Kwan, A. McNiven, J. D. Brierley, R. Tsang, B. Chan, D. P. Goldstein, L. W. Le, A. Hope and Meredith Giuliani
Curr. Oncol. 2017, 24(3), 226-232; https://0-doi-org.brum.beds.ac.uk/10.3747/co.24.3551 - 01 Jun 2017
Cited by 9 | Viewed by 621
Abstract
Background: The radiotherapy (RT) volumes in anaplastic (ATC) and differentiated thyroid carcinoma (DTC) are controversial. Methods: We retrospectively examined the patterns of failure after postoperative intensity-modulated RT for ATC and DTC. Computed tomography images were rigidly [...] Read more.
Background: The radiotherapy (RT) volumes in anaplastic (ATC) and differentiated thyroid carcinoma (DTC) are controversial. Methods: We retrospectively examined the patterns of failure after postoperative intensity-modulated RT for ATC and DTC. Computed tomography images were rigidly registered with the original RT plans. Recurrences were considered in-field if more than 95% of the recurrence volume received 95% of the prescribed dose, out-of-field if less than 20% received 95% of the dose, and marginal otherwise. Results: Of 30 DTC patients, 4 developed regional recurrence: 1 being in-field (level III), and 3 being out-of-field (all level II). Of 5 ATC patients, all 5 recurred at 7 sites: 2 recurrences being local, and 5 being regional [2 marginal (intramuscular to the digastric and sternocleidomastoid), 3 out-of-field (retropharyngeal, soft tissues near the manubrium, and lateral to the sternocleidomastoid)]. Conclusions: In DTC, locoregional recurrence is unusual after RT. Out-of-field DTC recurrences infrequently occurred in level II. Enlarged treatment volumes to level II must be balanced against a potentially greater risk of toxicity. Full article
578 KiB  
Article
Sentinel Node Necrosis Is a Negative Prognostic Factor in Patients with Nasopharyngeal Carcinoma: A Magnetic Resonance Imaging Study of 252 Patients
by L. Lu, X. Wei, Y. H. Li and Wenbin Li
Curr. Oncol. 2017, 24(3), 220-225; https://0-doi-org.brum.beds.ac.uk/10.3747/co.24.3168 - 01 Jun 2017
Cited by 7 | Viewed by 531
Abstract
Purpose: We explored the patterns of sentinel node metastasis and investigated the prognostic value of sentinel node necrosis (SNN) in patients with nasopharyngeal carcinoma (NPC), based on magnetic resonance imaging (MRI). Methods: This retrospective study enrolled 252 [...] Read more.
Purpose: We explored the patterns of sentinel node metastasis and investigated the prognostic value of sentinel node necrosis (SNN) in patients with nasopharyngeal carcinoma (NPC), based on magnetic resonance imaging (MRI). Methods: This retrospective study enrolled 252 patients at our institution who had metastatic lymph nodes from biopsy-confirmed NPC and who were treated with definitive radiation therapy, with or without chemotherapy. All participants underwent MRI before treatment, and the resulting images were reviewed to evaluate lymph node status. The patients were divided into SNN and non-SNN groups. Overall survival (OS), tumour-free survival (TFS), regional relapse–free survival (RRFS), and distant metastasis–free survival (DMFS) were calculated by the Kaplan–Meier method, and differences were compared using the log-rank test. Factors predictive of outcome were determined by univariate and multivariate analysis. Results: Of the 252 patients, 189 (75%) had retropharyngeal lymph node metastasis, and 189 (75%) had level IIA or IIB lymph node necrosis. The incidence of snn was 43.4% (91 of 210 patients with lymph node metastasis or necrosis, or both). After a median follow-up of 54 months, the 5-year rates of OS, TFS, RRFS, and DMFS in the SNN and non-SNN groups were, respectively, 79.4% and 95.3%, 73.5% and 93.3%, 80.4% and 96.6%, and 75.5% and 95.3% (all p < 0.01). Age greater than 40 years, SNN, T stage, and N stage were significant independent negative prognostic factors for OS, TFS, RRFS, and DMFS. Conclusions: Metastatic retropharyngeal lymph nodes and necrotic level II nodes both seem to act as sentinels. Sentinel node necrosis is an negative prognostic factor in patients with NPC. Patients with snn have a worse prognosis. Full article
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Article
Budget Impact Analysis of a Breast Rapid Diagnostic Unit
by M. Elmi, H. Hussein, S. Nofech-Mozes, B. Curpen, A. Leahey and Nicole J. Look Hong
Curr. Oncol. 2017, 24(3), 214-219; https://0-doi-org.brum.beds.ac.uk/10.3747/co.24.3381 - 01 Jun 2017
Cited by 2 | Viewed by 557
Abstract
Background: The Odette Cancer Centre’s recent implementation of a rapid diagnostic unit (RDU) for breast lesions has significantly decreased wait times to diagnosis. However, the economic impact of the unit remains unknown. This project defined the development and implementation costs and [...] Read more.
