318 results on '"Natalie G Coburn"'
Search Results
2. Integration of the social determinants of health into quality indicators for colorectal cancer surgery: a scoping review protocol
- Author
-
Natalie G Coburn, Julie Hallet, Rinku Sutradhar, Harsukh Benipal, Aisha Lofters, Tiago Ribeiro, Adom Bondzi-Simpson, Victoria Barabash, Rebecca A Snyder, and Callisia Clarke
- Subjects
Medicine - Abstract
Introduction Quality monitoring is a critical component of high-performing cancer care systems. Quality indicators (QIs) are standardised, evidence-based measures of healthcare quality that allow healthcare systems to track performance, identify gaps in healthcare delivery and inform areas of priority for strategic planning. Social structures and economic systems that allow for unequal access to power and resources that shape health and health inequities can be described through the social determinants of health (SDoH) framework. Therefore, granular analysis of healthcare quality through SDoH frameworks is required to identify patient subgroups who may experience health inequity. Given the high burden of disease of colorectal cancer (CRC) and well-defined cancer care pathways, CRC is often the first disease site targeted by health systems for quality improvement. The objective of this review is to examine how SDoH have been integrated into QIs for CRC surgery. This review aims to address three primary questions: (1) Have SDoH been integrated into the development, reporting and assessment of CRC surgery QIs? (2) When integrated, what measures and statistical methods have been applied? (3) In which direction do individual SDoH influence QIs outputs?Methods This review will follow Arksey and O’Malley frameworks for scoping reviews. We will search MEDLINE, EMBASE, HealthSTAR databases for papers that examine QIs for CRC surgery applicable to healthcare systems from database inception until January 2023. Interventional trials, prospective and retrospective observational studies, reviews, case series and qualitative study designs will be included. Two authors will independently review all titles, abstracts and full texts to determine which studies meet the inclusion criteria.Ethics & dissemination No ethics approval is required for this review. Results will be disseminated through scientific presentation and relevant conferences targeted for researchers examining healthcare quality and equity in cancer care.Registration details osf.io/vfzd3-Open Science Framework.
- Published
- 2023
- Full Text
- View/download PDF
3. Novel patient-centred outcome in cancer care, days at home: a scoping review protocol
- Author
-
Natalie G Coburn, Frances C Wright, Angela Jerath, Julie Hallet, Alyson Mahar, Tiago Ribeiro, Ekaterina Kosyachkova, Julie Deleemans, Adom Bondzi-Simpson, Victoria Barabash, and Austin A Barr
- Subjects
Medicine - Abstract
Introduction Patient-centred care is valued by patients and providers. As management of cancer becomes increasingly complex, the value of providing care that incorporates an individual’s values and preferences along with demographic and tumour factors is increasingly important. To improve care, patients with cancer need easily accessible information on the outcomes important to them. The patient-centred outcome, days at home (DAH), is based on a construct that measures the time a patient spends alive and out of hospitals and healthcare institutions. DAH is accurately measured from various data sources and has shown construct validity with many patient-centred outcomes. There is significant heterogeneity in terms used and definitions for DAH in cancer care. This scoping review aims to consolidate information on the outcome DAH in cancer care and to review definitions and terms used to date to guide future use of DAH as a patient-centred care, research and policy tool.Methods and analysis This scoping review protocol has been designed with joint guidance from the JBI Manual for Evidence Synthesis and the expanded framework from Arksey and O’Malley. We will systematically search MEDLINE, Embase and Scopus for studies measuring DAH, or equivalent, in the context of active adult cancer care. Broad inclusion criteria have been developed, given the recent introduction of DAH into cancer literature. Editorials, opinion pieces, case reports, abstracts, dissertations, protocols, reviews, narrative studies and grey literature will be excluded. Two authors will independently perform full-text selection. Data will be extracted, charted and summarised both qualitatively and quantitively.Ethics and dissemination No ethics approval is required for this scoping review. Results will be disseminated through scientific publication and presentation at relevant conferences.
- Published
- 2023
- Full Text
- View/download PDF
4. Assessing research methodologies used to evaluate inequalities in end-of-life cancer care research: a scoping review protocol
- Author
-
Sam Harper, Natalie G Coburn, Alyson L Mahar, Laura E Davis, Julie Hallet, Peter Tanuseputro, Geetanjali D Datta, Colleen Webber, Allison Wiens, and Lauren Konikoff
- Subjects
Medicine - Abstract
Introduction To provide equitable cancer care at the end of life, it is essential to first understand the evidence underpinning the existence of unequal cancer outcomes. Study design, measurement and analytical decisions made by researchers are a function of their social systems, academic training, values and biases, which influence both the findings and interpretation of whether inequalities or inequities exist. Methodological choices can lead to results with different implications for research and policy priorities, including where supplementary programmes and services are offered and for whom. The objective of this scoping review is to provide an overview of the methods, including study design, measures and statistical approaches, used in quantitative and qualitative observational studies of health equity in end-of-life cancer care, and to consider how these methods align with recommended approaches for studying health equity questions.Methods and analysis This scoping review follows Arksey and O’Malley’s expanded framework for scoping reviews. We will systematically search Medline, Embase, CINAHL and PsycINFO electronic databases for quantitative and qualitative studies that examined equity stratifiers in relation to end-of-life cancer care and/or outcomes published in English or French between 2010 and 2021. Two authors will independently review all titles, abstracts and full texts to determine which studies meet the inclusion criteria. Data from included full-text articles will be extracted into a data form that will be developed and piloted by the research team. Extracted information will be summarised quantitatively and qualitatively.Ethics and dissemination No ethics approval is required for this scoping review. Results will be disseminated to researchers examining questions of health equity in cancer care through scientific publication and presentation at relevant conferences.
- Published
- 2022
- Full Text
- View/download PDF
5. Patient-centered outcomes for gastrointestinal cancer care: a scoping review protocol
- Author
-
Natalie G Coburn, Frances C Wright, Alyson L Mahar, Lesley Gotlib Conn, Julie Hallet, Amy T Hsu, Paul D James, Joanna Yang, Tori Barabash, Luckshi Rajendran, Claire Ludwig, Ekaterina Kosyachkova, and Julie Deleemans
- Subjects
Medicine - Published
- 2022
- Full Text
- View/download PDF
6. Using Additive and Relative Hazards to Quantify Colorectal Survival Inequalities for Patients with A Severe Psychiatric Illness
- Author
-
Alyson L Mahar, Laura E Davis, Paul Kurdyak, Timothy P Hanna, Natalie G Coburn, and Patti A Groome
- Subjects
Demography. Population. Vital events ,HB848-3697 - Abstract
Introduction Despite recommendations, most studies examining health inequalities fail to report both absolute and relative summary measures. We examine colorectal cancer (CRC) survival for patients with and without severe psychiatric illness (SPI) to demonstrate the use and importance of relative and absolute effects. Objectives and Approach We conducted a retrospective cohort study of CRC patients diagnosed between 01/04/2007 and 31/12/2012, using linked administrative databases. SPI was defined as diagnoses of major depression, bipolar disorder, schizophrenia, and other psychotic illnesses six months to five years preceding cancer diagnosis and categorized as inpatient, outpatient or none. Associations between SPI history and risk of death were examined using Cox Proportional Hazards regression to obtain hazard ratios and Aalen’s semi-parametric additive hazards regression to obtain absolute differences. Both models controlled for age, sex, primary tumour location, and rurality. Results The final cohort included 24,507 CRC patients, 482 patients had an outpatient SPI history and 258 patients had an inpatient SPI history. 58.1% of patients with inpatient SPI history died, and 47.1% of patients with outpatient SPI history died. Patients with an outpatient SPI history had a 40% (HR 1.40, 95% CI: 1.22-1.59) increased risk of death and patients with an inpatient SPI history had a 91% increased risk of death (HR 1.91, 95% CI: 1.63-2.25), relative to no history of a mental illness. An outpatient SPI history was associated with an additional 33 deaths per 1000 person years, and an inpatient SPI was associated with an additional 82 deaths per 1000 person years after controlling for confounders. Conclusion / Implications We demonstrated that reporting of both relative and absolute effects is possible and calculating risk difference is relatively simple using Aalen models. We encourage future studies examining inequalities with time-to-event data to use this method and report both relative and absolute effect measures.
- Published
- 2020
- Full Text
- View/download PDF
7. The effect of a severe psychiatric illness on colorectal cancer treatment and survival: A population-based retrospective cohort study.
- Author
-
Alyson L Mahar, Paul Kurdyak, Timothy P Hanna, Natalie G Coburn, and Patti A Groome
- Subjects
Medicine ,Science - Abstract
ObjectivesTo identify inequalities in cancer survival rates for patients with a history of severe psychiatric illness (SPI) compared to those with no history of mental illness and explore differences in the provision of recommended cancer treatment as a potential explanation.DesignPopulation-based retrospective cohort study using linked cancer registry and administrative data at ICES.SettingThe universal healthcare system in Ontario, Canada.ParticipantsColorectal cancer (CRC) patients diagnosed between April 1st, 2007 and December 31st, 2012. SPI history (schizophrenia, schizoaffective disorders, other psychotic disorders, bipolar disorders or major depressive disorders) was determined using hospitalization, emergency department, and psychiatrist visit data and categorized as 'no history of mental illness, 'outpatient SPI history', and 'inpatient SPI history'.Main outcome measuresCancer-specific survival, non-receipt of surgical resection, and non-receipt of adjuvant chemotherapy or radiation.Results24,507 CRC patients were included; 482 (2.0%) had an outpatient SPI history and 258 (1.0%) had an inpatient SPI history. Individuals with an SPI history had significantly lower survival rates and were significantly less likely to receive guideline recommended treatment than CRC patients with no history of mental illness. The adjusted HR for cancer-specific death was 1.69 times higher for individuals with an inpatient SPI (95% CI 1.36-2.09) and 1.24 times higher for individuals with an outpatient SPI history (95% CI 1.04-1.48). Stage II and III CRC patients with an inpatient SPI history were 2.15 times less likely (95% CI 1.07-4.33) to receive potentially curative surgical resection and 2.07 times less likely (95% CI 1.72-2.50) to receive adjuvant radiation or chemotherapy. These findings were consistent across multiple sensitivity analyses.ConclusionsIndividuals with an SPI history experience inequalities in colorectal cancer care and survival within a universal healthcare system. Increasing advocacy and the availability of resources to support individuals with an SPI within the cancer system are warranted to reduce the potential for unnecessary harm.
- Published
- 2020
- Full Text
- View/download PDF
8. Symptom Assessment Following Surgery for Lung Cancer
- Author
-
Vaibhav Gupta, Wing Chan, Mark Doherty, Natalie G. Coburn, Victoria Zuk, Dhruvin H Hirpara, Gail Darling, Biniam Kidane, Mathieu Rousseau, Victoria Delibasic, and Julie Hallet
- Subjects
medicine.medical_specialty ,Chemotherapy ,business.industry ,medicine.medical_treatment ,MEDLINE ,Retrospective cohort study ,Disease ,medicine.disease ,Surgery ,Pneumonectomy ,Adjuvant therapy ,medicine ,Stage (cooking) ,Lung cancer ,business - Abstract
Objective To conduct a population-level analysis of temporal trends and risk factors for high symptom burden in patients receiving surgery for non-small-cell lung cancer (NSCLC). Summary background data A population-level overview of symptoms after curative intent surgery is necessary to inform decision making and supportive care for patients with lung cancer. Methods Retrospective cohort study of patients receiving surgery for stage I-III NSCLC between January 2007-September 2018. Prospectively collection Edmonton Symptom Assessment System (ESAS) scores, linked to provincial administrative data, were used to describe the prevalence, trajectory and predictors of moderate-to-severe symptoms in the year following surgery. Results A total of 5,350 patients, with 28,490 unique ESAS assessments, were included in the analysis. Moderate-to-severe tiredness (68%), poor wellbeing (63%) and shortness of breath (60%) were the most common symptoms reported. The rise and fall in the proportion of patients experiencing moderate-to-severe symptoms after surgery coincided with the median time to first (58 days, IQR: 47-72) and last cycle of chemotherapy (140 days, IQR: 118-168), respectively. There was eventual stabilization, albeit above the pre-operative baseline, within 6-7 months after surgery. Female sex (RR 1.09-1.26), lower income (RR 1.08-1.23), stage III disease (RR 1.15-1.43), adjuvant therapy (RR 1.09-1.42), chemotherapy within two weeks of an ESAS assessment (RR 1.14-1.73), and pneumonectomy (RR 1.05-1.15) were associated with moderate-to-severe symptoms following surgery. Conclusions Knowledge of population-level prevalence, trajectory and predictors of moderate-to-severe symptoms after surgery for NSCLC can be used to facilitate shared decision making and improve symptom management throughout the course of illness.
