Current Oncology

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Open AccessEditorial

Discover the Canadian Association of Medical Oncologists

by Alexi Campbell

Curr. Oncol. 2020, 27(1), 72-74; https://doi.org/10.3747/co.27.6165 - 1 Feb 2020

Viewed by 710

The Canadian Associat ion of Medical Oncologists [camo (https://camo-acom.ca/)], a national specialty society of the Royal College of Physicians and Surgeons of Canada, will contribute to cancer control through research, education, and clinical practice in prevention, screening, diagnosis, treatment, supportive care, palliative [...] Read more.

The Canadian Associat ion of Medical Oncologists [camo (https://camo-acom.ca/)], a national specialty society of the Royal College of Physicians and Surgeons of Canada, will contribute to cancer control through research, education, and clinical practice in prevention, screening, diagnosis, treatment, supportive care, palliative care, and rehabilitation[...]. Full article

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Open AccessMeeting Report

CanPROS Scientific Conference 2019 Poster Abstracts

by Sadia Ahmed, Farwa Naqvi, Aynharan Sinnarajah, Gwen McGhan and Maria Santana

Curr. Oncol. 2020, 27(1), 64-71; https://doi.org/10.3747/co.27.6045 - 1 Feb 2020

Viewed by 695

Abstract

Background: Palliative care is an approach that improves quality of life for patients and families facing challenges associated with life-threatening illness. In Alberta, most people who received palliative care received it late. Late palliative care negatively affects patient and caregiver experiences and decreases [...] Read more.

Background: Palliative care is an approach that improves quality of life for patients and families facing challenges associated with life-threatening illness. In Alberta, most people who received palliative care received it late. Late palliative care negatively affects patient and caregiver experiences and decreases quality of life. This study aims to understand patient and caregiver experiences of advanced colorectal cancer care to inform an early palliative care pathway for advanced cancer care. Methods: A qualitative study that is embedded within a larger program of research on the implementation of the Palliative Care Early and Systematic (paces) pathway. Semi-structured telephone interviews with patients and their caregivers living with advanced colorectal cancer were conducted to explore their experiences with cancer care services received before pathway implementation. Interviews were transcribed, and the data were thematically analyzed, supported by the qualitative analysis software NVivo. Results: Interviews with 15 patients and 7 caregivers from Edmonton and Calgary were conducted over the telephone. Most participants found the Putting Patients First tool to be useful at their appointments; however, some mentioned a preference for viewing their scores over time. A total of 6 main themes were identified: (1) Meaning of palliative care (2) Communication (3 main subthemes: communication of diagnosis, communication between patient and oncologist, communication between providers) (3) Relationship with health care providers (including oncologist, family doctor, and nurses) (4) Access to care (cost of care, proximity to care, after hours care) (5) Patient readiness for advance care planning (6) Patient and family engagement in care, with mixed experiences in how patients were involved in their care. Conclusions: Most participants misperceived palliative care to mean “end-of-life care,” suggesting a need for improvement in the delivery of palliative care information. Understanding the care experiences of patients and caregivers will inform the development of a care pathway for early palliative care. Full article

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Open AccessMeeting Report

CanPROS Scientific Conference 2019 Oral Abstracts

by Manraj Kaur, Andrea Pusic, Louise Bordeleau, Toni Zhong, Stefan Cano and Anne Klassen

Curr. Oncol. 2020, 27(1), 57-63; https://doi.org/10.3747/co.27.6043 - 1 Feb 2020

Viewed by 822

Abstract

Background: Generic preference-based measures (pbms), though commonly used, may not be optimal for use in the economic evaluations assessing the impact of breast cancer interventions. Concerns that are unique to women with breast cancer (for example, body image, appearance, treatment-specific adverse [...] Read more.