Background: The Odette Cancer Centre’s recent implementation of a rapid diagnostic unit (RDU) for breast lesions has significantly decreased wait times to diagnosis. However, the economic impact of the unit remains unknown. This project defined the development and implementation costs and the operational costs of a breast RDU in a tertiary care facility. Methods: From an institutional perspective, a budget impact analysis identified the direct costs associated with the breast RDU. A base-case model was also used to calculate the cost per patient to achieve a diagnosis. Sensitivity analyses computed costs based on variations in key components. Costs are adjusted to 2015 valuations using health care–specific consumer price indices and are reported in Canadian dollars. Results: Initiation cost for the RDU was $366,243. The annual operational cost for support staff was $111,803. The average per-patient clinical cost for achieving a diagnosis was $770. Sensitivity analyses revealed that, if running at maximal institutional capacity, the total annual clinical cost for achieving a diagnosis could range between $136,080 and $702,675. Conclusions: Establishment and maintenance of a breast rdu requires significant investment to achieve reductions in time to diagnosis. Expenditures ought to be interpreted in the context of institutional patient volumes and trade-offs in patient-centred outcomes, including lessened patient anxiety and possibly shorter times to definitive treatment. Our study can be used as a resource-planning tool for future rdus in health care systems wishing to improve diagnostic efficiency. Full article
405 KiB  
Article
Breast Magnetic Resonance Imaging: Are Those Who Need It Getting It?
by Stephanie Tan, J. David, L. Lalonde, M. El Khoury, M. Labelle, R. Younan, E. Patocskai, J. Richard and I. Trop
Curr. Oncol. 2017, 24(3), 205-213; https://0-doi-org.brum.beds.ac.uk/10.3747/co.24.3441 - 01 Jun 2017
Cited by 7 | Viewed by 524
Abstract
Background: Indications for breast magnetic resonance imaging (MRI), a very sensitive but less-specific tool for breast investigation, remain controversial, and accessibility is limited. The purposes of our study were to determine the proportion of breast MRI exams performed for various clinical [...] Read more.
Background: Indications for breast magnetic resonance imaging (MRI), a very sensitive but less-specific tool for breast investigation, remain controversial, and accessibility is limited. The purposes of our study were to determine the proportion of breast MRI exams performed for various clinical indications, to assess the wait times for breast MRI, and to create a list of evidence-based indications for breast MRI. Methods: The indications for breast MRI exams performed in September 2013 at our academic centre were audited. A multidisciplinary meeting held in May 2014 established a list of evidence-based indications for breast MRI, after which, in September 2014 and 2015, breast MRI exams were re-audited for clinical indications, and pending requests were calculated. Results: In September 2013, surveillance of women with a prior diagnosis of breast cancer represented 21% of breast MRI exams (24 of 113), with preoperative staging representing 18% of exams (20 of 113) and high-risk screening representing 12% (13 of 113). Of pending MRI requests, 230 were within the recommended delay period, and 457 exceeded the recommended delay. After elaboration of evidence-based guidelines, repeat audits in September 2014 and September 2015 showed that MRI performed for women with a prior breast cancer diagnosis represented 23% (33 of 141) and 7% (10 of 143) of exams respectively, with preoperative staging having declined to 9% (13 of 141) and 11% (16 of 143) of exams, and high-risk screening having increased to 36% (51 of 141) and 46% (66 of 143) of exams. Overall, wait times were improved for all breast MRI indications. Conclusions: Through multidisciplinary discussion, we actualized a list of breast MRI indications, prioritized requests more adequately, and improved wait times. Full article
626 KiB  
Short Communication
Choosing Wisely in Cancer Control across Canada—A Set of Baseline Indicators
by Kim Tran, R. Rahal, S. Fung, G. Lockwood, C. Louzado, J. Xu and H. Bryant
Curr. Oncol. 2017, 24(3), 201-206; https://0-doi-org.brum.beds.ac.uk/10.3747/co.24.3643 - 01 Jun 2017
Cited by 10 | Viewed by 562
Abstract
Value-based care, which balances high-quality care with the most efficient use of resources, has been considered the next frontier in cancer care and a means to maintain health system sustainability. Created to promote value-based care, Choosing Wisely Canada—modelled after Choosing Wisely in the [...] Read more.