- Published
- 2023
9. Incidence of psychiatric illness in patients with neuroendocrine tumors: a comparative population-based analysis
- Author
-
Julie Hallet, Elie Isenberg-Grzeda, Calvin H. L. Law, Victoria Barabash, Jesse Zuckerman, Simron Singh, Sten D. Myrehaug, Angela Assal, Wing C. Chan, Natalie G. Coburn, and Alyson L. Mahar
- Subjects
Oncology - Published
- 2022
10. Development and Validation of a Machine Learning Algorithm Predicting Emergency Department Use and Unplanned Hospitalization in Patients With Head and Neck Cancer
- Author
-
Christopher W. Noel, Rinku Sutradhar, Lesley Gotlib Conn, David Forner, Wing C. Chan, Rui Fu, Julie Hallet, Natalie G. Coburn, and Antoine Eskander
- Subjects
Hospitalization ,Machine Learning ,Ontario ,Otorhinolaryngology ,Head and Neck Neoplasms ,Humans ,Surgery ,Middle Aged ,Emergency Service, Hospital ,Algorithms ,Original Investigation - Abstract
ImportancePatient-reported symptom burden was recently found to be associated with emergency department use and unplanned hospitalization (ED/Hosp) in patients with head and neck cancer. It was hypothesized that symptom scores could be combined with administrative health data to accurately risk stratify patients.ObjectiveTo develop and validate a machine learning approach to predict future ED/Hosp in patients with head and neck cancer.Design, Setting, and ParticipantsThis was a population-based predictive modeling study of patients in Ontario, Canada, diagnosed with head and neck cancer from January 2007 through March 2018. All outpatient clinical encounters were identified. Edmonton Symptom Assessment System (ESAS) scores and clinical and demographic factors were abstracted. Training and test cohorts were randomly generated in a 4:1 ratio. Various machine learning algorithms were explored, including (1) logistic regression using a least absolute shrinkage and selection operator, (2) random forest, (3) gradient boosting machine, (4) k-nearest neighbors, and (5) an artificial neural network. Data analysis was performed from September 2021 to January 2022.Main Outcomes and MeasuresThe main outcome was any 14-day ED/Hosp event following symptom assessment. The performance of each model was assessed on the test cohort using the area under the receiver operator characteristic (AUROC) curve and calibration plots. Shapley values were used to identify the variables with greatest contribution to the model.ResultsThe training cohort consisted of 9409 patients (mean [SD] age, 63.3 [10.9] years) undergoing 59 089 symptom assessments (80%). The remaining 2352 patients (mean [SD] age, 63.3 [11] years) and 14 193 symptom assessments were set aside as the test cohort (20%). Several models had high predictive accuracy, particularly the gradient boosting machine (validation AUROC, 0.80 [95% CI, 0.78-0.81]). A Youden-based cutoff corresponded to a validation sensitivity of 0.77 and specificity of 0.66. Patient-reported symptom scores were consistently identified as being the most predictive features within models. A second model built only with symptom severity data had an AUROC of 0.72 (95% CI, 0.70-0.74).Conclusions and RelevanceIn this study, machine learning approaches predicted with a high degree of accuracy ED/Hosp in patients with head and neck cancer. These tools could be used to accurately risk stratify patients and may help direct targeted intervention.
- Published
- 2023
11. Second primary cancers and survival among neuroendocrine tumor patients
- Author
-
Sarah B Bateni, Natalie G Coburn, Calvin Law, Simron Singh, Sten Myrehaug, Angela Assal, and Julie Hallet
- Subjects
Cancer Research ,Endocrinology ,Oncology ,Endocrinology, Diabetes and Metabolism - Abstract
There is an increased risk of second primary cancers (SPCs) after neuroendocrine tumor (NET) diagnosis. The clinical significance of SPCs in this population is unknown. The purpose of this study was to evaluate the association between SPCs after NET diagnosis and survival. We performed a population-based, retrospective cohort study of NET patients (gastrointestinal, pancreatic, or lung primary) from 2000-2016 using the Surveillance, Epidemiology, and End Results (SEER) database. Cox regression models assessed the association between SPCs and NET-specific (NET-SS), cancer-specific (CSS), and overall survival (OS). Of 58,553 NET patients, 7.9% experienced a SPC. SPCs were associated with worse OS (HR 2.14, 95%CI 1.94-2.36) and CSS (HR 2.31, 95%CI 2.06-2.59) with no difference in NET-SS (HR 1.04, 95%CI 0.87-1.23). Stratified analyses by histologic grade showed similar results for well and moderately differentiated NETs, but no difference in OS or CSS for poorly differentiated NETs (p>0.05). In stratified analyses by NET site, SPCs were associated with worse OS (HR 3.41, 95%CI 3.01-3.87) and CSS (HR 4.96, 95%CI 4.28-5.74) in gastrointestinal NETs and worse OS (HR 1.25, 95%CI 1.03-1.52) with no difference in CSS (HR 1.08, 95%CI 0.85-1.36) in lung NETs. SPCs were not associated with a difference in OS or CSS in pancreatic NETs (p>0.05). In conclusion, SPCs after NETs were associated with inferior OS and CSS compared to no SPC, but were not associated with NET-SS. These data highlight the need for long-term follow-up in NETs to include detection of SPCs to ensure early diagnosis and timely management.
- Published
- 2023
12. Gaps in Depression Symptom Management for Patients With Head and Neck Cancer
- Author
-
Christopher W. Noel, Rinku Sutradhar, Wing C. Chan, Rui Fu, Justine Philteos, David Forner, Jonathan C. Irish, Simone Vigod, Elie Isenberg‐Grzeda, Natalie G. Coburn, Julie Hallet, and Antoine Eskander
- Subjects
Otorhinolaryngology - Published
- 2023
13. An Evaluation of Sex- and Gender-Based Analyses in Oncology Clinical Trials
- Author
-
Mathew Hall, Vaishali A Krishnanandan, Matthew C Cheung, Natalie G Coburn, Barbara Haas, Kelvin K W Chan, and Michael J Raphael
- Subjects
Male ,Cancer Research ,Oncology ,United States Food and Drug Administration ,Neoplasms ,Humans ,Reproducibility of Results ,Female ,Articles ,Medical Oncology ,Drug Approval ,United States - Abstract
Background The objective of this study was to evaluate whether sex- and gender-based analyses and proper sex and gender terminology were used in oncology trials leading to regulatory drug approval. Methods The Food and Drug Administration (FDA) Hematology/Oncology Approvals and Safety Notifications page was used to identify all anticancer therapies that received FDA approval between 2012 and 2019. The trials used to support FDA drug approval were collected along with all available supplemental tables and study protocols. Documents were reviewed to determine if there was a plan to analyze results according to sex and gender and to determine if consistent sex and gender terminology were used. Results We identified 128 randomized, controlled trials corresponding to a cancer medicine, which received FDA approval. No study specified how sex and gender were collected or analyzed. No study reported any information on the gender of participants. Sex and gender terminology were used inconsistently at least once in 76% (97 of 128) of studies. Among the 102 trials for nonsex-specific cancer sites, 89% (91 of 102) presented disaggregated survival outcome data by sex. No study presented disaggregated toxicity data by sex or gender. Conclusion The majority of pivotal clinical trials in oncology fail to account for the important distinction between sex and gender and conflate sex and gender terminology. More rigor in designing clinical trials to include sex- and gender-based analyses and more care in using sex and gender terms in the cancer literature are needed. These efforts are essential to improve the reproducibility, generalizability, and inclusiveness of cancer research.
- Published
- 2022
14. PATCH-DP: a single-arm phase II trial of intra-operative application of HEMOPATCH™ to the pancreatic stump to prevent post-operative pancreatic fistula following distal pancreatectomy
- Author
-
Jad Abou Khalil, Ved Tandan, Anton I. Skaro, Fady Balaa, Yigang Luo, Guillaume Martel, Douglas Quan, Steven Gallinger, Pablo E. Serrano, K. Bertens, Natalie G. Coburn, Hpb Concept team, Sulaiman Nanji, Michael Marcaccio, Ramy Behman, Calvin Law, Gavin Beck, Deepak Dath, Julie Hallet, Michael A. J. Moser, Lev D. Bubis, Ken Leslie, Paul J. Karanicolas, and Rachel Roke
- Subjects
medicine.medical_specialty ,Intra operative ,Phases of clinical research ,030230 surgery ,Pancreatic Fistula ,03 medical and health sciences ,Pancreatectomy ,Postoperative Complications ,0302 clinical medicine ,Animals ,Humans ,Medicine ,Prospective Studies ,Post operative ,Pancreas ,Retrospective Studies ,Fixation (histology) ,Hepatology ,business.industry ,Incidence (epidemiology) ,Gastroenterology ,medicine.disease ,Surgery ,Pancreatic fistula ,030220 oncology & carcinogenesis ,Cattle ,business ,Distal pancreatectomy ,Pancreatic stump - Abstract
Background Post-operative pancreatic fistula (POPF) is the most significant cause of morbidity following distal pancreatectomy. Hemopatch™ is a thin, bovine collagen-based hemostatic sealant. We hypothesized that application of Hemopatch™ to the pancreatic stump following distal pancreatectomy would decrease the incidence of clinically-significant POPF. Methods We conducted a prospective, single-arm, multicentre phase II study of application of Hemopatch™ to the pancreatic stump following distal pancreatectomy. The primary outcome was clinically-significant POPF within 90 days of surgery. A sample size of 52 patients was required to demonstrate a 50% relative reduction in Grade B/C POPF from a baseline incidence of 20%, with a type I error of 0.2 and power of 0.75. Secondary outcomes included incidence of POPF (all grades), 90-day mortality, 90-day morbidity, re-interventions, and length of stay. Results Adequate fixation Hemopatch™ to the pancreatic stump was successful in all cases. The rate of grade B/C POPF was 25% (95%CI: 14.0–39.0%). There was no significant difference in the incidence of grade B/C POPF compared to the historical baseline (p = 0.46). The 90-day incidence of Clavien–Dindo grade ≥3 complications was 26.9% (95%CI: 15.6–41.0%). Conclusion The use of Hemopatch™ was not associated with a decreased incidence of clinically-significant POPF compared to historical rates. (NCT03410914).