Background: Generic preference-based measures (pbms), though commonly used, may not be optimal for use in the economic evaluations assessing the impact of breast cancer interventions. Concerns that are unique to women with breast cancer (for example, body image, appearance, treatment-specific adverse effects) are not adequately captured by the existing generic measures. No breast cancer–specific pbm exists. The objective of this study was to construct a health state classification system specific to breast cancer which is amenable to valuation. Methods: We conducted semi-structured interviews in a heterogeneous sample of women with breast cancer [stages 0–4, any stage of treatment(s)]. Interviews were audio recorded, transcribed verbatim, and coded using the constant comparison approach to develop the conceptual framework. Patients were also asked to describe their most and least important concerns during the interview and to rate items in the related breast-q module (that is, mastectomy, breast-conserving therapy, or reconstruction) on a modified 5-point Likert scale (ranging from Not important to Very important). A faceto- face meeting with an expert panel of health care professionals, health economists, and hrqol researchers was used to obtain feedback on the health state classification system, response levels, and wording of the items. Results: Interviews (n = 59) with patients aged 59.9 years were completed. The resultant conceptual framework included site-specif ic (that is, abdomen, arm, breast) and overall (that is, body image, appearance, cancer, psychological, sexual, and social) domains. Triangulation of the qualitative and quantitative evidence led to the selection of key constructs for inclusion in the new pbm. The field test version of the breast-q utility health state classification system consisted of 13 attributes with 4 response levels each. Conclusions: The health state classification system for the preference-based module of the breast-q (breast-q-u) was derived using patient and expert feedback. The next phase will involve establishing psychometric properties of the breast-q-u, followed by a valuation study to generate utility weights. Full article

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Open AccessCase Report

Renal Medullary Carcinoma and Its Association with Sickle Cell Trait: A Case Report and Literature Review

by P. Holland, J. Merrimen, C. Pringle and L.A. Wood

Curr. Oncol. 2020, 27(1), 53-56; https://doi.org/10.3747/co.27.5043 - 1 Feb 2020

Cited by 9 | Viewed by 1134

Abstract

Renal medullary carcinoma (rmc) is a rare and aggressive renal malignancy that usually presents at an advanced stage, has a poor prognosis, and is associated with sickle cell trait. We present a case of rmc including radiologic and pathology findings, treatment, [...] Read more.

Renal medullary carcinoma (rmc) is a rare and aggressive renal malignancy that usually presents at an advanced stage, has a poor prognosis, and is associated with sickle cell trait. We present a case of rmc including radiologic and pathology findings, treatment, and outcome. A review of the literature is also presented, with an emphasis on the association of rmc with sickle cell trait, which was an unknown diagnosis in our patient preoperatively. Full article

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Open AccessArticle

Therapeutic Landscape of Metastatic Non-Small-Cell Lung Cancer in Canada in 2020

by A. Elkrief, P. Joubert, M. Florescu, M. Tehfe, N. Blais and B. Routy

Curr. Oncol. 2020, 27(1), 52-60; https://doi.org/10.3747/co.27.5953 - 1 Feb 2020

Cited by 17 | Viewed by 1993

Abstract

Lung cancer is the most commonly diagnosed cancer in Canada and remains associated with high mortality. Nevertheless, recent advances in the fields of immuno-oncology and precision medicine have led to significant improvements in clinical outcome in metastatic non-small-cell lung cancer (nsclc). [...] Read more.

Lung cancer is the most commonly diagnosed cancer in Canada and remains associated with high mortality. Nevertheless, recent advances in the fields of immuno-oncology and precision medicine have led to significant improvements in clinical outcome in metastatic non-small-cell lung cancer (nsclc). Those improvements were facilitated by a greater understanding of the biologic classification of nsclc, which catalyzed discoveries of novel therapies. Here, we present a comprehensive review of the recent avalanche of practice-changing trials in metastatic nsclc, and we offer an approach to the management of this disease from a Canadian perspective. We begin with an overview of the pathologic and molecular characterization of metastatic nsclc. Next, we review the indications for currently approved immune checkpoint inhibitors, and we provide an approach to the management of disease with a driver mutation. Finally, we address future avenues in both diagnostics and therapeutics for patients with advanced and metastatic nsclc. Full article

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Open AccessArticle

Humanism in Global Oncology Curricula: An Emerging Priority

by M. Giuliani, M.A. Martimianakis, M. Broadhurst, J. Papadakos, R. Fazelad, E. Driessen and J. Frambach

Curr. Oncol. 2020, 27(1), 46-51; https://doi.org/10.3747/co.27.5461 - 1 Feb 2020

Cited by 2 | Viewed by 908

Abstract

Introduction: Training in humanism provides skills important for improving the quality of care received by patients, achieving shared decision-making with patients, and navigating systems-level challenges. However, because of the dominance of the biomedical model, there is potentially a lack of attention to humanistic [...] Read more.

