Establishing a cancer center data bank and biorepository for multidisciplinary research.

The establishment of a biorepository with linkage to clinical and epidemiologic data will provide an invaluable resource for cancer research, including studies of cancer etiology, progression, and prognosis, as well as development of biomarkers for early detection. Developing an infrastructure for a biorepository linked to clinical, pathologic, and epidemiologic data requires significant efforts in strategic planning for efficient means to ascertain, identify, and consent participants, as well as guidelines for blood collection, processing, and storage while maintaining participant privacy rights. In this report, we present an approach to developing a Data Bank and Biorepository at our own institution, with discussion of elements to be considered when establishing such a bank.     

Chronic post-treatment symptoms in patients with breast cancer operated in different surgical units.

AIMS: This study was designed to find out whether women operated in high volume surgical units have less chronic symptoms than women operated in smaller volume units. METHODS: A questionnaire was sent to 265 consecutive women treated at the Department of Oncology, Helsinki University Central Hospital, from January to June 1996. Of the patients, 129 were operated in hospitals experienced in breast cancer surgery (high volume units = HVU) and 92 patients in district hospitals with less experience in breast surgery (low volume units = LVU). RESULTS: Chronic symptoms were less common in HVU than in LVU: chronic pain (56 vs. 43%, P<0.05) or strange sensations (45 vs. 26%, P<0.01) in the ipsilateral arm or phantom sensations in the removed breast (66 vs. 26%, P<0.001). The risk factors included in the multivariate model for chronic pain in the breast area were: intensity of acute post-operative pain, radiotherapy and depression and for the chronic arm pain: low volume unit and depression. CONCLUSIONS: More careful surgical technique seems to reduce the risk of chronic pain following treatment of breast cancer. Chronic pain is associated with more intense post-operative pain and depression.     

Progress in establishing non-surgical oncology within English cancer units

In 1995 the Department of Health recommended a minimum standard of five non-surgical oncology sessions per week at Cancer Units. Postal surveys of cancer units in England were conducted in 1996 and 1999 to establish the level of provision. Substantial progress has been made from 20-60% of responding units meeting the minimum standard.     

Use of radiation treatment units in breast cancer. Changes in the last 15 years

Introduction Advances in diagnosis and treatment in oncology combined with technical advances in radiotherapy have resulted in qualitative and quantitative changes in the use of radiation to treat breast cancer. Objective The objective was to analyse changes in radiation indications from 1990 to the present time and their consequences in the use of treatments units. Methods and material From January 1990 to December 2005, 4545 radiation treatments for breast cancer were performed, classified as radical after conservative surgery, radical after mastectomy or palliative. Data are presented as relative frequencies and as 3-year period groups. Results An increase in the proportion of treatments for breast cancer and in treatment unit use distribution is observed. Radical treatments have increased over time, ranging from 55% in the first 3-year period group to 82% in the last one. Unit treatment distribution analysis is similar, but with a less important increase, rising from 85% to 95%. A rise in conservative treatment is also observed, from 43% to 75%. Conclusions An increase in breast cancer incidence is observed and there was also an increase in irradiation after conservative treatment. On the contrary, probably due to the rise in the use of systemic treatments, a decrease in post-mastectomy irradiation and palliative treatments is shown.     

Establishing metastatic prostate cancer quality indicators using a modified Delphi approach

BackgroundThere is variation in the care provided to men with metastatic prostate cancer (mPCa). There has been no previous set of quality indicators (QIs) regarding the management of men with mPCa. The objective of this study is to develop a set of international mPCa-specific QIs, which will enable global benchmarking of quality of care.Materials and methodsPotential QIs were identified through a literature review. Fourteen multidisciplinary mPCa experts (representing medical and radiation oncology, nursing, psychology, palliative care and urology) from eight countries participated in a modified Delphi process, which consisted of two online surveys, one face-to-face meeting and two teleconferences. Panelists were asked to rate each indicator's importance and feasibility on a Likert scale from 1 to 9. Indicators that received median importance and median feasibility scores ≥ 7.5, and a disagreement index <1 for both measures, on the final round of voting were included in the final set.ResultsThere was consensus on 23 QIs out of total of 662. Four regarding “general management”, 12 “therapies”, three “complications” and four “patient-reported quality of life”. One of the inherent limitations of the Delphi process is that there is a small expert panel involved.ConclusionThe quality indicator set defined by our process for management of men with mPCa will enable greater understanding of the standard and variation of care globally and will promote consistency of good practice. Future directions will include retrospective evaluation for compliance with these indicators, as well as prospective monitoring.     