- Published
- 2022
15. The effectiveness of a provincial symptom assessment program in reaching adolescents and young adults with cancer: A population‐based cohort study
- Author
-
Rinku Sutradhar, Natalie G. Coburn, Qing Li, and Sumit Gupta
- Subjects
young adults ,Adult ,Gerontology ,Cancer Research ,Population ,Psychological intervention ,Symptom assessment ,Cohort Studies ,Young Adult ,Population based cohort ,03 medical and health sciences ,0302 clinical medicine ,Breast cancer ,population‐based ,Neoplasms ,Overall survival ,cancer ,Humans ,Medicine ,Symptom control ,Radiology, Nuclear Medicine and imaging ,adolescents ,030212 general & internal medicine ,Young adult ,education ,RC254-282 ,Research Articles ,Retrospective Studies ,Ontario ,education.field_of_study ,business.industry ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,Cancer ,Odds ratio ,medicine.disease ,humanities ,Confidence interval ,3. Good health ,Oncology ,030220 oncology & carcinogenesis ,symptoms ,Symptom Assessment ,Rural area ,patient‐reported outcomes ,business ,Cancer Prevention ,Research Article ,Demography - Abstract
Background Symptom control is prioritized by cancer patients and may improve overall survival. Ontario, Canada thus offers all cancer patients screening using the Edmonton Symptom Assessment System (ESAS) at outpatient cancer‐related visits. We determined whether this initiative reached adolescents and young adults (AYA) and factors associated with screening in this population. Methods We linked all Ontario AYA diagnosed with cancer 2010–2018 aged 15–29 years to population‐based databases identifying outpatient visits and ESAS screening. For each 2‐week period in the year post‐diagnosis, AYA with cancer‐related visits were categorized as “unscreened” (no ESAS score) versus “screened” (≥1 ESAS score). Demographic and disease‐related covariates were examined. Results Among 5435 AYA, 4204 (77.4%) had ≥1 ESAS screen. Within any 2‐week period, only 30%–44% of AYA attending cancer‐related visits were screened. Patients with hematologic malignancies were least likely to be screened [odds ratio (OR) vs. breast cancer 0.77, 95% confidence interval (95% CI) 0.67–0.88; p, Symptom control is prioritized by cancer patients; we assessed whether a population‐based symptom screening program was effective in screening adolescents and young adults (AYA). AYA living in rural and remote areas had high rates of screening, but those living in low‐income urban areas and those with hematologic cancers had lower screening rates. AYA‐specific measures may be warranted.
- Published
- 2021
16. A Population-Based Analysis of Long-Term Outcomes Among Older Adults Requiring Unexpected Intensive Care Unit Admission After Cancer Surgery
- Author
-
Bourke W Tillmann, Natalie G. Coburn, Victoria Zuk, Alyson L. Mahar, Julie Hallet, Jesse Zuckerman, Matthew P Guttman, Barbara Haas, Wing Chan, and Tyler R. Chesney
- Subjects
Mechanical ventilation ,medicine.medical_specialty ,business.industry ,Proportional hazards model ,medicine.medical_treatment ,Hazard ratio ,Subgroup analysis ,Intensive care unit ,Confidence interval ,law.invention ,Oncology ,Surgical oncology ,law ,Emergency medicine ,medicine ,Surgery ,business ,Cohort study - Abstract
High-intensity cancer surgery is increasingly common among older adults. However, these patients are at high-risk for unexpected intensive care unit (ICU) admissions after surgery. How these admissions impact older adults’ long-term outcomes is unknown. We performed a population-based, cohort study of older adults (age ≥ 70 years) who underwent high-intensity cancer surgery from 2007 to 2017. Analyses were performed to examine time alive and at home following surgery, defined as time from surgery to nursing home admission or death. Patients were followed for up to 5 years. Extended Cox proportional hazards models examined the independent association between unexpected ICU admission (ICU admissions excluding routine postoperative monitoring) and remaining alive and at home. Subgroup analysis stratified patients by duration of mechanical ventilation (MV). Of 47,367 identified older adults, 7372 (15.6%) had an unexpected ICU admission. Patients with an unexpected ICU admission had a significantly lower probability of being alive and at home at 5 years (26.2%; 95% confidence interval [CI] 25.1–27.2%) compared with those without an unexpected admission (56.8%; 95% CI 56.3–57.4%). After adjusting for baseline characteristics, unexpected ICU admission remained associated with less time alive and at home. The elevated risk of death or nursing home admission persisted for 5 years after surgery (years 2–5: hazard ratio [HR] 1.58, 95% CI 1.50–1.66). Duration of MV was inversely associated with time alive and at home. Older adults with an unexpected ICU admission after high-intensity cancer surgery are at increased risk for death or admission to a nursing home for at least 5 years.
- Published
- 2021
17. Risk of Cancer-Specific Death for Patients Diagnosed With Neuroendocrine Tumors: A Population-Based Analysis
- Author
-
Wing Chan, Natalie G. Coburn, Victoria Zuk, Calvin Law, Simron Singh, Angela Assal, Alyson L. Mahar, Sten Myrehaug, Haoyu Zhao, and Julie Hallet
- Subjects
Adult ,medicine.medical_specialty ,Population ,Neuroendocrine tumors ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Interquartile range ,Internal medicine ,medicine ,Humans ,Cumulative incidence ,030212 general & internal medicine ,education ,Retrospective Studies ,education.field_of_study ,business.industry ,Incidence ,Cancer ,Neoplasms, Second Primary ,Retrospective cohort study ,medicine.disease ,Primary tumor ,Comorbidity ,Neuroendocrine Tumors ,Oncology ,030220 oncology & carcinogenesis ,Female ,business - Abstract
Background: Although patients with neuroendocrine tumors (NETs) are known to have prolonged overall survival, the contribution of cancer-specific and noncancer deaths is undefined. This study examined cancer-specific and noncancer death after NET diagnosis. Methods: We conducted a population-based retrospective cohort study of adult patients with NETs from 2001 through 2015. Using competing risks methods, we estimated the cumulative incidence of cancer-specific and noncancer death and stratified by primary NET site and metastatic status. Subdistribution hazard models examined prognostic factors. Results: Among 8,607 included patients, median follow-up was 42 months (interquartile range, 17–82). Risk of cancer-specific death was higher than that of noncancer death, at 27.3% (95% CI, 26.3%–28.4%) and 5.6% (95% CI, 5.1%–6.1%), respectively, at 5 years. Cancer-specific deaths largely exceeded noncancer deaths in synchronous and metachronous metastatic NETs. Patterns varied by primary tumor site, with highest risks of cancer-specific death in bronchopulmonary and pancreatic NETs. For nonmetastatic gastric, small intestine, colonic, and rectal NETs, the risk of noncancer death exceeded that of cancer-specific deaths. Advancing age, higher material deprivation, and metastases were independently associated with higher hazards, and female sex and high comorbidity burden with lower hazards of cancer-specific death. Conclusions: Among all NETs, the risk of dying of cancer was higher than that of dying of other causes. Heterogeneity exists by primary NET site. Some patients with nonmetastatic NETs are more likely to die of noncancer causes than of cancer causes. This information is important for counseling, decision-making, and design of future trials. Cancer-specific mortality should be included in outcomes when assessing treatment strategies.
- Published
- 2021
18. Non-surgical management of advanced hepatocellular carcinoma: A systematic review by Cancer Care Ontario
- Author
-
Kelvin K. W. Chan, Brandon M. Meyers, JR Beecroft, Natalie G. Coburn, Aamer Mahmud, Jennifer J. Knox, Jolie Ringash, Derek J. Jonker, Jordan J. Feld, and Roxanne Cosby
- Subjects
Oncology ,medicine.medical_specialty ,business.industry ,medicine.drug_class ,Cancer ,Non surgical treatment ,Review Article ,General Medicine ,medicine.disease ,Systemic therapy ,Tyrosine-kinase inhibitor ,Resection ,Transplantation ,Internal medicine ,Hepatocellular carcinoma ,Global health ,Medicine ,business - Abstract
BACKGROUND: Hepatocellular carcinoma (HCC) is a global health problem, accounting for 4.7% of all new cancer cases and 8.2% of all cancer deaths worldwide in 2018. Resection and transplantation are the only modalities that offer a cure for HCC; however, most patients are diagnosed at an advanced stage, precluding these curative treatments. A number of local (ie, ablative therapies) and/or local-regional therapies (ie, chemo-embolization) are used and followed by systemic therapy for advanced or progressive disease. Other treatments are available, but their efficacy compared with these standards is not well known. METHODS: Literature searches (1/2000 to 1/2020 or 1/2005 to 1/2020, depending on the specific systematic review question) were conducted, including MEDLINE, Embase and the Cochrane Database of Systematic Reviews. RESULTS: Over 30,000 articles were identified. In total, 49 studies were included in the systematic review. CONCLUSIONS: There is no evidence to support the addition of sorafenib to any local or regional therapy. First-line systemic therapy options for unresectable or metastatic HCC include sorafenib, lenvatinib, and atezolizumab + bevacizumab. Regorafenib or cabozantinib provide survival benefits when given as second-line treatment.
- Published
- 2021
19. Restricted family presence for hospitalized surgical patients during the COVID-19 pandemic: How hospital care providers and families navigated ethical tensions and experiences of institutional betrayal
- Author
-
Lesley Gotlib Conn, Natalie G. Coburn, Lisa Di Prospero, Julie Hallet, Laurie Legere, Tracy MacCharles, Jessica Slutsker, Ru Tagger, Frances C. Wright, and Barbara Haas
- Abstract
Early in the COVID-19 pandemic restricted family presence in hospitals was a widespread public health intervention to preserve critical resources and mitigate the virus's spread. In this study, we explore the experiences of surgical care providers and family members of hospitalized surgical patients during the period of highly restricted visiting (March 2020 to April 2021) in a large Canadian academic hospital. Thirty-four interviews were completed with hospital providers, family members and members of the hospital's visitor task force. To understand hospital providers' experiences, we highlight the ethical tensions produced by the biomedical and public health ethics frameworks that converged during COVID-19 in hospital providers' bedside practice. Providers grappled with mixed feelings in support of and against restricted visiting, while simultaneously experiencing gaps in resources and care and acting as patient gatekeepers. To understand family members' experiences of communication and care, we use the theory of institutional betrayal to interpret the negative impacts of episodic and systemic communication failures during restricted visiting. Family members of the most vulnerable patients (and patients) experienced short- and long-term effects including anxiety, fear, and refusal of further care. Our analysis draws attention to the complex ways that hospital care providers and families of hospitalized surgical patients sought to establish and reconfigure how trust and patient-centeredness could be achieved under these unprecedented conditions. Practical learnings from this study suggest that if family presence in hospitals must be limited in the future, dedicated personnel for communication and emotional support for patients, families and staff must be prioritized.
- Published
- 2022
20. Association of frailty with long-term homecare utilization in older adults following cancer surgery: Retrospective population-based cohort study
- Author
-
Amy T Hsu, Haoyu Zhao, Frances C. Wright, Natalie G. Coburn, Victoria Zuk, Alyson L. Mahar, Tyler R. Chesney, Julie Hallet, Laura E. Davis, and Barbara Haas
- Subjects
Male ,Pediatrics ,medicine.medical_specialty ,Time Factors ,Population ,Rate ratio ,Cancer resection ,03 medical and health sciences ,Population based cohort ,0302 clinical medicine ,Neoplasms ,medicine ,Humans ,030212 general & internal medicine ,education ,Geriatric Assessment ,Aged ,Retrospective Studies ,Aged, 80 and over ,Postoperative Care ,education.field_of_study ,Frailty ,business.industry ,Hazard ratio ,Age Factors ,General Medicine ,Home Care Services ,Oncology ,Geriatric oncology ,030220 oncology & carcinogenesis ,Preoperative Period ,Female ,Surgery ,business ,Cancer surgery ,Follow-Up Studies ,Cohort study - Abstract
Introduction Frailty is an important prognostic factor, and the association with postoperative dependence is important outcome to older adults. We examined the association of frailty with long-term homecare utilization for older adults following cancer surgery. Methods In this population-based cohort study, we determined frailty status in all older adults (≥70 years old) undergoing cancer resection (2007–2017). Outcomes were receipt of homecare and intensity of homecare (days per month) over 5 years. We estimated the adjusted association of frailty with outcomes, and assessed interaction with age. Results Of 82,037 patients, 6443 (7.8%) had frailty. Receipt and intensity of homecare was greater with frailty, but followed similar trajectories over 5 years between groups. Homecare receipt peaked in the first postoperative month (51.4% frailty, 43.1% no frailty), and plateaued by 1 year until 5 years (28.5% frailty, 12.8% no frailty). After 1 year, those with frailty required 4 more homecare days per month than without frailty (14 vs 10 days/month). After adjustment, frailty was associated with increased homecare receipt (hazard ratio 1.40; 95%CI 1.35–1.45), and increasing intensity each year (year 1 incidence rate ratio [IRR] 1.22, 95%CI 1.18–1.27 to year 5 IRR 1.47, 95%CI 1.35–1.59). The magnitude of the association of frailty with homecare receipt decreased with age (pinteraction Conclusion While the trajectory of homecare receipt and intensity is similar between those with and without frailty, frailty is associated with increased receipt of homecare and increased intensity of homecare after cancer surgery across all age groups.