Introduction: Training in humanism provides skills important for improving the quality of care received by patients, achieving shared decision-making with patients, and navigating systems-level challenges. However, because of the dominance of the biomedical model, there is potentially a lack of attention to humanistic competencies in global oncology curricula. In the present study, we aimed to explore the incorporation of humanistic competencies into global oncology curricula. Methods: This analysis considered 17 global oncology curricula. A curricular item was coded as either humanistic (as defined by the iecares framework) or non-humanistic. If identified as humanistic, the item was coded using an aspect of humanism, such as Altruism, from the iecares framework. All items, humanistic and not, were coded under the canmeds framework using 1 of the 7 canmeds competency domains: Medical Expert, Communicator, Collaborator, Leader, Scholar, Professional, or Health Advocate. Results: Of 7792 identified curricular items in 17 curricula, 780 (10%) aligned with the iecares humanism framework. The proportion of humanistic items in individual curricula ranged from 2% to 26%, and the proportion increased from 3% in the oldest curricula to 11% in the most recent curricula. Of the humanistic items, 35% were coded under Respect, 31% under Compassion, 24% under Empathy, 5% under Integrity, 2% under Excellence, 1% under Altruism, and 1% under Service. Within the canmeds domains, the humanistic items aligned mostly with Professional (35%), Medical Expert (31%), or Communicator (25%). Conclusions: The proportion of humanistic competencies has been increasing in global oncology curricula over time, but the overall proportion remains low and represents a largely Western perspective on what constitutes humanism in health care. The representation of humanism focuses primarily on the iecares attributes of Respect, Compassion, and Empathy. Full article

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Open AccessEditor’s ChoiceArticle

Systemic Adjuvant Therapy for Adult Patients at High Risk for Recurrent Cutaneous or Mucosal Melanoma: An Ontario Health (Cancer Care Ontario) Clinical Practice Guideline

by T.M. Petrella, G.G. Fletcher, G. Knight, E. McWhirter, S. Rajagopal, X. Song and T.D. Baetz

Curr. Oncol. 2020, 27(1), 43-52; https://doi.org/10.3747/co.27.5933 - 1 Feb 2020

Cited by 13 | Viewed by 1623

Abstract

Background: Previous versions of the guideline from the Program in Evidence-Based Care (pebc) at Ontario Health (Cancer Care Ontario) recommended that the use of high-dose interferon alfa 2b therapy be discussed and offered to patients with resected cutaneous melanoma with a [...] Read more.

Background: Previous versions of the guideline from the Program in Evidence-Based Care (pebc) at Ontario Health (Cancer Care Ontario) recommended that the use of high-dose interferon alfa 2b therapy be discussed and offered to patients with resected cutaneous melanoma with a high risk of recurrence. Subsequently, several clinical trials in patients with resected or metastatic melanoma found that immune checkpoint inhibitors and targeted therapies have a benefit greater than that with interferon. It was therefore considered timely for an update to the guideline about adjuvant systemic therapy in melanoma. Methods: The present guideline was developed by the pebc and the Melanoma Disease Site Group (dsg). Based on a systematic review from a literature search conducted using medline, embase, and the Evidence Based Medicine Reviews databases for the period 1996 to 28 May 2019, the Working Group drafted recommendations. The systematic review and recommendations were then circulated to the Melanoma dsg and the pebcReport Approval Panel for internal review; the revised document underwent external review. Recommendations: For patients with completely resected cutaneous or mucosal melanoma with a high risk of recurrence, the recommended adjuvant therapies are nivolumab, pembrolizumab, or dabrafenib–trametinib for patients with BRAF V600E or V600K mutations; nivolumab or pembrolizumab are recommend for patients with BRAF wild-type disease. Use of ipilimumab is not recommended. Molecular testing should be conducted to help guide treatment decisions. Interferon alfa, chemotherapy regimens, vaccines, levamisole, bevacizumab, bacillus Calmette–Guérin, and isolated limb perfusion are not recommended for adjuvant treatment of cutaneous melanoma except as part of a clinical trial. Full article

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Open AccessEditor’s ChoiceArticle

Prognosis in Young Women less than 40 Years of Age with Brain Metastasis from Breast Cancer

by A. Mustillo, J.P. Ayoub, D. Charpentier, L. Yelle and M. Florescu

Curr. Oncol. 2020, 27(1), 39-45; https://doi.org/10.3747/co.27.5621 - 1 Feb 2020

Cited by 6 | Viewed by 992

Abstract

Background: Brain metastasis from breast cancer (bca) in young women is doubly devastating because both quality of life and life expectancy are significantly reduced. With new radiation technology and drugs that have emerged, survival is expected to increase for these young [...] Read more.