Establishing a clinic-based pancreatic cancer and periampullary tumour research registry in Quebec

Background

Enrolling patients in studies of pancreatic ductal adenocarcinoma (pdac) is challenging because of the high fatality of the disease. We hypothesized that a prospective clinic-based study with rapid ascertainment would result in high participation rates. Using that strategy, we established the Quebec Pancreas Cancer Study (qpcs) to investigate the genetics and causes of pdac and other periampullary tumours (pats) that are also rare and underrepresented in research studies.

Methods

Patients diagnosed with pdac or pat were introduced to the study at their initial clinical encounter, with a strategy to enrol participants within 2 weeks of diagnosis. Patient self-referrals and referrals of unaffected individuals with an increased risk of pdac were also accepted. Family histories, epidemiologic and clinical data, and biospecimens were collected. Additional relatives were enrolled in families at increased genetic risk.

Results

The first 346 completed referrals led to 306 probands being enrolled, including 190 probands affected with pdac, who represent the population focus of the qpcs. Participation rates were 88.4% for all referrals and 89.2% for pdac referrals. Family history, epidemiologic and clinical data, and biospecimens were ascertained from 91.9%, 54.6%, and 97.5% respectively of patients with pdac. Although demographics and trends in risk factors in our patients were consistent with published statistics for patients with pdac, the qpcs is enriched for families with French-Canadian ancestry (37.4%), a population with recurrent germ-line mutations in hereditary diseases.

Conclusions

Using rapid ascertainment, a pdac and pat research registry with high participation rates can be established. The qpcs is a valuable research resource and its enrichment with patients of French-Canadian ancestry provides a unique opportunity for studies of heredity in these diseases.     

Outcomes of cancer patients after unplanned admission to general intensive care units

Abstract Background. Acute admission to an intensive care unit (ICU) of cancer patients is considered with increasing frequency due to a better life expectancy and more aggressive therapies. The aim of this study was to determine the characteristics and outcomes of cancer patients with unplanned admissions to general ICUs, and to compare these with outcomes of critically ill patients without cancer. Material and methods. All unplanned ICU admissions in the Netherlands collected in the National Intensive Care Evaluation registry between January 2007 and January 2011 were analyzed. Results and conclusion. Of the 140,154 patients with unplanned ICU admission 10.9% had a malignancy. Medical cancer patients were more severely ill on ICU admission in comparison with medical non-cancer patients, as reflected by higher needs for mechanical ventilation (50.8% vs. 46.4%, p 相似文献   

Milky spots: omental functional units and hotbeds for peritoneal cancer metastasis

As the most common metastatic disease of abdomen pelvic cavity cancer, peritoneal carcinomatosis (PC) renders significant negative impact on patient survival and quality of life. Invasive peritoneal exfoliated cancer cells (PECCs) preferentially select the omentum as a predominant target site for cancer cell colonization and proliferation compared with other tissues in the abdominal cavity. The precise pathogenic mechanism remains to be determined. As omental milky spots (MSs) are the major implantation site for malignant cells in peritoneal dissemination, researches on mechanisms of PC have been mainly focused on MS, primitive lymphoid tissues with unique structural features, and functional characteristics. To date, extensive biophysical and biochemical methods have been manipulated to investigate the MS exact function in the peritoneal cavity. This review summarized MS as hotbeds for PECC. The anatomical distribution was briefly described first. Then, MS histology was systematically reviewed, including morphological features, cellular constituents, and histological staining methods. At last, the roles of MS in PC pathological process were summarized with special emphasis on the distinct roles of macrophages.     

Establishing the multidisciplinary care of patients with cancer in the state of Delaware

Delaware has the fifth highest cancer death rate in the U.S. As part of a comprehensive program to decrease the cancer mortality and incidence in the state, an infrastructure to establish the multidisciplinary care of patients with cancer was established. In May 2002, Christiana Care Health Services opened the Helen F. Graham Cancer Center to meet the specific need for coordinated and centralized comprehensive cancer care. This effort took the cooperation of many individuals in a community-based teaching hospital, the largest of six acute care hospitals in the state. These efforts have led to a 13% accrual rate to the Community Clinical Oncology Program funded by the National Cancer Institute. The effort also led to the establishment of multidisciplinary disease site centers with representation from the three major physician disciplines of surgery, medical oncology, and radiation oncology. In addition, translational research projects, a tissue procurement center, and genetic counseling and testing with the establishment of a high-risk family cancer registry and collaborative efforts with hospitals across the state were established. The current article reviewed the continued success of this program in the state of Delaware in the effort to reduce the cancer incidence and mortality.     