- Published
- 2021
21. When is a Ghost Really Gone? A Systematic Review and Meta-analysis of the Accuracy of Imaging Modalities to Predict Complete Pathological Response of Colorectal Cancer Liver Metastases After Chemotherapy
- Author
-
Woo Jin Choi, Paul J. Karanicolas, Calvin Law, Natalie G. Coburn, Julie Hallet, Helen M. C. Cheung, Stephanie Silva, and Hala Muaddi
- Subjects
medicine.medical_specialty ,Modality (human–computer interaction) ,medicine.diagnostic_test ,business.industry ,Colorectal cancer ,Context (language use) ,Magnetic resonance imaging ,medicine.disease ,Confidence interval ,03 medical and health sciences ,0302 clinical medicine ,Oncology ,Surgical oncology ,030220 oncology & carcinogenesis ,Meta-analysis ,Medicine ,030211 gastroenterology & hepatology ,Surgery ,Radiology ,business ,Pathological - Abstract
Administration of chemotherapy to patients with colorectal liver metastases may result in disappearing liver metastases (DLM). This poses a therapeutic dilemma due to the uncertainty of true complete (pathological) response. We aimed to examine the diagnostic performance of imaging modalities in detecting true complete response in patients with DLM after chemotherapy. We performed a systematic search for articles assessing the diagnostic performance of imaging modalities in evaluating DLM following chemotherapy. True complete response was defined as 1-year recurrence-free survival in non-resected patients or complete pathological response on histologic examination in resected patients. We calculated the negative predictive value (NPV) for detecting true complete response of each imaging modality using a random effects model. Thirteen studies comprising 332 patients with at least one DLM were included. The number of DLMs after chemotherapy was 955 with computed tomography (CT), 104 with positron emission tomography (PET), 50 with intraoperative ultrasound (IOUS), 585 with magnetic resonance imaging (MRI), and 175 with contrast-enhanced IOUS (CEIOUS). Substantial variation in study design, patient characteristics, and imaging features was observed. Pooled NPV was 0.79 (95% confidence interval [CI] 0.53–0.96), 0.73 (95% CI 0.58–0.85), 0.54 (95% CI 0.37–0.7), 0.47 (95% CI 0.34–0.61), and 0.22 (95% CI 0.11–0.39) for CEIOUS, MRI, IOUS, CT, and PET, respectively. After chemotherapy, MRI or CEIOUS are the most accurate imaging modalities for assessment of DLM and should be used routinely in this context. Given the high NPV of these two modalities, surgical resection of visible CRLM is warranted if technically possible, even if DLM remain.
- Published
- 2021
22. Association Between Preoperative Patient-Reported Symptoms and Postoperative Outcomes in Rectal Cancer Patients: A Retrospective Cohort Study
- Author
-
Rinku Sutradhar, Alyson L. Mahar, Natalie G. Coburn, Laura E. Davis, Paul J. Karanicolas, Vaibhav Gupta, Yunni Jeong, and Lev D. Bubis
- Subjects
Male ,medicine.medical_specialty ,Colorectal cancer ,medicine.medical_treatment ,Patient Readmission ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,Hospital Mortality ,Patient Reported Outcome Measures ,Aged ,Retrospective Studies ,Hospital readmission ,Proctectomy ,Rectal Neoplasms ,business.industry ,Symptom burden ,Cancer ,Retrospective cohort study ,Chemoradiotherapy, Adjuvant ,Emergency department ,Perioperative ,Middle Aged ,medicine.disease ,Neoadjuvant Therapy ,Radiation therapy ,030220 oncology & carcinogenesis ,Preoperative Period ,Female ,Radiotherapy, Adjuvant ,030211 gastroenterology & hepatology ,Surgery ,Symptom Assessment ,business - Abstract
Background Rectal cancer patients undergoing preoperative radiotherapy experience a significant symptom burden. However, it is unknown whether symptoms during radiotherapy may portend adverse postoperative outcomes and healthcare utilization. Methods A retrospective cohort study was performed of rectal cancer patients undergoing neoadjuvant radiotherapy and proctectomy in Ontario from 2007 to 2014. The primary outcome was a complicated postoperative course–a dichotomous variable created as a composite of postoperative mortality, major morbidity, or hospital readmission. Patient-reported Edmonton Symptom Assessment System (ESAS) scores, collected routinely at outpatient provincial cancer center visits, were linked to administrative healthcare databases. The receiver-operating characteristic analysis was used to compare ESAS scoring approaches and to stratify patients into low versus high symptom score groups. Multivariable regression models were constructed to evaluate associations between preoperative symptom scores and postoperative outcomes. Results 1455 rectal cancer patients underwent sequential radiotherapy and proctectomy during the study period and recorded symptom assessments. Patients with high preoperative symptom scores were significantly more likely to experience a complicated postoperative course (OR 1.55, 95% CI 1.23-1.95). High preoperative ESAS scores were also associated with the secondary outcomes of emergency department visits (OR 1.34, 95% CI 1.08-1.66) and longer length of stay (IRR 1.23, 95% CI 1.04-1.45). Conclusions Rectal cancer patients reporting elevated symptom scores during neoadjuvant radiotherapy have increased odds of experiencing a complicated postoperative course. Preoperative patient-reported outcome screening may be a useful tool to identify at-risk patients and to efficiently direct perioperative supportive care.
- Published
- 2021
23. Patient-Reported Symptom Burden as a Predictor of Emergency Department Use and Unplanned Hospitalization in Head and Neck Cancer: A Longitudinal Population-Based Study
- Author
-
Julie Hallet, Danny Enepekides, Christopher W. Noel, David Forner, Irene Karam, Natalie G. Coburn, Kelvin K. W. Chan, Rinku Sutradhar, Simron Singh, Alyson L. Mahar, Jonathan C. Irish, Jonathan Kim, Haoyu Zhao, Antoine Eskander, Zain A. Husain, and Victoria Delibasic
- Subjects
Cancer Research ,medicine.medical_specialty ,business.industry ,Head and neck cancer ,MEDLINE ,Symptom burden ,Emergency department ,medicine.disease ,Population based study ,03 medical and health sciences ,0302 clinical medicine ,Oncology ,hemic and lymphatic diseases ,030220 oncology & carcinogenesis ,Emergency medicine ,medicine ,030212 general & internal medicine ,business - Abstract
PURPOSE: To determine the association between patient-reported symptom burden and subsequent emergency department use and unplanned hospitalization (ED/Hosp) in a head and neck cancer (HNC) patient population. METHODS: This was a population-based study of patients diagnosed with HNC who had completed at least one outpatient Edmonton Symptom Assessment System (ESAS) assessment between January 2007 and March 2018 in Ontario, Canada. Logistic regression models were used to determine the relationship between outpatient ESAS scores and subsequent 14-day ED/Hosp use. A generalized estimating equation approach with an exchangeable correlation structure was incorporated to account for patient-level clustering RESULTS: There were 11,761 patients identified, completing a total of 73,282 ESAS assessments and experiencing 5,203 ED/Hosp events. Six of the nine ESAS symptom scores were positively associated with ED/Hosp use, with pain, appetite, shortness of breath, and tiredness demonstrating the strongest associations. A global ESAS score was calculated by selecting the highest individual symptom score (h-ESAS). Among patients reporting a maximum h-ESAS score of 10, 15.1% had an ED/Hosp event within 14 days compared with 1.5% for those with the lowest possible score of zero. In adjusted analysis, the odds of ED/Hosp use increased with h-ESAS (1.23 per one-unit increase [95% CI, 1.22 to 1.25]). When treated as a categorical variable, patients with the maximum h-ESAS score of 10 had 9.23 (95% CI, 7.22 to 11.33) higher odds of ED/Hosp use, relative to the minimum score of zero. CONCLUSION: ESAS scores are strongly associated with subsequent ED/Hosp events in patients with HNC. Clinician education around how ESAS data might inform patient care may enhance symptom detection and management.
- Published
- 2021
24. The impact of tranexamic acid on administration of red blood cell transfusions for resection of colorectal liver metastases
- Author
-
Ramy Behman, Rachel Roke, Madeline Lemke, Julie Hallet, Laura E. Davis, Natalie G. Coburn, Calvin Law, Kaitlyn Beyfuss, Sherif S. Hanna, Alisha A. Jaffer, and Paul J. Karanicolas
- Subjects
medicine.medical_specialty ,medicine.medical_treatment ,Blood Loss, Surgical ,030230 surgery ,Resection ,03 medical and health sciences ,0302 clinical medicine ,Primary outcome ,Hepatectomy ,Humans ,Medicine ,Hepatology ,business.industry ,Liver Neoplasms ,Gastroenterology ,Antifibrinolytic Agents ,Surgery ,Red blood cell ,medicine.anatomical_structure ,Tranexamic Acid ,030220 oncology & carcinogenesis ,Inflow occlusion ,Colorectal Neoplasms ,Erythrocyte Transfusion ,business ,Tranexamic acid ,medicine.drug - Abstract
Red blood cell transfusions (RBCT) remain a concern for patients undergoing hepatectomy. The effect of tranexamic acid (TXA), an anti-fibrinolytic, on receipt of RBCT in colorectal liver metastases (CRLM) resection was examined.Hepatectomies for CRLM over 2009-2014 were included. Primary outcome was 30-day receipt of RBCT. Secondary outcomes were 30-day major morbidity (Clavien-Dindo III-V) and 90-day mortality. Multivariable modelling examined the adjusted association between TXA and outcomes.Of 433 included patients, 146 (34%) received TXA. TXA patients were more likely to have inflow occlusion (41.8% vs. 23.1%; p 0.01) and major hepatectomies (56.1% vs. 45.6%; p = 0.0193). TXA was independently associated with lower risk of RBCT (Relative risk (RR) 0.59; 95% confidence interval (95%CI): 0.42-0.85), but not with 30-day major morbidity (adjusted RR 1.02; 95%CI: 0.64-1.60) and 90-day mortality (univariable RR 0.99; 95%CI: 0.95-1.03).Intraoperative TXA was associated with a 41% reduction in risk of 30 -day receipt of RBCT after hepatectomy for CRLM. This finding is important to potentially improve healthcare resource allocation and patient outcomes. Pending further evidence, intraoperative TXA may be an effective method of reducing RBCT in hepatectomy for CRLM.
