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Previous studies have highlighted the importance of promoting health literacy and minimizing misinformation to encourage higher adherence to key sanitary measures during the COVID-19 pandemic. This study explores how one’s understanding of information and sources’ reliability can hinder adherence to sanitary measures implemented by the Canadian government. Data was collected from a representative sample of 3,617 Canadians, following a longitudinal design of 11 measurement times from April 2020 to April 2021. Overall, a low level of understanding was associated with membership in lower adherence trajectories to sanitary measures. Adjusted odds ratio (AOR) showed it was between 3 and 34 times more likely for participants with low understanding to be in the lowest adherence trajectory. Information sources’ reliability also showed a significant effect on adherence trajectories for social distancing and staying home (AOR: between 1.5 and 2.5). These results are discussed considering future policy implications.

At the University of Alberta's Campus Saint-Jean, the only French-speaking campus in the province of Alberta in Canada, students are confronted with a variety of French spoken by professors, causing many challenges for learners who, for the most part, have French as their second language. This linguistic plurality among the faculty prompted us to explore the linguistic and pedagogical challenges that this diversity can create in the classroom. We used a qualitative method of inquiry to collect the corpus of this research. Specifically, we chose a written questionnaire with open-ended questions. The participants comprised 71 students (26 native French speakers and 45 non-native French speakers) enrolled in a bachelor program at the Campus Saint-Jean. Results indicated that this linguistic plurality posed many emotional, cognitive, and learning challenges for the participants of this study. These results are discussed in the perspective of teacher effectiveness.

Summary Background BIG 3-07/TROG 07.01 is an international, multicentre, randomised, controlled, phase 3 trial evaluating tumour bed boost and hypofractionation in patients with non-low-risk ductal carcinoma in situ following breast-conserving surgery and whole breast radiotherapy. Here, we report the effects of diagnosis and treatment on health-related quality of life (HRQOL) at 2 years. Methods The BIG 3-07/TROG 07.01 trial is ongoing at 118 hospitals in 11 countries. Women aged 18 years or older with completely excised non-low-risk ductal carcinoma in situ were randomly assigned, by use of a minimisation algorithm, to tumour bed boost or no tumour bed boost, following conventional whole breast radiotherapy or hypofractionated whole breast radiotherapy using one of three randomisation categories. Category A was a 4-arm randomisation of tumour bed boost versus no boost following conventional whole breast radiotherapy (50 Gy in 25 fractions over 5 weeks) versus hypofractionated whole breast radiotherapy (42·5 Gy in 16 fractions over 3·5 weeks). Category B was a 2-arm randomisation between tumour bed boost versus no boost following conventional whole breast radiotherapy, and category C was a 2-arm randomisation between tumour bed boost versus no boost following hypofractionated whole breast radiotherapy. Stratification factors were age at diagnosis, planned endocrine therapy, and treating centre. The primary endpoint, time to local recurrence, will be reported when participants have completed 5 years of follow-up. The HRQOL statistical analysis plan prespecified eight aspects of HRQOL, assessed by four questionnaires at baseline, end of treatment, and at 6, 12, and 24 months after radiotherapy: fatigue and physical functioning (EORTC QLQ-C30); cosmetic status, breast-specific symptoms, arm and shoulder functional status (Breast Cancer Treatment Outcome Scale); body image and sexuality (Body Image Scale); and perceived risk of invasive breast cancer (Cancer Worry Scale and a study-specific question). For each of these measures, tumour bed boost was compared with no boost, and conventional whole breast radiotherapy compared with hypofractionated whole breast radiotherapy, by use of generalised estimating equation models. Analyses were by intention to treat, with Hochberg adjustment for multiple testing. This trial is registered with ClinicalTrials.gov , NCT00470236 . Findings Between June 1, 2007, and Aug 14, 2013, 1208 women were enrolled and randomly assigned to receive no tumour bed boost (n=605) or tumour bed boost (n=603). 396 of 1208 women were assigned to category A: conventional whole breast radiotherapy with tumour bed boost (n=100) or no boost (n=98), or to hypofractionated whole breast radiotherapy with tumour bed boost (n=98) or no boost (n=100). 447 were assigned to category B: conventional whole breast radiotherapy with tumour bed boost (n=223) or no boost (n=224). 365 were assigned to category C: hypofractionated whole breast radiotherapy with tumour bed boost (n=182) or no boost (n=183). All patients were followed up at 2 years for the HRQOL analysis. 1098 (91%) of 1208 patients received their allocated treatment, and most completed their scheduled HRQOL assessments (1147 [95%] of 1208 at baseline; 988 [87%] of 1141 at 2 years). Cosmetic status was worse with tumour bed boost than with no boost across all timepoints (difference 0·10 [95% CI 0·05–0·15], global p=0·00014, Hochberg-adjusted p=0·0016); at the end of treatment, the estimated difference between tumour bed boost and no boost was 0·13 (95% CI 0·06–0·20; p=0·00021), persisting at 24 months (0·13 [0·06–0·20]; p=0·00021). Arm and shoulder function was also adversely affected by tumour bed boost across all timepoints (0·08 [95% CI 0·03–0·13], global p=0·0033, Hochberg adjusted p=0·045); the difference between tumour bed boost and no boost at the end of treatment was 0·08 (0·01 to 0·15, p=0·021), and did not persist at 24 months (0·04 [–0·03 to 0·11], p=0·29). None of the other six prespecified aspects of HRQOL differed significantly after adjustment for multiple testing. Conventional whole breast radiotherapy was associated with worse body image than hypofractionated whole breast radiotherapy at the end of treatment (difference –1·10 [95% CI –1·79 to –0·42], p=0·0016). No significant differences were reported in the other PROs between conventional whole breast radiotherapy compared with hypofractionated whole breast radiotherapy. Interpretation Tumour bed boost was associated with persistent adverse effects on cosmetic status and arm and shoulder functional status, which might inform shared decision making while local recurrence analysis is pending. Funding National Health and Medical Research Council, Susan G Komen for the Cure, Breast Cancer Now, OncoSuisse, Dutch Cancer Society.