Background: Brain metastasis from breast cancer (bca) in young women is doubly devastating because both quality of life and life expectancy are significantly reduced. With new radiation technology and drugs that have emerged, survival is expected to increase for these young women. Methods: Using the oacis and sardo patient databases, we identified 121 patients diagnosed with bca and brain metastasis between 2006 and 2016 at the University of Montreal Hospital Centre. Those patients were divided into Group A, patients who developed brain metastasis during the evolution of metastatic bca, and Group B, patients whose first metastasis was to the brain. For each group, we compared young patients (<40 years of age) with older patients (≥40 years of age). Results: Among the 121 patients with brain metastasis, median overall survival (mos) was significantly longer for those less than 40 years of age than for those 40 or more years of age (18 months vs. 4 months, p < 0.001). With respect to the timing of brain metastasis, survival was significantly longer in Group B than in Group A (7 months vs. 4 months, p = 0.032). In Group A, mos was significantly longer for patients less than 40 years of age than for patients 40 or more years of age (18 months vs. 3 months, p = 0.0089). In Group B, the 2-year overall survival rate was 57% for patients less than 40 years of age and 12% for those 40 or more years of age (mos: not reached vs. 7 months; p = 0.259). Conclusions: In our single-centre retrospective cohort of women with brain metastasis from bca, prognosis was better for young women (<40 years) than for older women (≥40 years). Survival was also longer for patients whose initial metastasis was to the brain than for patients whose brain metastasis developed later in the disease course. In patients who received systemic treatment, median survival remained significantly higher in women less than 40 years of age. Further studies are needed to validate those results. Full article

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Open AccessArticle

Complex Surgery and Perioperative Systemic Therapy for Genitourinary Cancer of the Retroperitoneum

by A. Finelli, N. Coakley, J. Chin, T.A. Flood, A. Loblaw, C. Morash, B. Shayegan and R. Siemens

Curr. Oncol. 2020, 27(1), 34-42; https://doi.org/10.3747/co.27.5713 - 1 Feb 2020

Viewed by 996

Abstract

Objective: The purpose of the present guideline is to recommend surgical or systemic treatment for metastatic testicular cancer; T3b or T4, or node-positive, and metastatic renal cell cancer (rcc); and T3, T4, or node-positive upper tract urothelial (utuc) cancer. [...] Read more.

Objective: The purpose of the present guideline is to recommend surgical or systemic treatment for metastatic testicular cancer; T3b or T4, or node-positive, and metastatic renal cell cancer (rcc); and T3, T4, or node-positive upper tract urothelial (utuc) cancer. Methods: Draft recommendations were formulated based on evidence obtained through a systematic review of randomized controlled trials, comparative retrospective studies, and guideline endorsement. The draft recommendations underwent an internal review by clinical and methodology experts, and an external review by clinical practitioners. Results: The primary literature search yielded eight guidelines, five systematic reviews, and twenty-seven primary studies that met the eligibility criteria. Conclusions: Cytoreductive nephrectomy should no longer be considered the standard of care in patients with T3b or T4, or node-positive, and metastatic rcc. Eligible patients should be treated with systemic therapy and have their primary tumour removed only after review at a multidisciplinary case conference (mcc). Adjuvant sunitinib after surgery is not recommended. Patients with venous tumour thrombus should be considered for surgical intervention. Patients with T3, T4, or node-positive utuc should have their tumour removed without delay. Decisions concerning lymph node dissection should be done at a mcc and be based on stage, expertise, and imaging. Adjuvant systemic treatment is recommended for resected high-risk utuc. Patients with metastasis-positive testicular cancer with residual tumour after systemic treatment should be treated at specialized centres. For all complex retroperitoneal surgeries, the evidence shows that higher-volume centres are associated with lower rates of procedure-related mortality, and patients should be referred to higher-volume centres for surgical resection. Full article

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Open AccessArticle

Analyzing the Effect of Physician Assignment in the Survival of Patients with Advanced Non-Small-Cell Lung Cancer

by P. Wheatley-Price, H. Jonker, K. Al-Baimani, T. Mhang, G. Nicholas, G. Goss and S.A. Laurie

Curr. Oncol. 2020, 27(1), 34-38; https://doi.org/10.3747/co.27.5291 - 1 Feb 2020

Viewed by 813

Abstract

Background: Non-small-cell lung cancer (nsclc) is the most common cause of cancer deaths worldwide, with a 5-year survival of 17%. The low survival rate observed in patients with nsclc is primarily attributable to advanced stage of disease at diagnosis, with more [...] Read more.