- Published
- 2021
25. Locoregional options in the management of cholangiocarcinoma: single center experience
- Author
-
Elizabeth David, Hussein Baydoun, Natalie G. Coburn, Harley Meirovich, and Gilbert Maroun
- Subjects
medicine.medical_specialty ,Carcinoma, Hepatocellular ,Percutaneous ,Radiofrequency ablation ,medicine.medical_treatment ,Single Center ,030218 nuclear medicine & medical imaging ,law.invention ,Cholangiocarcinoma ,03 medical and health sciences ,0302 clinical medicine ,law ,medicine ,Humans ,Progression-free survival ,Chemoembolization, Therapeutic ,Retrospective Studies ,Advanced and Specialized Nursing ,business.industry ,Liver Neoplasms ,medicine.disease ,Ablation ,Combined Modality Therapy ,Bile Ducts, Intrahepatic ,Treatment Outcome ,Anesthesiology and Pain Medicine ,Bile Duct Neoplasms ,Response Evaluation Criteria in Solid Tumors ,030220 oncology & carcinogenesis ,Adenocarcinoma ,Radiology ,business ,Ablation zone - Abstract
Background The purpose of this case series is to assess the safety and efficacy, as well as the overall survival (OS) and progression free survival (PFS) of patients with intrahepatic cholangiocarcinoma (ICC) treated with percutaneous ablation, transarterial arterial chemoembolization (TACE) or a combination of both at our institution. Methods Ten patients with pathological diagnosis of adenocarcinoma treated at out institution between January 1st 2013 and January 1st 2019 were reviewed. Three patients received a combined TACE and ablation treatment, three patients received TACE without ablation and four patients were treated with ablation only. Ablation technical success was determined by absence of residual tumor in the ablation zone on follow-up imaging one-month post-ablation. TACE response was assessed using the Modified Response Evaluation Criteria in Solid Tumors (mRECIST). Technical success was defined as injection of chemoembolic material in the involved liver lobes. PFS and OS were calculated from the date of diagnosis. Results In the TACE and radiofrequency ablation (RFA) group, OS was 12, 55 and 56 months; PFS was 5, 6 and 32 months, one patient died and two others remain alive. In the TACE group, OS was 29, 10 and 5 months; PFS was 15, 10 and 4 months. All three patients remain alive. In the ablation group, OS and PFS were 16, 31, 30 and 40 months. All patients remain alive. Overall, 9 of 10 patients are alive, with a Median OS and PFS of 29.5 and 15.5 months, respectively, with some patients remain alive over four years following initial presentation. Conclusions Our study shows that ablation and TACE in combination with more traditional modalities such as chemoradiation and surgical resection can extend survival in patients with ICC significantly. Locoregional therapy is well tolerated with only minor adverse events. The use of stereotactic body radiation therapy (SBRT) with ablation demonstrated the synergistic nature of using multiple lines of interventions.
- Published
- 2021
26. Novel patient-centred outcome in cancer care, days at home: a scoping review protocol
- Author
-
Tiago Ribeiro, Alyson Mahar, Angela Jerath, Adom Bondzi-Simpson, Victoria Barabash, Austin A Barr, Frances C Wright, Ekaterina Kosyachkova, Julie Deleemans, Natalie G Coburn, and Julie Hallet
- Subjects
General Medicine - Abstract
IntroductionPatient-centred care is valued by patients and providers. As management of cancer becomes increasingly complex, the value of providing care that incorporates an individual’s values and preferences along with demographic and tumour factors is increasingly important. To improve care, patients with cancer need easily accessible information on the outcomes important to them. The patient-centred outcome, days at home (DAH), is based on a construct that measures the time a patient spends alive and out of hospitals and healthcare institutions. DAH is accurately measured from various data sources and has shown construct validity with many patient-centred outcomes. There is significant heterogeneity in terms used and definitions for DAH in cancer care. This scoping review aims to consolidate information on the outcome DAH in cancer care and to review definitions and terms used to date to guide future use of DAH as a patient-centred care, research and policy tool.Methods and analysisThis scoping review protocol has been designed with joint guidance from theJBI Manual for Evidence Synthesisand the expanded framework from Arksey and O’Malley. We will systematically search MEDLINE, Embase and Scopus for studies measuring DAH, or equivalent, in the context of active adult cancer care. Broad inclusion criteria have been developed, given the recent introduction of DAH into cancer literature. Editorials, opinion pieces, case reports, abstracts, dissertations, protocols, reviews, narrative studies and grey literature will be excluded. Two authors will independently perform full-text selection. Data will be extracted, charted and summarised both qualitatively and quantitively.Ethics and disseminationNo ethics approval is required for this scoping review. Results will be disseminated through scientific publication and presentation at relevant conferences.
- Published
- 2023
27. Does prophylactic ureteric stenting at the time of colorectal surgery reduce the risk of ureteric injury? A systematic review and meta‐analysis
- Author
-
Natalie G. Coburn, Robert K. Nam, Andra Nica, Amanda Hird, Girish S. Kulkarni, and Lilian T. Gien
- Subjects
Adult ,medicine.medical_specialty ,medicine.medical_treatment ,Urinary system ,urologic and male genital diseases ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,Adverse effect ,Ureteric stent ,Retrospective Studies ,urogenital system ,business.industry ,Gastroenterology ,Acute kidney injury ,Retrospective cohort study ,Odds ratio ,medicine.disease ,female genital diseases and pregnancy complications ,Colorectal surgery ,Surgery ,surgical procedures, operative ,030220 oncology & carcinogenesis ,Meta-analysis ,Urinary Tract Infections ,Stents ,030211 gastroenterology & hepatology ,Ureter ,business ,Colorectal Surgery - Abstract
AIM Cystoscopic placement of ureteric stents during colorectal surgery (CRS) may aid in the intraoperative identification of the ureters and thus prevent ureteric injury, but may also be associated with prolonged operating time, increased cost and adverse events. No formal recommendations exist regarding the use of ureteric stents prior to CRS. Our aim was to determine the effect of prophylactic ureteric stent insertion on the risk of ureteric injury among adult patients undergoing CRS. METHOD A systematic search using the Ovid platform was completed. The primary outcome was risk of ureteric injury. Secondary outcomes included the risk of acute kidney injury (AKI), urinary tract infection (UTI), sepsis, length of stay (LOS) and mortality. The Paule-Mandel pooling and a random effects model was used to produce odds ratios (ORs) with 95% confidence intervals (CIs) for binary outcomes. Standardized mean differences (MD) were reported for continuous variables. Analyses were completed using R3.5. RESULTS Nine retrospective cohort studies evaluating 98 507 patients were included. The incidence of ureteric injury was 0.6%. Overall, 5.1% of patients underwent ureteric stenting. There was no change in the odds of ureteric injury among stented patients compared with controls (OR 1.30, 95% CI 0.39-4.29, I2 = 25%). Operating time was significantly longer (MD 49.3 min, 95% CI 35.3-63.4, I2 = 96%) in the intervention group. There was no difference in rates of AKI, UTI, sepsis, LOS or mortality between groups. CONCLUSION Given the retrospective nature of the identified studies, the benefit of prophylactic ureteric stenting remains uncertain. Prophylactic ureteric stenting was not associated with increased patient morbidity but did significantly increase operating time.
- Published
- 2021
28. Upfront Small Bowel Resection for Small Bowel Neuroendocrine Tumors With Synchronous Metastases
- Author
-
Sean Bennett, Calvin Law, Simron Singh, Haoyu Zhao, Jordan Levy, Alyson L. Mahar, Natalie G. Coburn, Victoria Zuk, Sten Myrehaug, Julie Hallet, and Vaibhav Gupta
- Subjects
Adult ,medicine.medical_specialty ,Population ,Neuroendocrine tumors ,Lower risk ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Stomach Neoplasms ,Internal medicine ,Intestinal Neoplasms ,medicine ,Humans ,Cumulative incidence ,education ,Retrospective Studies ,education.field_of_study ,business.industry ,Hazard ratio ,medicine.disease ,Primary tumor ,Pancreatic Neoplasms ,Neuroendocrine Tumors ,030220 oncology & carcinogenesis ,Propensity score matching ,030211 gastroenterology & hepatology ,Surgery ,business ,Cohort study - Abstract
OBJECTIVE We examined the impact of upfront small bowel resection (USBR) for metastatic SB-NET compared to non-operative management (NOM) on long-term healthcare utilization and survival outcomes. SUMMARY BACKGROUND DATA The role of early resection of the primary tumor in metastatic small bowel neuroendocrine (SB-NET) remains controversial. Conflicting data exist regarding its clinical and survival benefits. METHODS This is a population-based retrospective matched comparative cohort study of adults diagnosed with synchronous metastatic SB-NET between 2001-2017 in Ontario. USBR was defined as resection within 6 months of diagnosis. Primary outcomes were subsequent unplanned acute care admissions and small bowel related surgery. Secondary outcome was overall survival (OS). USBR and NOM patients were matched 2:1 using a propensity-score. We used time-to-event analyses with cumulative incidence functions and univariate Andersen-Gill regression for primary outcomes. E-value methods assessed the potential for residual confounding. RESULTS Of 1000 patients identified, 785 had USBR. The matched cohort included 348 patients with USBR and 174 with NOM. Patients with USBR had lower 3-year risk of subsequent admissions (72.6% vs 86.4%, p < 0.001) than those with NOM, with hazard ratio (HR) 0.72 (95%CI 0.57-0.91). USBR was associated with lower risk of subsequent small bowel related surgery (15.4% vs 40.3%, p < 0.001), with HR 0.44 (95%CI 0.29-0.67). E-values indicated it was unlikely that the observed risk estimates could be explained by an unmeasured confounder. Sensitivity analysis excluding emergent resections to define USBR did not alter the results. CONCLUSIONS USBR for SB-NETs in the presence of metastatic disease was associated with better patient-oriented outcomes of decreased subsequent admissions and interventions, compared to NOM. USBR should be considered for metastatic SB-NETs.
- Published
- 2020
29. Reply to K. Yokoyama et al
- Author
-
Christopher W. Noel, John Kim, Kelvin K. W. Chan, Jonathan C. Irish, Rinku Sutradhar, Julie Hallet, Natalie G. Coburn, Haoyu Zhao, David Forner, Victoria Delibasic, Antoine Eskander, Danny Enepekides, Alyson L. Mahar, Zain A. Husain, Irene Karam, and Simron Singh
- Subjects
Gynecology ,Cancer Research ,medicine.medical_specialty ,Oncology ,business.industry ,MEDLINE ,Medicine ,business - Published
- 2021
30. Prediction of breast cancer–related outcomes with the Edmonton Symptom Assessment Scale: A literature review
- Author
-
Yasmeen Razvi, Tara Behroozian, Maureen E. Trudeau, Edward Chow, Henry Lam, Lauren Milton, Natalie G. Coburn, Erin McKenzie, and Irene Karam
- Subjects
medicine.medical_specialty ,Population ,Breast Neoplasms ,03 medical and health sciences ,0302 clinical medicine ,Breast cancer ,Quality of life ,Surveys and Questionnaires ,hemic and lymphatic diseases ,medicine ,Humans ,030212 general & internal medicine ,Medical diagnosis ,education ,education.field_of_study ,Models, Statistical ,business.industry ,Palliative Care ,Cancer ,Emergency department ,Prognosis ,medicine.disease ,Oncology ,Sample size determination ,030220 oncology & carcinogenesis ,Emergency medicine ,Quality of Life ,Female ,Symptom Assessment ,business ,Predictive modelling - Abstract
The Edmonton Symptom Assessment Scale (ESAS) is a validated tool used in patients with varied cancer diagnoses to measure patient symptoms. The present manuscript will review the literature assessing the ability of the ESAS to predict patient-related outcomes in breast cancer patients. A literature search was conducted of Cochrane Central Register of Controlled Trials databases, Ovid MEDLINE, and Embase for English articles that investigated the use of predictive modelling with the ESAS in the breast cancer population. Study type, publication year, sample size, patient demographics, predicted outcomes, and strongest predictive factors/symptoms were summarized for each study. A total of nine articles were included in this review. Five articles used the ESAS in predictive models to determine patient time to death. ESAS was also used to predict emergency department visits, determine symptoms associated with decreased quality of life, and generate a Health Utility Score. Lack of appetite was the most common ESAS symptom, as it was reported in five studies to be associated with decreased survival. In four of the nine articles, an additional survey investigating physical functioning was used in combination with ESAS to strengthen the predictive models. Included studies support the use of ESAS in predictive models, particularly for predicting survival. Using the ESAS as a predictive tool allows for more accurate time to death predictions, potentially improving symptom management and preventing overtreatment of palliative patients near the end of life.