Value-based care, which balances high-quality care with the most efficient use of resources, has been considered the next frontier in cancer care and a means to maintain health system sustainability. Created to promote value-based care, Choosing Wisely Canada—modelled after Choosing Wisely in the United States—is a national clinician-driven campaign to identify unnecessary or harmful services that are frequently used in Canada. As part of the campaign, national medical societies have developed recommendations for tests and treatments that clinicians and patients should question. Here, we present baseline indicator findings about current practice patterns associated with 7 cancer-related recommendations from Choosing Wisely Canada and about the effects of those practices on patients and the health care system. Indicator findings point to substantial variations in cancer system performance between Canadian jurisdictions, most notably for breast cancer screening practices, treatment practices for men with low-risk localized prostate cancer, and radiation therapy practices for early-stage breast cancer and bone metastases. Extrapolating indicator findings to the entire country, it was estimated that 740,000 breast and cervical cancer screening tests were performed outside of the recommended age ranges, and within 1 year of diagnosis, 17,000 patients received treatments that could be low-value. A 15% reduction in the use of the 7 screening and treatment practices examined could lead to multiple benefits for patients and the health care system: 9000 false-positive results and 3000 treatments and related side effects could be avoided, and 4500 h of linear accelerator capacity could be freed up each year. Interjurisdictional performance variations suggest potential differences in clinical practice patterns in the planning and delivery of cancer control services, and in some cases, in disease management outcomes. Although the cancer screening and treatment practices described might be unnecessary for some patients, it is important to realize that they could, in fact, be necessary for other patients. Further research into appropriate rates of use could help to determine how much cancer care represents overuse of practices that are not supported by evidence or underuse of practices that are supported by evidence. Full article
311 KiB  
Article
Efficacy of Metronomic Vinorelbine in Elderly Patients with Advanced Non-Small-Cell Lung Cancer and Poor Performance Status
by Cemil Bilir, S. Durak, B. Kızılkaya, I. Hacıbekiroglu, E. Nayır and H. Engin
Curr. Oncol. 2017, 24(3), 199-204; https://0-doi-org.brum.beds.ac.uk/10.3747/co.24.3486 - 01 Jun 2017
Cited by 17 | Viewed by 657
Abstract
Background: Metronomic chemotherapy—administration of low-dose chemotherapy—allows for a prolonged treatment duration and minimizes toxicity for unfit patients diagnosed with advanced non-small-cell lung cancer (NSCLC). Methods: Oral metronomic vinorelbine at 30 mg thrice weekly was given to 35 chemotherapy-naïve patients who were [...] Read more.
Background: Metronomic chemotherapy—administration of low-dose chemotherapy—allows for a prolonged treatment duration and minimizes toxicity for unfit patients diagnosed with advanced non-small-cell lung cancer (NSCLC). Methods: Oral metronomic vinorelbine at 30 mg thrice weekly was given to 35 chemotherapy-naïve patients who were elderly and vulnerable to toxicity and who had been diagnosed with advanced NSCLC. Results: Median age in this male-predominant cohort (29:6) was 76 years (range: 65–86 years). Histology was squamous cell carcinoma in 21 patients and adenocarcinoma in 14. There were no complete responses and 9 partial responses, for an overall response rate of 26%. Stable disease was seen in 15 patients (43%), and 11 patients (31%) had progressive disease. The 1-year survival rate was 34%, and the 2-year survival rate was 8%. The survival analysis showed a median progression-free survival duration of 4 months (range: 2–15 months) and an overall survival duration of 7 months (range: 3–24 months). Conclusions: Metronomic vinorelbine had an acceptable efficacy and safety profile in elderly patients with multiple comorbidities who had been diagnosed with advanced NSCLC. Metronomic vinorelbine could be a treatment option for elderly patients with poor performance status who are unfit for platinum-based chemotherapy and intravenous single-agent chemotherapy, and who are not candidates for combination modalities. Full article
219 KiB  
Article
Interventions to Address Sexual Problems in People with Cancer
by Lisa Barbera, C. Zwaal, D. Elterman, K. McPherson, W. Wolfman, A. Katz, A. Matthew and
Curr. Oncol. 2017, 24(3), 192-200; https://0-doi-org.brum.beds.ac.uk/10.3747/co.24.3583 - 01 Jun 2017
Cited by 46 | Viewed by 1212
Abstract
Background: Sexual dysfunction in people with cancer is a significant problem. The present clinical practice guideline makes recommendations to improve sexual function in people with cancer. Methods: This guideline was undertaken by the Interventions to Address Sexual Problems in People with Cancer [...] Read more.