Background: Non-small-cell lung cancer (nsclc) is the most common cause of cancer deaths worldwide, with a 5-year survival of 17%. The low survival rate observed in patients with nsclc is primarily attributable to advanced stage of disease at diagnosis, with more than 50% of cases being stage iv at presentation. For patients with advanced disease, palliative systemic therapy can improve overall survival (os); however, a recent review at our institution of more than 500 consecutive cases of advanced nsclc demonstrated that only 55% of the patients received palliative systemic therapy. What is unknown to date is whether that observed low rate of systemic therapy in our previous study is uniform across oncologists. Methods: With ethics approval, we performed a retrospective analysis of newly diagnosed patients with stage iv nsclc seen as outpatients at our institution between 2009 and 2012 by 4 different oncologists. Demographics, treatment, and survival data were collected and compared for the 4 oncologists. Results: The 4 oncologists saw 528 patients overall, with D seeing 115; L, 158; R, 137; and M, 118. Significant variation was observed in the proportion receiving 1 line or more of chemotherapy: D, 60%; L, 65%; R, 43%; and M, 52%. Physician assignment was not associated with a difference in median os, with D’s cohort having a median os of 6.8 months; L, 8.4 months; R, 7.0 months; and M, 7.0 months. Conclusions: Practice size and proportion of patients treated varied between oncologists, but those differences did not translate into significantly different survival outcomes for patients. Full article

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Open AccessArticle

Can Concordance between Actual Care Received and a Pathway Map Be Measured on a Population Level in Ontario? A Pilot Study

by K. Forster, K. Tsang, S. Li, L. Ieraci, P. Murray, K.J. Woltman, D. Chmelnitsky, C.M.B. Holloway and E.D. Kennedy

Curr. Oncol. 2020, 27(1), 27-33; https://doi.org/10.3747/co.27.5349 - 1 Feb 2020

Cited by 7 | Viewed by 889

Abstract

Background: Clinical pathways are associated with improved adherence to clinical guidelines; however, most studies have evaluated pathways for a single intervention at a single institution. The objective of the present study was to develop and evaluate a method of measuring concordance with a [...] Read more.

Background: Clinical pathways are associated with improved adherence to clinical guidelines; however, most studies have evaluated pathways for a single intervention at a single institution. The objective of the present study was to develop and evaluate a method of measuring concordance with a population-based clinical pathway map to determine if that method could be feasible for assessing overall health system performance. Methods: Patients with stage ii or iii colon cancer diagnosed in 2010 were identified, and clinical data were obtained through linkages to administrative databases. Pathway concordance was defined a priori based on receipt of key elements of the Ontario Health (Cancer Care Ontario) colorectal pathway maps. For stages ii and iii colon cancer alike, concordance was reported as the proportion of patients receiving care that followed the predefined key elements of the pathway map. Regression analysis was used to identify predictors of concordant care. Results: Our study identified 816 patients with stage ii and 800 patients with stage iii colon cancer. Of the patients with stage ii disease, 70% (n = 571) received concordant care. Of the patients with stage iii disease, results showed high concordance for all key elements except receipt of chemotherapy, leading to an overall concordance rate of 39% for that cohort. Conclusions: Our method of measuring concordance was feasible on a population-based level, but future studies to validate it and to develop more sophisticated methods to measure concordance in larger cohorts and various disease sites are necessary. Measurement of clinical pathway concordance on a population-based level has the potential to be a useful tool for assessing system performance. Full article

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Open AccessArticle

Biopsy on Progression in Patients with EGFR Mutation–Positive Advanced Non-Small-Cell Lung Cancer—A Canadian Experience

by Q. Chu, A. Agha, N. Devost, R.N. Walton, S. Ghosh and C. Ho

Curr. Oncol. 2020, 27(1), 27-33; https://doi.org/10.3747/co.27.5347 - 1 Feb 2020

Cited by 5 | Viewed by 1215

Abstract

Background: Epidermal growth factor receptor (egfr) tyrosine kinase inhibitors (tkis) are standard therapy for patients with advanced or metastatic non-small-cell lung cancer harbouring an EGFR mutation. Upon progression, 50%–60% develop a secondary T790M mutation. Recent trials demonstrated outcome improvement [...] Read more.