Information for teenagers with cancer: current state in French pediatric oncology units

In France, teenagers with cancer are managed mainly in paediatric units, given that there are only few teenage cancer units. This situation leads to the following question: are teenagers with cancer provided with tailored patient education? The object of this study was to identify education programmes specifically designed for teenagers in French paediatric oncology units. This study was conducted first by questionnaires, second by interviews with health care providers in units where information programs had been implemented. Nine information programmes or projects were identified: 2 booklets, one log book, one Web chat, one video, one DVD, one educative muppet, one peer based education group project, one nursing education session project and one qualitative study project. Only 5 from these programmes or project were specifically designed for teenagers. Four approaches can be identified: conception of education materials, individual patient education, group patient education, informal patient education.     

Treatment of acute leukemia in protected environment units.

Thirty evaluable patients with acute leukemia (AL), aged 14 to 48-year-old received remission induction chemotherapy on a protected environment-prophylactic antibiotic program. Twenty-seven (90%) of these patients achieved complete remission and 17 remained in complete remission for 1 to 22 months. Although these patients spent 36% of their time with neutrophil counts less than 100/mm3, they spent only 20% of their time with fever. Major infection was present during only 7% of the days when neutrophil count was less than 100/mm3. No patient died of an infectious complication during remission induction therapy.     

建立初诊肺癌患者骨转移风险评估模型

目的:建立一个列线图来预测肺癌患者骨转移的风险。方法:收集2012年1月至2019年12月未经任何治疗(包括手术、放疗和化疗)的肺癌患者的临床资料,包括骨转移情况、性别、年龄、病理类型、血清钙浓度、碱性磷酸酶(alkaline phosphatase,ALP)、癌胚抗原(carcinoembryonic antigen,CEA)、T分期、N分期。分析骨转移的危险因素,通过Logistic回归分析建立列线图。结果:在分析的306例患者中,有137例(44.78%)肺癌患者在初次诊断时已经发生骨转移。其中ALP、CEA、病理类型和N分期是新诊肺癌患者骨转移的危险因素,列线图模型曲线下面积(area under curve,AUC)值为 0.867。结论:当临床上出现初诊 ALP 值高、CEA＞7.285 ng/ml、N分期高、腺癌和小细胞癌的患者时,有必要及时对患者进行相关骨转移检查。     

The performance of mobile screening units in a breast cancer screening program in Brazil

Purpose

In Brazil, access to breast cancer screening outside of urban centers is limited. This study aims to describe the coverage and performance of a breast cancer screening program implemented with Mobile Screening Units (MSU) in northern São Paulo state.

Methods

This is a retrospective cohort study of a population-based mammography program targeting women ages 40–69 in 108 municipalities from 12/2010 to 07/2015. Screening coverage rates were estimated using the Brazil 2010 census data. We calculated performance measures for the number of exams, recalls, and detected cases of cancer. Screen-detected cases were compared to clinically detected cases using hospital cancer registry data and a propensity-score matching method. The down-staging of screen-detected cases relative to clinically detected cases was assessed using logistic regression to calculate risk ratios (RRs) with 95% confidence intervals.

Results

122,634 women were screened through the MSU program, representing a cumulative coverage rate of 54.8% in the target population. For initial and subsequent rounds, recall rates were 12.25 and 6.10% and cancer detection rates were 3.63 (95% CI 3.23–4.10) and 1.94 (95% CI 1.59–2.41), respectively. 92.51% of referrals were successful. Screen-detected cases had more favorable prognoses than clinically detected cases, including smaller tumor size and a decreased risk of late-stage detection (RR 0.14 95% CI 0.074–0.25).

Conclusions

MSUs are a feasible method for the delivery of mammography services in this setting. Patients who had breast cancer detected on an MSU had favorable prognostic factors when compared with clinically detected cases arising from the same target population.

     

Establishing a valid approach for estimating familial risk of cancer explained by common genetic variants

We critically examined existing approaches for the estimation of the excess familial risk of cancer that can be attributed to identified common genetic risk variants and propose an alternative, more straightforward approach for calculating this proportion using well-established epidemiological methodology. We applied the underlying equations of the traditional approaches and the new epidemiological approach for colorectal cancer (CRC) in a large population-based case–control study in Germany with 4,447 cases and 3,480 controls, who were recruited from 2003 to 2016 and for whom interview, medical and genomic data were available. Having a family history of CRC (FH) was associated with a 1.77-fold risk increase in our study population (95% CI 1.52–2.07). Traditional approaches yielded estimates of the FH-associated risk explained by 97 common genetics variants from 9.6% to 23.1%, depending on various assumptions. Our alternative approach resulted in smaller and more consistent estimates of this proportion, ranging from 5.4% to 14.3%. Commonly employed methods may lead to strongly divergent and possibly exaggerated estimates of excess familial risk of cancer explained by associated known common genetic variants. Our results suggest that familial risk and risk associated with known common genetic variants might reflect two complementary major sources of risk.