Background: Sexual dysfunction in people with cancer is a significant problem. The present clinical practice guideline makes recommendations to improve sexual function in people with cancer. Methods: This guideline was undertaken by the Interventions to Address Sexual Problems in People with Cancer Expert Panel, a group organized by the Program in Evidence-Based Care (PEBC). Consistent with the PEBC standardized approach, a systematic search was conducted for existing guidelines, and the literature in MEDLINE and EMBASE for the years 2003–2015 was systematically searched for both systematic reviews and primary literature. Evidence found for men and for women was evaluated separately, and no restrictions were placed on cancer type or study design. Content and methodology experts performed an internal review of the resulting draft recommendations, which was followed by an external review by targeted experts and intended users. Results: The search identified 4 existing guidelines, 13 systematic reviews, and 103 studies with relevance to the topic. The present guideline provides one overarching recommendation concerning the discussion of sexual health and dysfunction, which is aimed at all people with cancer. Eleven additional recommendations made separately for men and women deal with issues such as sexual response, body image, intimacy and relationships, overall sexual functioning and satisfaction, and vasomotor and genital symptoms. Conclusions: To our knowledge this clinical practice guideline is the first to comprehensively evaluate interventions for the improvement of sexual problems in people with cancer. The guideline will be a valuable resource to support practitioners and clinics in addressing sexuality in cancer survivors. Full article
831 KiB  
Article
Rehabilitation and Exercise Oncology Program: Translating Research into a Model of Care
by Mary-Ann Dalzell, N. Smirnow, W. Sateren, A. Sintharaphone, M. Ibrahim, L. Mastroianni, L. D. Vales Zambrano and S. O’Brien
Curr. Oncol. 2017, 24(3), 191-198; https://0-doi-org.brum.beds.ac.uk/10.3747/co.24.3498 - 01 Jun 2017
Cited by 43 | Viewed by 1800
Abstract
Introduction: The Rehabilitation and Exercise Oncology model of care (ActivOnco) was established to optimize cancer survivorship through exercise prescription and active lifestyle promotion, providing a transition of care from hospital to community. Patients having any cancer diagnosis, stage of disease, and treatment were [...] Read more.
Introduction: The Rehabilitation and Exercise Oncology model of care (ActivOnco) was established to optimize cancer survivorship through exercise prescription and active lifestyle promotion, providing a transition of care from hospital to community. Patients having any cancer diagnosis, stage of disease, and treatment were eligible for evaluation and exercise prescription upon deterioration of performance status. The team of professionals included hospital-based physiotherapists proactively screening for rehabilitation needs, loss of functional independence, and exercise eligibility, plus exercise specialists in a community-based Wellness Centre to provide follow-up or direct access for post-treatment or non-complex patients. Methods: From January 2011 to December 2015, the hospital team assessed 1635 patients representing all major cancer sites, and the Wellness Centre team evaluated and prescribed exercise for 1066 participants. Primary interventions provided were education about fatigue management, physical activity promotion, exercise prescription, fracture risk reduction, referral to specialized follow-up services (for example, occupational therapy, lymphedema clinic), and coordination for mobility aids and paratransit services. Results and Conclusions: Implementation of the ActivOnco model of care showed that exercise alone is not a panacea for all functional deterioration associated with the cancer trajectory and its treatment. However, screening to identify rehabilitation needs combined with exercise prescription can effectively improve the quality of survivorship in cancer patients. Program developments are limited by the cost of human resources, lack of hospital-based physical resources, and lack of public funding, all of which significantly limit the scope and development of appropriate services. Full article
158 KiB  
Review
Palliative Care as a Public Health Issue: Understanding Disparities in Access to Palliative Care for the Homeless Population Living in Toronto, Based on a Policy Analysis
by Blair Henry, N. Dosani, L. Huynh and N. Amirault
Curr. Oncol. 2017, 24(3), 187-191; https://0-doi-org.brum.beds.ac.uk/10.3747/co.24.3129 - 01 Jun 2017
Cited by 23 | Viewed by 1849
Abstract
Even in a developed country such as Canada, there are disparities in just access to adequate health care—and, more specifically, palliative care. That inequality is most notable in an underserved group such as the homeless population. Even the word "homeless" has become both [...] Read more.
