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Peer review aims to select articles for publication and to improve articles before publication. We believe that this process can be infused by kindness without losing rigor. In 2014, the founding editorial team of the Canadian Journal of Kidney Health and Disease (CJKHD) made an explicit commitment to treat authors as we would wish to be treated ourselves. This broader group of authors reaffirms this principle, for which we suggest the terminology "supportive review."

Background: Clinical practice guidelines (CPGs) for the adjuvant treatment of colorectal cancer were published by the National Institutes of Health in 1991. The American Society of Clinical Oncology and Cancer Care Ontario have recommended adjuvant chemotherapy for patients with high-risk stage II colon cancer. We evaluated differences in concordance with guidelines in the treatment of patients with stage I-III colon cancer in the Canadian provinces of Newfoundland and Labrador and Ontario. Methods: We assessed clinical data and treatment from January 1999 to December 2000 for 130 patients from Newfoundland and Labrador and 315 patients from Ontario who had stage I-III colon cancer. The primary outcome was concordance with guidelines for adjuvant treatment. We evaluated factors affecting the use of chemotherapy in patients with stage II disease. Results: No patients received adjuvant therapy for stage I disease. Forty-five of 52 patients (87%) in Newfoundland and Labrador and 108 of 115 patients (94%) in Ontario received adjuvant chemotherapy for stage III colon cancer. Twenty of 55 patients (36%) in Newfoundland and Labrador and 44 of 116 patients (38%) in Ontario received adjuvant therapy for stage II disease. Eighteen of 41 patients (44%) in Newfoundland and Labrador and 30 of 53 patients (57%) in Ontario with high-risk features received adjuvant treatment, which was significantly higher than patients without high-risk features. There was a strong trend toward using chemotherapy in patients with stage II disease who were 50 years or younger, independent of high-risk status. Conclusion: Concordance with CPGs for adjuvant chemotherapy in patients with stage II colon cancer was not optimal. This may reflect selection bias among referring surgeons, a paucity of level-I evidence and the belief that other factors such as age may play a role in predicting outcome. Contexte : Les National Institutes of Health ont publie en 1991 leurs lignes directrices sur le traitement adjuvant du cancer colorectal. L'American Society of Clinical Oncology et Action Cancer Ontario ont recommande la chimiotherapie adjuvante aux patients atteints d'un cancer du colon de stade II a haut risque. Nous avons mesure les differences en ce qui a trait au respect des lignes directrices dans le traitement des patients atteints d'un cancer du colon de stade I a III dans les provinces canadiennes de Terre-Neuve-et-Labrador et de l'Ontario. Methodes : Nous avons analyse, pour la periode allant de janvier 1999 a decembre 2000, les donnees cliniques et les traitements relatifs a 130 patients de Terre-Neuve-et-Labrador et de 315 patients de l'Ontario atteints d'un cancer du colon de stade I a III. Le parametre principal etait la fidelite aux lignes directrices pour le traitement adjuvant. Nous avons examine les facteurs affectant l'utilisation de la chimiotherapie chez les patients atteints d'un cancer de stade II. Resultats : Aucun patient n'a recu de traitement adjuvant pour un cancer de stade I. Quarante-cinq patients sur 52 (87 %) de Terre-Neuve-et-Labrador et 108 patients sur 115 (94 %) de l'Ontario ont recu une chimiotherapie adjuvante pour un cancer du colon de stade III. Vingt patients sur 55 (36 %) de T-N-L et 44 patients sur 116 (38 %) de l'Ontario ont recu un traitement adjuvant pour un cancer de stade II. Dixhuit patients sur 41 (44 %) de T-N-L et 30 patients sur 53 (57 %) de l'Ontario presentant des caracteristiques de risque eleve ont recu un traitement adjuvant, soit un nombre significativement plus eleve que chez les patients ne presentant pas ces caracteristiques. On a note une forte tendance a l'utilisation de la chimiotherapie chez les patients atteints d'un cancer de stade II ages de 50 ans ou moins, independamment du degre de risque. Conclusion : La fidelite aux lignes directrices en matiere de chimiotherapie adjuvante dans le cancer du colon de stade II n'a pas ete jugee optimale. Ce phenomene pourrait resulter d'un biais de selection de la part des chirurgiens referents, d'un manque de preuves de niveau 1 et de la perception que d'autres facteurs, comme l'age, peuvent jouer un role dans le pronostic., Colorectal cancer is the third most common cancer in Canada. (1) Although screening has been shown to improve survival, (2-4) almost 50% of patients in North America present with either [...]

Background Women who carry a mutation for Lynch syndrome face complex decisions regarding strategies for managing their increased cancer risks. At present, there is limited understanding of the factors influencing women's prophylactic surgery decisions. Methods As part of an exploratory pilot project, semi-structured interviews were conducted with 10 women who were Lynch syndrome mutation carriers and had made prophylactic surgery decisions. Nine of 10 women had chosen to undergo prophylactic hysterectomy and/or oophorectomy as a means of managing their increased gynecological cancer risks. Results Study findings revealed that surgery decisions were influenced by multiple factors, including demographic variables such as age and parity, as well as psychosocial factors such as cancer worry, in addition to personal and social knowledge of gynecological cancer. While all women were satisfied with their surgery decision, some reported they were not fully informed about the negative impact on their quality of life post-surgery (e.g., complications of surgically-induced menopause), nor about the potential for, or risks and benefits of, hormone replacement therapy. Conclusions Study findings highlight some of the factors associated with prophylactic surgery decisions and women's perceptions about pre-surgical information provision and needs. Suggestions are made for improving the information and support provided to female carriers of a Lynch syndrome mutation. Keywords: Lynch syndrome, HNPCC, Prophylactic surgery, Gynecological, Author(s): Holly Etchegary[sup.1] , Elizabeth Dicks[sup.2] , Kathy Watkins[sup.3] , Sabrina Alani[sup.4] and Lesa Dawson[sup.5] Background Hereditary non-polyposis colorectal cancer (HNPCC) or Lynch sndrome (LS), accounts for 3-5% of all [...]