Background: Epidermal growth factor receptor (egfr) tyrosine kinase inhibitors (tkis) are standard therapy for patients with advanced or metastatic non-small-cell lung cancer harbouring an EGFR mutation. Upon progression, 50%–60% develop a secondary T790M mutation. Recent trials demonstrated outcome improvement with osimertinib compared with standard platinum-based chemotherapy as second-line therapy for patients with secondary T790M mutation. To identify T790M, a biopsy of the tumour or, more recently, plasma is necessary. This retrospective study aimed to evaluate biopsy procedures and mutational analysis at 2 Canadian cancer centres. Methods: In a retrospective review of patients who were approached to enrol in the aura2, aura3, or astris studies, demographics, eligibility for rebiopsy upon progression after an egfr tki, rebiopsy methods and complications, number of rebiopsies, and incidence of the T790M mutation were collected. Results: Of 84 patients considered for trial enrolment, 80 signed a consent. In 78 patients who underwent rebiopsy, computed tomography or ultrasonography guidance were the most common methods used. The most common biopsy sites were lung and lymph nodes. The median number of rebiopsies performed to find a T790M mutation was 2. Only 9% of patients experienced complications. Of samples obtained, 74% were adequate for testing after initial rebiopsy. A T790M mutation was found in 47 patients, of whom 44 were enrolled on a trial. After multiple rebiopsies, only 5% of samples were inadequate for molecular analysis. Conclusions: In the Canadian setting, the acceptance of rebiopsy on progression was high. Multiple rebiopsies were clinically feasible and could increase the yield for T790M mutation. The incidence of complications was low despite the most common site for rebiopsy being lung. Full article

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Open AccessArticle

A Systematic Review and Network Meta-Analysis of Adjuvant Therapy for Curatively Resected Biliary Tract Cancers

by M. Kish, K. Chan, K. Perry and Y.J. Ko

Curr. Oncol. 2020, 27(1), 20-26; https://doi.org/10.3747/co.27.5465 - 1 Feb 2020

Cited by 7 | Viewed by 1041

Abstract

Background: Recent randomized controlled trials (rcts) have contributed high-quality data about adjuvant therapy in curatively resected biliary tract cancer (btc); however, a standard approach to treating those patients still has not been developed. Methods: We conducted a systematic review [...] Read more.

Background: Recent randomized controlled trials (rcts) have contributed high-quality data about adjuvant therapy in curatively resected biliary tract cancer (btc); however, a standard approach to treating those patients still has not been developed. Methods: We conducted a systematic review of published studies and abstracts up to and including June 2018, choosing rcts involving patients with btc receiving adjuvant chemotherapy after complete surgical resection. Network meta-analysis methods were used for indirect comparisons of overall survival (os) and relapse-free survival (rfs) for various adjuvant therapies. Results: Five rcts were included in qualitative synthesis, and three rcts (bilcap, prodige 12–accord 18, and bcat) had data sufficient for inclusion in the meta-analysis. Results from the indirect comparison demonstrated no significant improvement in os for capecitabine compared with gemcitabine or with gemcitabine–oxaliplatin (gemox), the hazard ratios (hrs) being 0.82 [95% confidence interval (ci): 0.53 to 1.27] and 0.86 (95% ci: 0.56 to 1.34) respectively. Similarly, no significant improvement in rfs was observed for capecitabine compared with gemcitabine or gemox. Conclusions: Although in the present analysis, we found no statistically significant improvements in os or rfs for capecitabine compared with gemox or gemcitabine, capecitabine can—until further prospective trials are completed—be considered the standard of care in the adjuvant setting based on a single randomized phase iii study. Full article

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Open AccessArticle

Acceptability of Anal Cancer Screening Tests for Women Living with HIV in the EVVA Study

by E. Kaufman, C. de Castro, T. Williamson, B. Lessard, M. Munoz, M.H. Mayrand, A.N. Burchell, M.B. Klein, L. Charest, M. Auger, V. Marcus, F. Coutlée, A. de Pokomandy and

Curr. Oncol. 2020, 27(1), 19-26; https://doi.org/10.3747/co.27.5401 - 1 Feb 2020

Cited by 13 | Viewed by 1151

Abstract

Background: Anal cancer is potentially preventable through screening. For screening to be implemented, the screening procedures must be acceptable to the affected population. The objective of the present study was to measure the acceptability of currently available anal cancer screening tests in a [...] Read more.