Even in a developed country such as Canada, there are disparities in just access to adequate health care—and, more specifically, palliative care. That inequality is most notable in an underserved group such as the homeless population. Even the word "homeless" has become both a negative descriptor and a stereotype in our society. We posit that the provision of hospice palliative care is structured on several problematic assumptions: an expectation that patients will have an informal support network (family and friends), a stable and secure residence, a predictive terminal illness trajectory, and reasonable access to health care. Those assumptions create structural inequality within the system. Homeless individuals have considerable experience with death and dying, and qualitative research has shown them to hold the expectation that their death will be both sudden and violent. Here, we look at the current data concerning known disparities in access to good palliative care services experienced by the homeless population, based on a stakeholder analysis of the available literature. That information, coupled with the use of a public health ethics decision-making tool, such as the Good Decision Making in Real Time framework, is used to explore the common ethics challenges that can arise in public health interventions aimed at the provision of end-of-life care to homeless adults. A broad exploration of the system that underlies our care is critical to the proper and appropriate provision of care for homeless individuals. Full article
506 KiB  
Article
Lessons Learned Implementing a Province-Wide Smoking Cessation Initiative in Ontario’s Cancer Centres
by William K. Evans, R. Truscott, E. Cameron, A. Peter, R. Reid, P. Selby, P. Smith and A. Hey
Curr. Oncol. 2017, 24(3), 185-190; https://0-doi-org.brum.beds.ac.uk/10.3747/co.23.3506 - 01 Jun 2017
Cited by 14 | Viewed by 740
Abstract
Purpose: A large body of evidence clearly shows that cancer patients experience significant health benefits with smoking cessation. Cancer Care Ontario, the provincial agency responsible for the quality of cancer services in Ontario, has undertaken a province-wide smoking cessation initiative. The strategies used, [...] Read more.
Purpose: A large body of evidence clearly shows that cancer patients experience significant health benefits with smoking cessation. Cancer Care Ontario, the provincial agency responsible for the quality of cancer services in Ontario, has undertaken a province-wide smoking cessation initiative. The strategies used, the results achieved, and the lessons learned are the subject of the present article. Methods: Evidence related to the health benefits of smoking cessation in cancer patients was reviewed. A steering committee developed a vision statement for the initiative, created a framework for implementation, and made recommendations for the key elements of the initiative and for smoking cessation best practices. Results: New ambulatory cancer patients are being screened for their smoking status in each of Ontario’s 14 regional cancer centres. Current or recent smokers are advised of the benefits of cessation and are directed to smoking cessation resources as appropriate. Performance metrics are captured and used to drive improvement through quarterly performance reviews and provincial rankings of the regional cancer centres. Conclusions: Regional smoking cessation champions, commitment from Cancer Care Ontario senior leadership, a provincial secretariat, and guidance from smoking cessation experts have been important enablers of early success. Data capture has been difficult because of the variety of information systems in use and non-standardized administrative and clinical processes. Numerous challenges remain, including increasing physician engagement; obtaining funding for key program elements, including in-house resources to support smoking cessation; and overcoming financial barriers to access nicotine replacement therapy. Future efforts will focus on standardizing processes to the extent possible, while tailoring the approaches to the populations served and the resources available within the individual regional cancer programs. Full article
240 KiB  
Article
Current Practice in Total-Body Irradiation: Results of a Canada-Wide Survey
by Ryan C. N. Studinski, D. J. Fraser, R. S. Samant and M. S. MacPherson
Curr. Oncol. 2017, 24(3), 181-186; https://0-doi-org.brum.beds.ac.uk/10.3747/co.24.3484 - 01 Jun 2017
Cited by 19 | Viewed by 672
Abstract
Background: Total-body irradiation (TBI) is used to condition patients before bone marrow transplant. A variety of tbi treatment strategies have been described and implemented, but no consensus on best practice has been reached. We report on the results of a survey [...] Read more.