Abstract Background Diet is regarded as one of the most important environmental factors associated with colorectal cancer (CRC) risk. A recent report comprehensively concluded that total energy intake does not have a simple relationship with CRC risk, and that the data were inconsistent for carbohydrate, cholesterol and protein. The objective of this study was to identify the associations of CRC risk with dietary intakes of total energy, protein, fat, carbohydrate, fiber, and alcohol using data from a large case-control study conducted in Newfoundland and Labrador (NL) and Ontario (ON), Canada. Methods Incident colorectal cancer cases (n = 1760) were identified from population-based cancer registries in the provinces of ON (1997-2000) and NL (1999-2003). Controls (n = 2481) were a random sample of residents in each province, aged 20-74 years. Family history questionnaire (FHQ), personal history questionnaire (PHQ), and food frequency questionnaire (FFQ) were used to collect study data. Logistic regression was used to evaluate the association of intakes of total energy, macronutrients and alcohol with CRC risk. Results Total energy intake was associated with higher risk of CRC (OR: 1.56; 95% CI: 1.21-2.01, p-trend = 0.02, 5th versus 1st quintile), whereas inverse associations emerged for intakes of protein (OR: 0.85, 95%CI: 0.69-1.00, p-trend = 0.06, 5th versus 1st quintile), carbohydrate (OR: 0.81, 95%CI: 0.63-1.00, p-trend = 0.05, 5th versus 1st quintile) and total dietary fiber (OR: 0.84, 95% CI:0.67-0.99, p-trend = 0.04, 5th versus 1st quintile). Total fat, alcohol, saturated fatty acids, monounsaturated fatty acids, polyunsaturated fatty acids, and cholesterol were not associated with CRC risk. Conclusion This study provides further evidence that high energy intake may increase risk of incident CRC, whereas diets high in protein, fiber, and carbohydrate may reduce the risk of the disease.

Lynch syndrome (LS) is a genetic condition conferring an elevated risk of gastrointestinal, gynecologic and other malignancies, often before the age of 50. Current guidelines recommend prophylactic gynecologic surgery to manage inherited cancers for female mutation carriers. Data is lacking on women's quality of life following surgery. In this pilot study, we explored how women described their quality of life post-prophylactic gynecologic surgery and the factors that affected post-surgery experiences. A qualitative interview study was the chosen design. Ten female Lynch syndrome mutation carriers were interviewed by phone. Interviews were transcribed and analysed for themes relating to quality of life post-surgery using content analysis and constant comparison. Women largely reported doing well since their surgeries, though all described deleterious impacts on quality of life. Positive impacts of surgery included a reduction in cancer worry and an increase in healthy lifestyle behaviors, while negative impacts due to the sudden onset of menopause and impact on sexual function were common. Pre-surgical knowledge, drug and topical therapies, and post-surgical support all contributed to a positive quality of life. This small pilot study revealed increased endocrine symptoms and a negative impact on sexual health following prophylactic gynecological surgery. Women who were informed of potential symptoms pre-surgery coped better with surgical outcomes, as did women using some form of HRT. All women experienced reduced cancer worry post-surgery. Findings highlight areas for discussion in pre-operative settings (e.g., sexual health), as well as the need for better follow-up support post-surgery. [ABSTRACT FROM AUTHOR]

Background. Breast cancer remains the second-leading cause of cancer death among Canadian women. Treatment for breast cancer often includes surgery. Many women have a choice between mastectomy (MT; removal of the entire breast) or breast conserving surgery (BCS; removal of the tumour and some noncancerous breast tissue) followed by radiation. However, Newfoundland and Labrador consistently has a higher rate of mastectomies than the rest of Canada. In this project, we aim to better understand that trend. Design and methods. A multi-method design was chosen. Surgical treatment data kept by the province will be examined to describe the number and types of breast cancer surgeries over time. Second, we will hold focus groups with women around the province who have made surgical treatment choices to explore influences on their decisions. Finally, semi-structured interviews with breast cancer surgeons and surgical residents will explore their opinions on surgical treatment choices. Expected impact for public health. Cancer treatment choices are complex decisions, affected by clinical, demographic and social variables. Understanding why women from Newfoundland and Labrador have the highest rate of mastectomy in Canada is critical to ensure they are receiving appropriate screening and care. Greater understanding of the influences on women's surgical choices may encourage informed decisions amongst women and physicians and promote active communication about treatment, benefits relevant to all jurisdictions and health authorities. Further, if factors such as geographic proximity to treatment facilities are associated with treatment decisions, this information is important for public health screening and service planners. [ABSTRACT FROM AUTHOR]