Purpose To evaluate the feasibility and toxicity of a single-fraction 8-Gy stereotactic boost after whole-breast irradiation in early breast cancer. The primary aim of this phase 2 study was to evaluate cutaneous breast toxicity using National Cancer Institute Common Terminology Criteria for Adverse Events (version 4) 3 months after the boost. Secondary objectives were local control, survival, and patient-reported quality of life using the European Organisation for Research and Treatment of Cancer QLQ-C30 and breast-specific European Organisation for Research and Treatment of Cancer QLQ-BR 23 questionnaires. Methods and Materials Patients with invasive ductal or lobular pT1-2 breast cancer treated with lumpectomy with clear margins and pN0 were included. Patients requiring chemotherapy were excluded. Results Twenty-eight eligible patients received the planned boost, and 26 had hormonal therapy. The procedure was technically successful without procedural complications. A median of 3 fiducials were tracked, and 115 beams were used. There were 22 acute grade 1 breast skin toxicities, including fibrosis, pain, erythema, or pigmentation. There were 2 acute grade 2 erythemas. Median skin boost dose was inversely correlated with acute skin toxicity (P = .028). QLQ-C30 scores revealed acute dyspnea and arm symptoms without correlation to the boost dose. Breast symptom QLQ-BR23 scores did not deteriorate, although upset with hair loss and systemic side effects of hormonal therapy were observed. After a median follow-up of 38 months, 1 patient had in-boost-field relapse, and there were 5 late grade 1 and 1 grade 2 skin toxicities. Conclusions Single-fraction stereotactic boost after conventional whole-breast irradiation in early breast cancer is feasible with minor toxicities. Quality of life and specific breast items showed excellent patient acceptance.

Resume Introduction Le cas expose est un cas unique du fait de l’apparition de nodules de permeation dans le champ d’irradiation d’un cancer du sein 2 ans apres traitement chirurgical d’un melanome. Il permet egalement d’apprecier cliniquement l’efficacite du vemurafenib. Cas clinique Nous exposons le cas d’une patiente de 47 ans qui a presente un melanome type SSM, Breslow 1,02 mm, sans ulceration et d’activite mitotique faible, sous-scapulaire droit, traite par exerese chirurgicale avec des marges a 2 cm. Un mois apres, un carcinome canalaire infiltrant du sein gauche etait diagnostique. Le traitement a consiste en une tumorectomie, exerese de ganglion sentinelle et radiotherapie de 50 grays avec un boost de 15 grays. Moins de 3 mois apres la fin de la radiotherapie, la patiente a developpe de multiples metastases cutanees sur le champ d’irradiation au niveau du sein gauche. Du fait de la presence de la mutation BRAFV600E et de l’echec du traitement par dacarbazine (decitene), un traitement par vemurafenib a ete debute. Nous avons constate une regression notable de la taille des nodules de permeation sans aucune nouvelle lesion. De ce fait, une chirurgie carcinologique en marges saines avec reconstruction par lambeau pedicule de muscle grand dorsal gauche a ete l’attitude therapeutique retenue par la RCP. Les resultats anatomopathologiques ont montre une exerese complete des lesions metastatiques. Nous avons realise une symetrisation du sein controlateral afin d’ameliorer la qualite de vie de la patiente. Apres un suivi de 2 ans et demi, la patiente ne presente aucun signe de recidive local, regional ou a distance. Discussion La rapidite du developpement et la localisation des metastases cutanees dans le cas clinique presente ici nous ont amenes a reflechir sur les effets de la radiotherapie au niveau cutane. La radiotherapie entraine des complications aigues (radiodermite) et chroniques par des mecanismes cellulaires et moleculaires. De plus, un effondrement de l’immunite est retrouve apres irradiation. L’association de ces differents mecanismes pourrait expliquer l’apparition de ces metastases sur le territoire d’irradiation. L’efficacite du vemurafenib retrouve dans notre cas clinique est en accord avec ce qui est decrit dans la litterature avec des reponses souvent rapides et une augmentation de la mediane de survie. Conclusion Ce cas unique dans la litterature montre les effets de la radiotherapie sur les tissus cutanes et l’efficacite du vemurafenib. Il souligne surtout qu’une etroite collaboration entre les differents praticiens ainsi qu’une connaissance des nouvelles therapies contribuent a une meilleure prise en charge des melanomes.