- Published
- 2020
31. Patient-reported symptoms in metastatic gastric cancer patients in the last 6 months of life
- Author
-
Lev D. Bubis, Laura E. Davis, Paul J. Karanicolas, Ekaterina Kosyachkova, Yunni Jeong, Natalie G. Coburn, Alyson L. Mahar, Victoria Delibasic, and Kelvin K. W. Chan
- Subjects
medicine.medical_specialty ,Routine screening ,Palliative care ,Nausea ,business.industry ,Symptom burden ,Retrospective cohort study ,Logistic regression ,3. Good health ,Metastatic gastric cancer ,03 medical and health sciences ,0302 clinical medicine ,Oncology ,030220 oncology & carcinogenesis ,Internal medicine ,medicine ,030212 general & internal medicine ,medicine.symptom ,business ,Depression (differential diagnoses) - Abstract
Patients with metastatic gastric cancer have poor survival outcomes and may experience high symptom burden. We evaluated symptom trajectory and risk factors for increased symptom severity among metastatic gastric cancer patients during the last 6 months of life. We conducted a retrospective cohort study among patients ≥ 18 years diagnosed with metastatic gastric cancer from January 2007 to December 2014 in the province of Ontario, Canada. We included patients who died during the study period and who reported at least one Edmonton Symptom Assessment System (ESAS) score during the last 6 months of life. We described the proportion of patients who reported moderate-to-severe symptom scores (≥ 4) by month. Multivariable logistic regression models were created to identify risk factors for moderate-to-severe symptom scores. Seven hundred eighty-eight eligible patients with 3286 unique symptom scores completed during their last 6 months of life were identified. The highest prevalence of moderate-to-severe scores was observed for tiredness and lack of appetite, while nausea and depression had the lowest prevalence of elevated scores. The prevalence of moderate-to-severe was consistently high for all symptoms, particularly approaching end-of-life. Timing of ESAS scores, receipt of cancer-directed therapy, urban residence, and female sex were associated with increased odds of reporting moderate-to-severe symptom scores. Patients with metastatic gastric cancer experience significant symptom burden at the end-of-life. Routine screening with patient-reported outcome tools may assist in shared decision-making and effective palliative care by ensuring patients’ health status and supportive care needs are identified promptly at the time of clinical encounters.
- Published
- 2020
32. Severe symptoms persist for Up to one year after diagnosis of stage I-III lung cancer: An analysis of province-wide patient reported outcomes
- Author
-
Dhruvin H. Hirpara, Mark Doherty, Alexander V. Louie, Haoyu Zhao, Natalie G. Coburn, Gail Darling, Biniam Kidane, Rinku Sutradhar, Alyson L. Mahar, Julie Hallet, Vaibhav Gupta, and Laura E. Davis
- Subjects
Male ,0301 basic medicine ,Pulmonary and Respiratory Medicine ,Canada ,Cancer Research ,Pediatrics ,medicine.medical_specialty ,Lung Neoplasms ,Population ,Psychological intervention ,Comorbidity ,Disease ,Anxiety ,03 medical and health sciences ,0302 clinical medicine ,Quality of life ,medicine ,Humans ,Patient Reported Outcome Measures ,Stage (cooking) ,Lung cancer ,education ,Fatigue ,Aged ,Retrospective Studies ,Aged, 80 and over ,education.field_of_study ,business.industry ,Middle Aged ,Prognosis ,medicine.disease ,Dyspnea ,030104 developmental biology ,Oncology ,030220 oncology & carcinogenesis ,Quality of Life ,Female ,Symptom Assessment ,business ,Follow-Up Studies ,Cohort study - Abstract
Objectives Lung cancer is associated with significant disease- and treatment-related morbidity. The Edmonton Symptom Assessment System (ESAS) is a tool developed to elicit patients' own assessment of the severity of common cancer-associated symptoms. The objective of this study was to examine symptom severity in the 12 months following diagnosis of lung cancer, and to identify predictors of high symptom burden. Materials and Methods : This was a retrospective population-based cohort study, including patients with stage I-III lung cancer diagnosed between 2007–2016, and who had symptom screening in the 12 months following diagnosis. The proportion of patients reporting severe symptoms (ESAS ≥ 7) in the year following diagnosis was plotted over time. Multivariable regression models were constructed to identify factors associated with severe symptoms. Results 69,440 unique symptom assessments were reported by 11,075 lung cancer patients. Tiredness was the most prevalent severe symptom (47.3 %), followed by shortness of breath (39.4 %) and poor wellbeing (36.5 %) among all disease stages. Patients diagnosed with higher stage disease reported more severe symptoms, but symptom trajectories were similar for all stages in the year following diagnosis. Disease stage (RR 1.10–2.01), comorbidity burden (RR 1.17–1.51), degree of socioeconomic marginalization (RR1.15-1.45), and female sex (RR 1.15–1.50) were associated with reporting severe symptoms in the year following diagnosis. Conclusion Severe physical and psychological symptoms persist throughout the first year following lung cancer diagnosis, regardless of disease stage. Those at risk of experiencing high symptom burden may benefit from targeted supportive care interventions, including psychosocial support aimed at improving health-related quality of life.
- Published
- 2020
33. Patient-Reported Symptoms for Esophageal Cancer Patients Undergoing Curative Intent Treatment
- Author
-
Vaibhav Gupta, Laura E. Davis, Julie Hallet, Alyson L. Mahar, Jolie Ringash, Natalie G. Coburn, Gail E. Darling, Haoyu Zhao, Biniam Kidane, and Catherine Allen-Ayodabo
- Subjects
Adult ,Male ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Multivariate analysis ,Databases, Factual ,Esophageal Neoplasms ,030204 cardiovascular system & hematology ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Cost of Illness ,Quality of life ,Interquartile range ,Internal medicine ,medicine ,Humans ,Neoplasm Invasiveness ,Patient Reported Outcome Measures ,Survivors ,Aged ,Neoplasm Staging ,Retrospective Studies ,Ontario ,business.industry ,Palliative Care ,Cancer ,Retrospective cohort study ,Chemoradiotherapy ,Middle Aged ,Esophageal cancer ,medicine.disease ,Comorbidity ,Esophagectomy ,Treatment Outcome ,030228 respiratory system ,Multivariate Analysis ,Quality of Life ,Female ,Surgery ,Symptom Assessment ,Cardiology and Cardiovascular Medicine ,business ,Cohort study - Abstract
Background Esophageal cancer (EC) patients experience considerable symptom burden from treatment. This study utilized population-level patient-reported Edmonton Symptom Assessment System (ESAS) scores collected as part of standard clinical care to describe symptom trajectories and characteristics associated with severe symptoms for patients undergoing curative intent EC treatment. Methods EC patients treated with curative intent at regional cancer centers and affiliates between 2009 and 2016 and assessed for symptoms in the 12 months after diagnosis were included. The ESAS measures 9 common patient-reported cancer symptoms. The outcome was report of a severe symptom score (score ≥7 our of 10). Multivariable analyses were used to identify characteristics associated with severe symptom scores. Results A total of 1751 patients reported a median of 7 (interquartile range, 4-12) ESAS assessments in the year after diagnosis, for a total of 14,953 unique ESAS assessments included in the analysis. The most frequently reported severe symptoms were lack of appetite (n = 918, 52%), tiredness (n = 787, 45%), and poor well-being (n = 713, 41%). The highest symptom burden was within the first 5 months after diagnosis, with moderate improvement in symptom burden in the second half of the first year. Characteristics associated with severe scores for all symptoms included female sex, high comorbidity, lower socioeconomic status, urban residence, and symptom assessment temporally close to diagnosis. Conclusions This study demonstrates a high symptom burden for EC patients undergoing curative intent therapy. Targeted treatment of common severe symptoms and increased support for patients at risk for severe symptoms may enhance patient quality of life.