Background: Total-body irradiation (TBI) is used to condition patients before bone marrow transplant. A variety of tbi treatment strategies have been described and implemented, but no consensus on best practice has been reached. We report on the results of a survey created to assess the current state of tbi delivery in Canada. Results: A 19-question survey was distributed to 49 radiation oncology programs in Canada. Responses were received from 20 centres, including 12 centres that perform tbi. A variety of tbi dose prescriptions was reported, although 12 Gy in 6 fractions was used in 11 of the 12 centres performing TBI. Half of the centres also reported using a dose prescription unique to their facility. Most centres use an extended-distance parallel-opposed-pair technique, with the patient standing or lying on a stretcher against a wall. Others translate the patient under the beam, sweep the beam over the patient, or use a more complicated multi-field technique. All but 1 centre indicated that they attenuate the lung dose; only 3 centres indicated attenuating the dose for other organs at risk. The survey also highlighted the considerable resources used for tbi, including extra staff, prolonged planning and treatment times, and use of locally developed hardware or software. Conclusions: At transplant centres, tbi is commonly used, but there is no commonly accepted approach to planning and treatment delivery. The important discrepancies in practice between centres in Canada creates an opportunity to prompt more discussion and collaboration between centres, improving consistency and uniformity of practice. Full article
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Article
Diagnostic Value of Epidermal Growth Factor, Cancer Antigen 125, and Cancer Antigen 15-3 in Bronchoalveolar Lavage Fluid of Lung Cancer
by S. Sun, Z. Chen, Chao Cao, B. Wu, B. Wang, Y. Yu, Z. Chen, Z. Hu and Zaichun Deng
Curr. Oncol. 2017, 24(3), 180-184; https://0-doi-org.brum.beds.ac.uk/10.3747/co.24.3348 - 01 Jun 2017
Cited by 2 | Viewed by 436
Abstract
Aim: In the present study, we assessed the diagnostic value of epidermal growth factor (EGF) and cancer antigens 125 (CA125) and 15-3 (CA15-3) in bronchoalveolar lavage fluid (BALF) of lung cancer from 79 enrolled patients [...] Read more.
Aim: In the present study, we assessed the diagnostic value of epidermal growth factor (EGF) and cancer antigens 125 (CA125) and 15-3 (CA15-3) in bronchoalveolar lavage fluid (BALF) of lung cancer from 79 enrolled patients with suspected lung cancer. Methods: All patients underwent fibrescopic examination, during which BALF samples were collected. Levels of EGF, CA125, and CA15-3 were determined in BALF using commercially available test kits. Results: The results showed that levels of EGF in BALF were significantly higher in patients with lung cancer than in patients with benign diseases (p < 0.01); no significant differences for CA125 (p = 0.67) or CA15-3 (p = 0.43) in BALF were observed between the lung cancer patients and the non-cancer control subjects. With a cut-off value of 27.22 pg/mL, EGF showed a sensitivity of 63.6% and a specificity of 65.7% in predicting the malignant nature of pulmonary disease. Conclusions: The study findings suggest that levels of EGF are significantly increased in BALF from patients with lung cancer than in BALF from patients with benign disease. Detection of the level of EGF in BALF is proposed as a noninvasive test to identify patients at high risk for lung cancer. Full article
133 KiB  
Commentary
Physician "Out of Office" Alert: Does It Work?
by Mark Clemons, A. A. Joy, J. Hilton, A. Arnaout, M. Brackstone, P. Wheatley-Price, C. Stober, R. Dinniwell, S. Mazzarello, M. da Costa and B. Hutton
Curr. Oncol. 2017, 24(3), 176-179; https://0-doi-org.brum.beds.ac.uk/10.3747/co.24.3548 - 01 Jun 2017
Cited by 1 | Viewed by 362
Abstract
The rapid expansion of electronic communication has aided in patient care, but it has also increased the amount of time that physicians spend reviewing and responding to e-mail messages. [...] Full article
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Article
Trastuzumab-Induced Cardiotoxicity: Testing a Clinical Risk Score in a Real-World Cardio-Oncology Population
by M. Rushton, C. Johnson and Susan Dent
Curr. Oncol. 2017, 24(3), 176-180; https://0-doi-org.brum.beds.ac.uk/10.3747/co.24.3349 - 01 Jun 2017
Cited by 30 | Viewed by 699
Abstract
Background: Trastuzumab has improved survival for women with HER2-positive breast cancer, but its use is associated with an increased risk of cardiotoxicity. With increased survivorship, the long-term effects of cancer treatment are an important consideration for clinicians and patients. We reviewed the [...] Read more.