Background: Anal cancer is potentially preventable through screening. For screening to be implemented, the screening procedures must be acceptable to the affected population. The objective of the present study was to measure the acceptability of currently available anal cancer screening tests in a population of women living with hiv who had experienced the tests. Methods: The EVVA study (“Evaluation of Human Immunodeficiency Virus, Human Papillomavirus, and Anal Intraepithelial Neoplasia in Women”) is a prospective cohort study of adult women living with HIV in Montreal, Quebec. Participants were screened with cervical or anal hpv testing and cervical or anal cytology every 6 months for 2 years. High-resolution anoscopy (HRA) and digital anal rectal examination (DARE) were also performed systematically, with biopsies, at baseline and at 2 years. An acceptability questionnaire was administered at the final visit or at study withdrawal. Results: Of 124 women who completed the acceptability questionnaire, most considered screening “an absolute necessity” in routine care for all women living with HIV [77%; 95% confidence interval (CI): 69% to 84%]. Yearly anal cytology or anal HPV testing was considered very acceptable by 81% (95% CI: 73% to 88%); HRA every 2 years was considered very acceptable by 84% (95% CI: 77% to 90%); and yearly DARE was considered very acceptable by 87% (95% CI: 79% to 92%). Acceptability increased to more than 95% with a longer proposed time interval. Pain was the main reason for lower acceptability. Conclusions: Most participating women considered anal cancer screening necessary and very acceptable. Longer screening intervals and adequate pain management could further increase the acceptability of repeated screening. Full article

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Open AccessArticle

Does Free nicotine Replacement Improve Smoking Cessation Rates in Cancer Patients?

by A.J. Arifin, L.C. McCracken, S. Nesbitt, A. Warner, R.E. Dinniwell, D.A. Palma and A.V. Louie

Curr. Oncol. 2020, 27(1), 14-18; https://doi.org/10.3747/co.27.5267 - 1 Feb 2020

Cited by 4 | Viewed by 917

Abstract

Background: Cigarette smoking is carcinogenic and has been linked to inferior treatment outcomes and complication rates in cancer patients. Here, we report the results of an 18-month pilot smoking cessation program that provided free nicotine replacement therapy (nrt). Methods: In January [...] Read more.

Background: Cigarette smoking is carcinogenic and has been linked to inferior treatment outcomes and complication rates in cancer patients. Here, we report the results of an 18-month pilot smoking cessation program that provided free nicotine replacement therapy (nrt). Methods: In January 2017, the smoking cessation program at our institution began offering free nrt for actively cigarette-smoking patients with cancer. The cost of 4 weeks of nrt was covered by the program, and follow-up was provided by smoking cessation champions. Results: From January 2017 to June 2018, 8095 patients with cancer were screened for cigarette use, of whom 1135 self-identified as current or recent smokers. Of those 1135 patients, 117 enrolled in the program and accepted a prescription for nrt. The rates of patient referral and patients attending a referral appointment were significantly higher in 2018–2018 than they had been in 2015–2016 (100% vs. 80.3%, p < 0.001, and 27.6% vs. 11.3%, p < 0.001, respectively). Median follow-up was 9.0 months (25%–75% interquartile range: 5.7–11.6 months). Of the patients who accepted nrt and who also had complete data (n = 71), 25 (35.2%) reported complete smoking cessation, and 32 (45.1%) reported only decreased cigarette smoking. On univariable analysis, no factors were significantly predictive of smoking cessation, although initial cigarette use (>10 vs. ≤10 initial cigarettes) was significantly predictive of smoking reduction (odds ratio: 5.04; 95% confidence interval: 1.46 to 17.45; p = 0.011). Conclusions: This pilot study of free nrt demonstrated rates of referral and acceptance of nrt that were improved compared with historical rates, and most referred patients either decreased their use of cigarettes or quit entirely. Full article

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Open AccessCommentary

The Evolving Field of Bone Imaging in Multiple Myeloma: Is it Time to Abandon Skeletal Surveys?

by H.S. Mian and A. McCurdy

Curr. Oncol. 2020, 27(1), 10-11; https://doi.org/10.3747/co.27.5789 (registering DOI) - 1 Feb 2020

Cited by 1 | Viewed by 592

Abstract

Multiple myeloma (mm) is an incurable plasma cell neoplasm that is caused by the clonal proliferation of malignant plasma cells within the bone marrow[...]. Full article

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Open AccessArticle

Patient and Physician Perceptions of Lung Cancer Care in a Multidisciplinary Clinic Model

by G. Linford, R. Egan, A. Coderre-Ball, N. Dalgarno, C.J.L. Stone, A. Robinson, D. Robinson, S. Wakeham and G.C. Digby

Curr. Oncol. 2020, 27(1), 9-19; https://doi.org/10.3747/co.27.5499 - 1 Feb 2020

Cited by 10 | Viewed by 1503

Abstract

Background: Lung cancer (lc) is a complex disease requiring coordination of multiple health care professionals. A recently implemented lc multidisciplinary clinic (mdc) at Kingston Health Sciences Centre, an academic tertiary care hospital, improved timeliness of oncology assessment and treatment. [...] Read more.