- Published
- 2020
34. Prospective, observational, multicenter study on minimally invasive gastrectomy for gastric cancer: robotic, laparoscopic and open surgery compared on operative and follow-up outcomes - IMIGASTRIC II study protocol: IMIGASTRIC II
- Author
-
Orhan Alimoglu, Christos Chatzakis, Alexander Novotny, Martine Goergen, Stefano Trastulli, Daniel Reim, Orestis Ioannidis, Benedetta Badii, Fabio Cianchi, Enrique Norero, J.S. Azagra, Lydia Loutzidou, Ninh T. Nguyen, Arda Isik, Leonardo Solaini, Cuneyt Kayaalp, Graziano Pernazza, Rémy Sindayigaya, Shougen Cao, Jacopo Desiderio, Ibrahim Ali Ozemir, Andrea Avanzolini, Olivier Saint-Marc, S D’Imporzano, Yanbing Zhou, Lu Zang, Chao-Hui Zheng, Amilcare Parisi, Francesco Guerra, Alessandra Marano, Natalie G. Coburn, Jian-Xian Lin, Feng Qi, Francesco Giovanardi, Johan Gagnière, Chang-Ming Huang, A. Coratti, Felice Borghi, Maurizio Cesari, Giacomo Arcuri, Steven Brower, Francesca Bazzocchi, Tong Liu, and Denis Pezet
- Subjects
Protocol (science) ,medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,General surgery ,medicine.medical_treatment ,Cancer ,medicine.disease ,Good clinical practice ,Medicine ,Robotic surgery ,Observational study ,Gastrectomy ,business ,Prospective cohort study ,Laparoscopy - Abstract
Background: Several meta-analyses have tried to defi ne the role of minimally invasive approaches. However, further evidence to get a wider spread of these methods is necessary. Current studies describe minimally invasive surgery as a possible alternative to open surgery but deserving further clarifi cation. However, despite the increasing interest, the difficulty of planning prospective studies of adequate size accounts for the low level of evidence, which is mostly based on retrospective experiences. A multi-institutional prospective study allows the collection of an impressive amount of data to investigate various aspects of minimally invasive procedures with the opportunity of developing several subgroup analyses. A prospective data collection with high methodological quality on minimally invasive and open gastrectomies can clarify the role of diff erent procedures with the aim to develop specifi c guidelines. Methods and analysis: a multi-institutional prospective database will be established including information on surgical, clinical and oncological features of patients treated for gastric cancer with robotic, laparoscopic or open approaches and subsequent follow-up. The study has been shared by the members of the International study group on Minimally Invasive surgery for GASTRIc Cancer (IMIGASTRIC) The database is designed to be an international electronic submission system and a HIPPA protected real time data repository from high volume gastric cancer centers. Ethics: This study is conducted in compliance with ethical principles originating from the Helsinki Declaration, within the guidelines of Good Clinical Practice and relevant laws/regulations. Trial registration number: NCT02751086
- Published
- 2019
35. Economic impacts of care by high-volume providers for non-curative esophagogastric cancer: a population-based analysis
- Author
-
Nicole Mittmann, Natalie G. Coburn, Victoria Zuk, Nicole J. Look Hong, Laura E. Davis, Julie Hallet, Craig C. Earle, and Vaibhav Gupta
- Subjects
Male ,Canada ,Cancer Research ,medicine.medical_specialty ,Esophageal Neoplasms ,Cost-Benefit Analysis ,Health Personnel ,Population ,03 medical and health sciences ,0302 clinical medicine ,Stomach Neoplasms ,Acute care ,Health care ,medicine ,Humans ,Economic impact analysis ,Activity-based costing ,education ,health care economics and organizations ,Aged ,Retrospective Studies ,Aged, 80 and over ,education.field_of_study ,business.industry ,Gastroenterology ,General Medicine ,Middle Aged ,Prognosis ,Combined Modality Therapy ,Confidence interval ,3. Good health ,Quantile regression ,Oncology ,030220 oncology & carcinogenesis ,Emergency medicine ,Female ,030211 gastroenterology & hepatology ,Esophagogastric Junction ,business ,Hospitals, High-Volume ,Follow-Up Studies ,Cohort study - Abstract
Esophagogastric cancer (EGC) is one of the deadliest and costliest malignancies to treat. Care by high-volume providers can provide better outcomes for patients with EGC. Cost implications of volume-based cancer care are unclear. We examined the cost-effectiveness of care by high-volume medical oncology providers for non-curative management of EGC. We conducted a population-based cohort study of non-curative EGC over 2005–2017 by linking administrative datasets. High-volume was defined as ≥ 11 patients/provider/year. Healthcare costs ($USD/patient/month-survived) were computed from diagnosis to death or end of follow-up from the perspective of the healthcare system. Multivariable quantile regression examined the association between care by high-volume providers and costs. Sensitivity analyses were conducted by varying costing horizons and high-volume definitions. Among 7011 non-curative EGC patients, median overall survival was superior with care by high-volume providers with 7.0 (IQR 3.3–13.3) compared to 5.9 (IQR 2.6–12.1) months (p
- Published
- 2019
36. Comparison of Patient-Reported Outcomes in Laparoscopic and Open Right Hemicolectomy: A Retrospective Cohort Study
- Author
-
Laura E. Davis, Natalie G. Coburn, Erin D. Kennedy, Lev D. Bubis, Alyson L. Mahar, and Nivethan Vela
- Subjects
Adult ,Male ,medicine.medical_specialty ,Databases, Factual ,Colorectal cancer ,Treatment outcome ,MEDLINE ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,Patient Reported Outcome Measures ,Young adult ,Colectomy ,Aged ,Retrospective Studies ,Aged, 80 and over ,Ontario ,Patient discharge ,business.industry ,General surgery ,Gastroenterology ,Retrospective cohort study ,General Medicine ,Perioperative ,Middle Aged ,medicine.disease ,Patient Discharge ,Treatment Outcome ,030220 oncology & carcinogenesis ,Colonic Neoplasms ,Female ,Laparoscopy ,030211 gastroenterology & hepatology ,business ,Right hemicolectomy - Abstract
Open and laparoscopic resections for colon cancer have equivalent perioperative morbidity and mortality. However, there are little data concerning patient-reported outcomes in the early postdischarge period.We examined patient-reported outcomes in the early postdischarge period for open and laparoscopic right hemicolectomy for colon cancer.This was a retrospective cohort study.The study was conducted using linked administrative healthcare databases in the province of Ontario, Canada.Patients undergoing laparoscopic or open right hemicolectomy for colon cancer between January 2010 and December 2014 were identified using the Ontario Cancer Registry and physician billing data.The primary outcome was the presence of moderate-to-severe symptom scores on the Edmonton Symptom Assessment System (≥4 of 10) within 6 weeks of hospital discharge after right hemicolectomy.A total of 1022 patients completed ≥1 Edmonton Symptom Assessment System survey within 6 weeks of surgery and were included in the study. Patients undergoing laparoscopic resection were more likely to have an urban residence, to have undergone planned resections, and to have had proportionally more stage 1 disease compared with patients undergoing open resection. On multivariable analyses, adjusting for patient demographics, cancer stage, and planned versus unplanned admission status, there were no differences in the adjusted odds of moderate-to-severe symptom scores between the laparoscopic and open approaches.Edmonton Symptom Assessment System scores are not collected for inpatients and thus only represent outpatient postoperative visits. Scores were reported by 19% of all resections in the population, with a bias to patients treated at cancer centers, and therefore they are not fully representative of the general population of right hemicolectomy. The Edmonton Symptom Assessment System is not a disease-specific tool and may not measure all relevant outcomes for patients undergoing right hemicolectomy.Receipt of the open or laparoscopic surgical technique was not associated with increased risk of elevated symptom burden in the early postdischarge period. See Video Abstract at http://links.lww.com/DCR/B27. REPORTE COMPARATIVO DE RESULTADOS INFORMADOS DE PACIENTES CON HEMICOLECTOMÍA DERECHA LAPAROSCÓPICA Y ABIERTA: UN ESTUDIO DE COHORTE RETROSPECTIVO: Las resecciones abiertas y laparoscópicas para el cáncer de colon, presentan semejante morbilidad y mortalidad perioperatoria. Sin embargo, en el período inicial posterior al alta, hay pocos datos sobre los resultados informados por los pacientes.Examinamos los resultados informados por los pacientes, en el período temprano posterior al alta, para hemicolectomía derecha abierta y laparoscópica en cáncer de colon.Estudio de cohorte retrospectivo.El estudio se realizó utilizando bases de datos administrativas de atención médica en la provincia de Ontario, Canadá.Pacientes sometidos a hemicolectomía derecha abierta o laparoscópica para cáncer de colon, de enero 2010 a diciembre 2014, se identificaron mediante el Registro de cáncer de Ontario y de los datos médicos de facturación.El resultado primario, después de la hemicolectomía derecha, fue la presencia de síntomas de moderados a graves en el Sistema de evaluación de síntomas de Edmonton (≥4 de cada 10) dentro de las seis semanas posteriores al alta hospitalaria.Un total de 1022 pacientes completaron al menos una encuesta del Sistema de evaluación de síntomas de Edmonton, dentro de las seis semanas de la cirugía y se incluyeron en el estudio. Los pacientes sometidos a resección laparoscópica fueron más propensos a residir en zona urbana, a resecciones planificadas y proporcionalmente más enfermedad en estadio 1; en comparación con los pacientes sometidos a resecciones abiertas. En los análisis multivariables, que se ajustaron a la demografía del paciente, al estadio del cáncer y del estado de ingreso planificado versus no planificado, no hubo diferencias en las probabilidades ajustadas de las puntuaciones de los síntomas moderados a severos entre el abordaje abierto o laparoscópico.Las puntuaciones del Sistema de evaluación de síntomas de Edmonton no se recopilan para pacientes hospitalizados y por lo tanto, solo representan las visitas postoperatorias de pacientes ambulatorios. Las puntuaciones informadas fueron del 19% de todas las resecciones en la población, con un sesgo en los pacientes tratados en los Centros de Cáncer y por lo tanto, no son totalmente representativos de la población general de hemicolectomía derecha. El Sistema de evaluación de síntomas de Edmonton no es una herramienta específica de la enfermedad y puede no medir todos los resultados relevantes para los pacientes que se someten a una hemicolectomía derecha.La recepción entre una técnica quirúrgica abierta o laparoscópica, no se asoció con un aumento del riesgo de síntomas en el período temprano posterior al alta. Vea el Resumen del Video en http://links.lww.com/DCR/B27.
- Published
- 2019
37. Incidence of and Factors Associated With Nonfatal Self-injury After a Cancer Diagnosis in Ontario, Canada
- Author
-
Alyson L. Mahar, Ravleen Vasdev, James M. Bolton, Natalie G. Coburn, Victoria Zuk, Barbara Haas, Elie Isenberg-Grzeda, Christopher W. Noel, Stephanie A. Mason, Julie Hallet, Rinku Sutradhar, Wing Chan, Simone N. Vigod, Julie M. Deleemans, and Antoine Eskander
- Subjects
Adult ,Male ,medicine.medical_specialty ,Adolescent ,Population ,Young Adult ,Risk Factors ,Internal medicine ,Neoplasms ,medicine ,Humans ,Cumulative incidence ,Young adult ,education ,Aged ,Retrospective Studies ,Original Investigation ,Ontario ,Psychiatry ,education.field_of_study ,business.industry ,Incidence (epidemiology) ,Incidence ,Research ,Retrospective cohort study ,General Medicine ,Emergency department ,Middle Aged ,Mental health ,Distress ,Online Only ,Female ,business ,Self-Injurious Behavior - Abstract
Key Points Question How common is nonfatal self-injury (NFSI) after a cancer diagnosis, and what are the associated risk factors? Findings In this cohort study of 806 910 adults with cancer, 0.3% of the population had an NFSI event within 5 years of diagnosis. Age, history of severe psychiatric illness, and prior self-injury were the factors most strongly associated with NFSI. Meaning These findings suggest that age, prior severe psychiatric illness, and prior self-injury could be used to identify patients with cancer at risk of NFSI events., This cohort study examines the risk of nonfatal self-injury following a cancer diagnosis., Importance Psychological distress is a key component of patient-centered cancer care. While a greater risk of suicide among patients with cancer has been reported, more frequent consequences of distress, including nonfatal self-injury (NFSI), remain unknown. Objective To examine the risk of NFSI after a cancer diagnosis. Design, Setting, and Participants This population-based retrospective cohort study used linked administrative databases to identify adults diagnosed with cancer between 2007 and 2019 in Ontario, Canada. Exposures Demographic and clinical factors. Main Outcomes and Measures Cumulative incidence of NFSI, defined as emergency department presentation of self-injury, was computed, accounting for the competing risk of death from all causes. Factors associated with NFSI were assessed using multivariable Fine and Gray models. Results In total, 806 910 patients met inclusion criteria. The mean (SD) age was 65.7 (14.3) years, and 405 161 patients (50.2%) were men. Overall, 2482 (0.3%) had NFSI and 182 (
- Published
- 2021
38. Incident Cancer Detection During the COVID-19 Pandemic
- Author
-
Antoine Eskander, Qing Li, Jiayue Yu, Julie Hallet, Natalie G. Coburn, Anna Dare, Kelvin K.W. Chan, Simron Singh, Ambica Parmar, Craig C. Earle, Lauren Lapointe-Shaw, Monika K. Krzyzanowska, Timothy P. Hanna, Antonio Finelli, Alexander V. Louie, Nicole Look Hong, Jonathan C. Irish, Ian J. Witterick, Alyson Mahar, Christopher W. Noel, David R. Urbach, Daniel I. McIsaac, Danny Enepekides, and Rinku Sutradhar
- Subjects
Oncology - Abstract
Background: Resource restrictions were established in many jurisdictions to maintain health system capacity during the COVID-19 pandemic. Disrupted healthcare access likely impacted early cancer detection. The objective of this study was to assess the impact of the pandemic on weekly reported cancer incidence. Patients and Methods: This was a population-based study involving individuals diagnosed with cancer from September 25, 2016, to September 26, 2020, in Ontario, Canada. Weekly cancer incidence counts were examined using segmented negative binomial regression models. The weekly estimated backlog during the pandemic was calculated by subtracting the observed volume from the projected/expected volume in that week. Results: The cohort consisted of 358,487 adult patients with cancer. At the start of the pandemic, there was an immediate 34.3% decline in the estimated mean cancer incidence volume (relative rate, 0.66; 95% CI, 0.57–0.75), followed by a 1% increase in cancer incidence volume in each subsequent week (relative rate, 1.009; 95% CI, 1.001–1.017). Similar trends were found for both screening and nonscreening cancers. The largest immediate declines were seen for melanoma and cervical, endocrinologic, and prostate cancers. For hepatobiliary and lung cancers, there continued to be a weekly decline in incidence during the COVID-19 period. Between March 15 and September 26, 2020, 12,601 fewer individuals were diagnosed with cancer, with an estimated weekly backlog of 450. Conclusions: We estimate that there is a large volume of undetected cancer cases related to the COVID-19 pandemic. Incidence rates have not yet returned to prepandemic levels.