Background: Trastuzumab has improved survival for women with HER2-positive breast cancer, but its use is associated with an increased risk of cardiotoxicity. With increased survivorship, the long-term effects of cancer treatment are an important consideration for clinicians and patients. We reviewed the current literature on predicting trastuzumab-related cardiotoxicity and tested a clinical risk score (CRS) in a real-world breast cancer population to assess its utility in predicting permanent cardiotoxicity. Methods: In this retrospective exploratory cohort study of breast cancer patients referred to a cardio-oncology clinic at a tertiary care centre between October 2008 and August 2014, a CRS was calculated for each patient, and a sensitivity analysis was performed. Results: Of the 143 patients included in the study, 62 (43%) experienced a cardiac event, and of those 62 patients, 43 (69%) experienced full recovery of cardiac function. In applying the CRS, 119 patients (83%) would be considered at low risk, 14 (10%) at moderate risk, and 10 (7%) at high risk to develop heart failure or cardiomyopathy. When applied to the study population, the high-risk cut-off score had a sensitivity of 0.13 [95% confidence interval (CI): 0.08 to 0.20] and a specificity of 0.94 (95% CI: 0.87 to 0.97). The positive predictive value was 0.07 (95% CI: 0.03 to 0.13), and the negative predictive value was 0.93 (95% CI: 0.87 to 0.96). Conclusions: The CRS demonstrated good specificity and negative predictive value for the development of permanent cardiotoxicity in a real-world population of breast cancer patients, suggesting that intensive cardiac monitoring might not be warranted in low-risk patients, but that high-risk patients might benefit from early referral to cardio-oncology for optimization. Further study using the CRS in a larger breast cancer population is warranted to identify patients at low risk of long-term trastuzumab-related cardiotoxicity. Full article
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Commentary
Multidisciplinary Retroperitoneal and Pelvic Soft-Tissue Sarcoma Case Conferences: The Added Value that Radiologists Can Provide
by Robert S. Lim, A. Z. Kielar, R. H. El-Maraghi, M. A. Fraser, C. Nessim and S. Thipphavong
Curr. Oncol. 2017, 24(3), 171-175; https://0-doi-org.brum.beds.ac.uk/10.3747/co.24.3478 - 01 Jun 2017
Cited by 1 | Viewed by 462
Abstract
Clinical Vignette: A 50-year-old woman presents to the emergency department with increasing abdominal pain. Abdominal computed tomography imaging reveals an expanded inferior vena cava–filling defect that is suspicious for a retroperitoneal sarcoma, possibly a primary leiomyosarcoma of the inferior vena cava. The surgery [...] Read more.
Clinical Vignette: A 50-year-old woman presents to the emergency department with increasing abdominal pain. Abdominal computed tomography imaging reveals an expanded inferior vena cava–filling defect that is suspicious for a retroperitoneal sarcoma, possibly a primary leiomyosarcoma of the inferior vena cava. The surgery team discusses the case with the radiologist, and all agree that there are multiple challenges with obtaining a tissue diagnosis and determining resectability. Thus, it is decided that this patient should be discussed at a multidisciplinary case conference. In the present article, we feature a case-based scenario focusing on the role of the radiologist in this type of multidisciplinary team. Full article
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Article
Resource Utilization and Costs of Managing Patients with Advanced Melanoma: A Canadian Population-Based Study
by F. Gwadry-Sridhar, Soodeh Nikan, A. Hamou, S. J. Seung, T. Petrella, A. M. Joshua, S. Ernst and N. Mittmann
Curr. Oncol. 2017, 24(3), 168-175; https://0-doi-org.brum.beds.ac.uk/10.3747/co.24.3432 - 01 Jun 2017
Cited by 10 | Viewed by 647
Abstract
Background: The use and detailed costs of services provided for people with advanced melanoma (aMEL) are not well known. We conducted an analysis to determine the use of health care services and the associated costs delineated by relevant attributable costs, which [...] Read more.
Background: The use and detailed costs of services provided for people with advanced melanoma (aMEL) are not well known. We conducted an analysis to determine the use of health care services and the associated costs delineated by relevant attributable costs, which we defined for subjects in the province of Ontario. Methods: Through the Ontario Cancer Data Linkage Project, a cohort of amel patients with diagnoses between 31 August 2005 and 2012 (follow-up to 2013) and with valid International Classification of Diseases (9th revision, Clinical Modification) 172 codes and histology codes was identified. A cohort of individuals with amel having a combination of at least 1 palliative, 1 medical oncology, and 1 hospitalization code was generated. The health system services used by this population were clustered into hospitalization, palliation, physician medical visits, medication, homecare, laboratory, diagnostics, and other resources. Overall rates of use and disaggregated costs were determined by phase of care for the entire cohort. Results: The mean age for the 2748 individuals in the cohort was 67 years. The greater proportion of the patients were men (65.6%) and were more than 65 years of age (>50%). In this advanced cohort, fewer than 45% of patients were alive 3 years after the malignant melanoma diagnosis. The average annual cost per patient over the time horizon was $6551. At $15,830, year 1 after diagnosis was the most expensive, followed by year 2, at $8166. Conclusions: Our data provide a baseline for the costs associated with aMEL treatment. Future studies will include newer agents and comparative effectiveness research for personalized therapies. Full article
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Article
Linkage of Clinical Trial and Administrative Data: A Survey of Cancer Patient Preferences
by Annette E. Hay, Y. W. Leung, J. L. Pater, M. C. Brown, E. Bell, D. Howell, Z. Kassam, S. Willing, C. Tian and G. Liu
Curr. Oncol. 2017, 24(3), 161-167; https://0-doi-org.brum.beds.ac.uk/10.3747/co.24.3400 - 01 Jun 2017
Cited by 15 | Viewed by 743
Abstract
Background: Personal health information, including diagnoses and hospital admissions, is routinely collected in administrative databases. Patients enrolling on clinical trials consent to separate collection and storage of their personal health information. We evaluated patient preferences for linking long-term data from administrative databases with [...] Read more.