Background: Lung cancer (lc) is a complex disease requiring coordination of multiple health care professionals. A recently implemented lc multidisciplinary clinic (mdc) at Kingston Health Sciences Centre, an academic tertiary care hospital, improved timeliness of oncology assessment and treatment. This study describes patient, caregiver, and physician experiences in the mdc. Methods: We qualitatively studied patient, caregiver, and physician experiences in a traditional siloed care model and in the mdc model. We used purposive sampling to conduct semi-structured interviews with patients and caregivers who received care in one of the models and with physicians who worked in both models. Thematic design by open coding in the ATLAS.ti software application (ATLAS.ti Scientific Software Development, Berlin, Germany) was used to analyze the data. Results: Participation by 6 of 72 identified patients from the traditional model and 6 of 40 identified patients from the mdc model was obtained. Of 9 physicians who provided care in both models, 8 were interviewed (2 respirologists, 2 medical oncologists, 4 radiation oncologists). Four themes emerged: communication and collaboration, efficiency, quality of care, and effect on patient outcomes. Patients in both models had positive impressions of their care. Patients in the mdc frequently reported convenience and a positive effect of family presence at appointments. Physicians reported that the mdc improved communication and collegiality, clinic efficiency, patient outcomes and satisfaction, and consistency of information provided to patients. Physicians identified lack of clinic space as an area for mdc improvement. Conclusions: This qualitative study found that a lc mdc facilitated patient communication and physician collaboration, improved quality of care, and had a perceived positive effect on patient outcomes. Full article

178 KiB

Open AccessEditorial

Oncologists and General Practitioners in Oncology: Allies in Cancer Care Delivery

by G. Chaput and E. Lilly

Curr. Oncol. 2020, 27(1), 6-7; https://doi.org/10.3747/co.27.5961 - 1 Feb 2020

Cited by 1 | Viewed by 594

Abstract

The number of cancer cases in Canada is projected to be 79% higher in 2028–2032 than it was in 2003–2007[...]. Full article

526 KiB

Open AccessArticle

Trends in Survival Based on Treatment Modality in Patients with Pancreatic Cancer: A Population-Based Study

by S. Shakeel, C. Finley, G. Akhtar-Danesh, H.Y. Seow and N. Akhtar-Danesh

Curr. Oncol. 2020, 27(1), 1-8; https://doi.org/10.3747/co.27.5211 - 1 Feb 2020

Cited by 9 | Viewed by 1124

Abstract

Backgorund: Pancreatic cancer (pcc) is one of the most lethal types of cancer, and surgery remains the optimal treatment modality for patients with resectable tumours. The objective of the present study was to examine and compare trends in the survival rate [...] Read more.

Backgorund: Pancreatic cancer (pcc) is one of the most lethal types of cancer, and surgery remains the optimal treatment modality for patients with resectable tumours. The objective of the present study was to examine and compare trends in the survival rate based on treatment modality in patients with pcc. Methods: This population-based retrospective analysis included all patients with known-stage pcc in Ontario between 2007 and 2015. Flexible parametric models were used to conduct the survival analysis. Survival rates were calculated based on treatment modality, while adjusting for patient- and tumour-specific covariates. Results: The study included 6437 patients. We found no noticeable improvement in survival for patients with stage iii or iv tumours; however, for stage i disease, the 1-, 2-, and 5-year survival rates increased over time to 81% from 51%, to 71% from 35%, and to 61% from 22% respectively. Most improvements were seen for surgical modalities, with 2-year survivals increasing to 89% from 65% for distal pancreatectomy (dp) without radiation (rt) or chemotherapy (ctx), to 65% from 37% for dp plus rt or ctx, to 60% from 44% for Whipple-only, and to 50% from 36% for Whipple plus rt or ctx. Lastly, 5-year survival improved to 81% from 52% for dp only, to 41% from 12% for dp plus rt or ctx, to 49% from 25% for Whipple-only, and to 26% from 12% for Whipple plus rt or ctx. Conclusions: Most cases of pcc continue to be diagnosed at a late stage, with poor short-term and long-term prognoses. After adjustment for patient age, sex, and year of diagnosis, the survival for stage i tumours and for surgical modalities increased over time. Further research is needed to identify the reasons for improvement in survival during the study period. Full article

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Curr. Oncol., Volume 27, Issue 1 (February 2020) – 19 articles

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