Background: Personal health information, including diagnoses and hospital admissions, is routinely collected in administrative databases. Patients enrolling on clinical trials consent to separate collection and storage of their personal health information. We evaluated patient preferences for linking long-term data from administrative databases with clinical trials. Methods: Adults with cancer attending outpatient clinics at 3 Ontario hospitals were surveyed about their willingness, when faced with the hypothetical scenario of participating in a clinical trial, to provide potentially identifying information such as initials and date of birth to facilitate long-term research access to normally deidentified publicly collected databases. Results: Of 569 patients surveyed, 335 (59%) were women, 452 (79%) were white, 385 (68%) had a post-secondary education, and 386 (68%) had never participated in a clinical trial. Median age in the group was 59 years. Most participants (93%, cohort 1) would allow long-term access to their information and allow personal information to be used to match clinical trial with administrative data. At the time of clinical trial closure, two thirds of participants (68%, cohort 2) preferred to make additional clinical information available through linkage with administrative databases, and 8 (9%) preferred to have no further information made available to researchers. No significant differences were found in the subset of patients who were part of a clinical trial and those who had never participated (p = 0.65). Interpretation: Almost all patients would allow a clinical trial research team to access their confidential information, providing a more comprehensive assessment of an intervention’s long-term risks and benefits. Full article
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Article
Development and Pre-Testing of a Rehabilitation Planning Consultation for Head-and-Neck Cancer
by Sara McEwen, C. Dunphy, J. Norman Rios, A. Davis, J. Jones, A. Lam, I. Poon, R. Martino and J. Ringash
Curr. Oncol. 2017, 24(3), 153-160; https://0-doi-org.brum.beds.ac.uk/10.3747/co.24.3529 - 01 Jun 2017
Cited by 7 | Viewed by 864
Abstract
Background: In contrast with other major chronic conditions such as heart disease and stroke, cancer care does not routinely integrate evidence-based rehabilitation services within the standard continuum. The objectives of the present project were to develop a rehabilitation planning consultation (RPC) [...] Read more.
Background: In contrast with other major chronic conditions such as heart disease and stroke, cancer care does not routinely integrate evidence-based rehabilitation services within the standard continuum. The objectives of the present project were to develop a rehabilitation planning consultation (RPC) for survivors of head-and-neck (HN) cancer, to test its feasibility, and to make refinements. Methods: Using intervention mapping, the RPC-alpha was developed by examining potential theoretical methods and practical applications relative to the program objectives. During feasibility testing, a single case series was conducted with survivors of HN cancer who had completed their cancer treatment within the preceding 11 months; iterative refinements were made after each case. Results: The RPC-alpha was led by a rehabilitation professional and was based on self-management principles. The initial consultation included instruction in a global cognitive strategy, goal-setting, introduction to available resources, action planning, and coping planning. A follow-up consultation was conducted a few weeks later. Of 9 participants recruited, 5 completed post-intervention assessments. Participants reported that the rpc helped them to make rehabilitation plans. Conclusions: The rpc was feasible to use and satisfactory to a small group of hn cancer survivors. A pilot test of the refined version is in process. Full article
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Commentary
Quality of Life for Patients Surviving Cancer: Are We Moving Ahead?
by Martin Chasen, S. Hollingshead, H. Conter and R. Bhargava
Curr. Oncol. 2017, 24(3), 151-152; https://0-doi-org.brum.beds.ac.uk/10.3747/co.24.3671 - 01 Jun 2017
Cited by 2 | Viewed by 1000
Abstract
Much has changed in the United States and worldwide since Richard Nixon signed the U.S. National Cancer Act of 1971. [...] Full article
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Editorial
When Cancer Hits the Streets
by Kelli I. Stajduhar, A. Mollison, D. Gleave and S. W. Hwang
Curr. Oncol. 2017, 24(3), 149-150; https://0-doi-org.brum.beds.ac.uk/10.3747/co.24.3698 - 01 Jun 2017
Cited by 3 | Viewed by 648
Abstract
Toby died 5 October 2015. [...] Full article
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