- Published
- 2021
39. 563 VARIATION IN TREATMENT PATTERNS AND OUTCOMES FOR RESECTED ESOPHAGEAL CANCER AT DESIGNATED THORACIC SURGERY CENTERS
- Author
-
Biniam Kidane, Jordan Levy, Rinku Sutradhar, Alyson L. Mahar, Natalie G. Coburn, Gail Darling, Jolie Ringash, and Vaibhav Gupta
- Subjects
medicine.medical_specialty ,Variation (linguistics) ,Cardiothoracic surgery ,business.industry ,Gastroenterology ,medicine ,General Medicine ,Radiology ,Esophageal cancer ,medicine.disease ,business - Abstract
Ontario defined designated thoracic surgery centres to provide high-volume care for patients undergoing esophageal cancer resection. The objective of this study was to compare thoracic centres’ performance to non-thoracic centres, and to assess variation in treatment patterns and outcomes across thoracic centres. Methods A retrospective cohort study (2002–2014) was conducted in Ontario, Canada (population 13.6 million), examining adults with resected esophageal cancer. Case mix, use of neoadjuvant therapy, surgical outcomes (lymph node yield and positive margin rates) and survival were described across the 15 thoracic centres. Multivariable regression was used to estimate the effect of having surgery at designated thoracic centres on postoperative (in-hospital & 90-day post-discharge) mortality and overall survival, adjusting for case mix. Results Of 3,880 patients meeting study criteria, 2,213 had pathology data available and were included in the analysis. Average age was 64 years, 85.7% had adenocarcinoma, 50.2% were pT3, and 38.4% were pN0. Patients at thoracic centres (82.6%) received more neoadjuvant therapy, but there was no difference in positive margin rates, lymph node harvest, postoperative mortality and overall survival between thoracic and non-thoracic centres. Across thoracic centres, rates of neoadjuvant therapy varied from 16.4–81.6%, positive margin rates varied from 8.2–29.6%, median lymph node harvest varied from 7–20 nodes, postoperative mortality varied from 0–18.7%, and median survival varied from 17–26 months. Conclusion There was significant variability in treatment patterns, surgical outcomes, and survival among patients treated at designated thoracic centres. Feedback of patient outcomes to surgeons and hospitals, and translating best practices from high-performing hospitals to other hospitals, is the next step in improving outcomes.
- Published
- 2021
40. 587 PATIENT-REPORTED SYMPTOMS FOR ESOPHAGEAL CANCER PATIENTS UNDERGOING CURATIVE INTENT TREATMENT
- Author
-
Laura E. Davis, Catherine Allen-Ayodabo, Vaibhav Gupta, Natalie G. Coburn, Jolie Ringash, Gail Darling, Alyson L. Mahar, Julie Hallet, Biniam Kidane, and Haoyu Zhao
- Subjects
Curative intent ,medicine.medical_specialty ,business.industry ,Internal medicine ,Gastroenterology ,Medicine ,General Medicine ,Esophageal cancer ,business ,medicine.disease - Abstract
Esophageal cancer (EC) patients experience considerable symptom burden from treatment. This study utilized population-level patient-reported Edmonton Symptom Assessment System (ESAS) scores collected as part of standard clinical care to describe symptom trajectories and characteristics associated with severe symptoms for patients undergoing curative intent EC treatment. Methods EC patients treated with curative intent at regional cancer centers and affiliates between 2009–2016 and assessed for symptoms in the 12 months following diagnosis were included. ESAS measures nine common patient-reported cancer symptoms. The outcome was reporting of severe (≥7/10) symptom scores. Multivariable analyses were used to identify characteristics associated with severe symptom scores. Results 1,751 patients reported a median of 7 (IQR 4–12) ESAS assessments in the year following diagnosis, for a total of 14,953 unique ESAS assessments included in the analysis. The most frequently reported severe symptoms were lack of appetite (n = 918, 52%), tiredness (n = 787, 45%) and poor wellbeing (713, 40.7%). The highest symptom burden is within the first five months following diagnosis, with moderate improvement in symptom burden in the second half of the first year. Characteristics associated with severe scores for all symptoms included female sex, high comorbidity, lower socioeconomic status, urban residence, and symptom assessment temporally close to diagnosis. Conclusion This study demonstrates a high symptom burden for EC patients undergoing curative intent therapy. Targeted treatment of common severe symptoms, and increased support for patients at risk for severe symptoms, may enhance patient quality of life.
- Published
- 2021
41. 590 VARIATION IN RECEIPT OF THERAPY AND SURVIVAL WITH PROVIDER-VOLUME IN NON-CURATIVE ESOPHAGO-GASTRIC CANCER: A POPULATION-BASED ANALYSIS
- Author
-
Alyson L. Mahar, Natalie G. Coburn, Victoria Zuk, Julie Hallet, Craig C. Earle, Ying Lui, Vaibhav Gupta, and Laura E. Davis
- Subjects
Receipt ,Oncology ,medicine.medical_specialty ,business.industry ,Gastroenterology ,Cancer ,General Medicine ,Population based ,medicine.disease ,Variation (linguistics) ,Internal medicine ,medicine ,business ,Volume (compression) - Abstract
While surgical care by high-volume providers for esophago-gastric cancer (EGC) yields better outcomes, volume-outcome relationships are unknown for systemic therapy. We examined receipt of therapy and outcomes in the non-curative management of EGC based on medical oncology provider-volume. Methods We conducted a population based retrospective cohort study of non-curative EGC over 2005–2017 by linking administrative healthcare datasets. The volume of new EGC consultations per medical oncology provider per year was calculated and divided into quintiles. High-volume (HV) providers were defined as the 4-5th quintiles. Outcomes were receipt of chemotherapy and overall survival (OS). Multivariate logistic and Cox-proportional hazards regressions examined the association between management by HV provider, receipt of systemic therapy, and OS. Results 7,011 EGC patients with non-curative management consulted with medical oncology. One-year OS was superior for HV providers (>11 patients/year), with 28.4% (95%CI: 26.7–30.2%) compared to 25.1% (95%CI: 23.8–26.3%) for low-volume (p Conclusion Medical oncology provider-volume was associated with variation in non-curative management and outcomes of EGC. Care by a HV provider was independently associated with higher odds of receiving chemotherapy and superior OS, after adjusting for case-mix. This information is important to inform disease care pathways and care organization; increase in the number of HV providers may reduce variation and improve outcomes.
- Published
- 2021
42. Minimally Invasive Compared to Open Colorectal Cancer Resection for Older Adults: A Population-based Analysis of Long-term Functional Outcomes
- Author
-
Natalie G. Coburn, Victoria Zuk, Ramy Behman, Barbara Haas, Alyson L. Mahar, Haoyu Zhao, Shady Ashamalla, Lev D. Bubis, Julie Hallet, and Tyler R. Chesney
- Subjects
medicine.medical_specialty ,education.field_of_study ,Colorectal cancer ,business.industry ,Hazard ratio ,Population ,MEDLINE ,medicine.disease ,Confidence interval ,Resection ,Interquartile range ,Internal medicine ,Open Resection ,medicine ,Surgery ,education ,business - Abstract
Objective We sought to compare long-term healthcare dependency and time-at-home between older adults undergoing minimally invasive surgery (MIS) for colorectal cancer (CRC) and those undergoing open resection. Background Although the benefits of MIS for CRC resection are established, data specific to older adults are lacking. Long-term functional outcomes, central to decision-making in the care for older adults, are unknown. Methods We performed a population-based analysis of patients ≥70 years old undergoing CRC resection between 2007 to 2017 using administrative datasets. Outcomes were receipt of homecare and "high" time-at-home, which we defined as years with ≤14 institution-days, in the 5 years after surgery. Homecare was analyzed using time-to-event analyses as a recurrent dichotomous outcome with Andersen-Gill multivariable models. High time-at-home was assessed using Cox multivariable models. Results Of 16,479 included patients with median follow-up of 4.3 (interquartile range 2.1-7.1) years, 7822 had MIS (47.5%). The MIS group had lower homecare use than the open group with 22.3% versus 31.6% at 6 months and 14.8% versus 19.4% at 1 year [hazard ratio 0.87, 95% confidence interval (CI) 0.83-0.92]. The MIS group had higher probability of high time-at-home than open surgery with 54.9% (95% CI 53.6%-56.1%) versus 41.2% (95% CI 40.1%-42.3%) at 5 years (hazard ratio 0.71, 95% CI 0.68-0.75). Conclusions Compared to open surgery, MIS for CRC resection was associated with lower homecare needs and higher probability of high time-at-home in the 5 years after surgery, indicating reduced long-term functional dependence. These are important patient-centered endpoints reflecting the overall long-term treatment burden to be taken into consideration in decision-making.
- Published
- 2021
43. Serum amlyoid A: An inflammatory adipokine mediating postburn outcomes
- Author
-
Nancy Yu, Roohi Vinaik, Osai Samadi, Abdikarim Abdullahi, Mile Stanojcic, Natalie G. Coburn, Ali-Reza Sadri, and Marc G. Jeschke
- Subjects
0303 health sciences ,Serum Amyloid A Protein ,Medicine (General) ,business.industry ,MEDLINE ,Medicine (miscellaneous) ,Adipokine ,Bioinformatics ,Antibodies, Monoclonal, Humanized ,Prognosis ,Letter to Editor ,03 medical and health sciences ,0302 clinical medicine ,Text mining ,R5-920 ,Case-Control Studies ,Sepsis ,Molecular Medicine ,Medicine ,Humans ,030212 general & internal medicine ,business ,Burns ,030304 developmental biology - Published
- 2021
44. All-Cause and Cancer-Specific Death of Older Adults Following Surgery for Cancer
- Author
-
Laura E. Davis, Tyler R. Chesney, Natalie G. Coburn, Victoria Zuk, Alyson L. Mahar, Frances C. Wright, Amy T Hsu, Julie Hallet, Barbara Haas, and Haoyu Zhao
- Subjects
Male ,medicine.medical_specialty ,Population ,MEDLINE ,030230 surgery ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Interquartile range ,Prostate ,Cause of Death ,Neoplasms ,Medicine ,Humans ,Cumulative incidence ,education ,Aged ,Original Investigation ,Aged, 80 and over ,Ontario ,education.field_of_study ,Frailty ,business.industry ,Age Factors ,Cancer ,medicine.disease ,Surgery ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Female ,business ,All cause mortality ,Cohort study - Abstract
Importance Cancer care has inherent complexities in older adults, including balancing risks of cancer and noncancer death. A poor understanding of cause-specific outcomes may lead to overtreatment and undertreatment. Objective To examine all-cause and cancer-specific death throughout 5 years for older adults after cancer resection. Design, setting, and participants This population-based cohort study was conducted in Ontario, Canada, using the administrative databases stored at ICES (formerly the Institute for Clinical Evaluative Sciences). All adults 70 years or older who underwent resection for a new diagnosis of cancer between January 1, 2007, and December 31, 2017, were included. Patients were followed up until death or censored at date of last contact of December 31, 2018. Exposures Cancer resection. Main outcome and measures Using a competing risks approach, the cumulative incidence of cancer and noncancer death was estimated and stratified by important prognostic factors. Multivariable subdistribution hazard models were fit to explore prognostic factors. Results Of 82 037 older adults who underwent surgery (all older than 70 years; 52 119 [63.5%] female), 16 900 of 34 044 deaths (49.6%) were cancer related at a median (interquartile range) follow-up of 46 (23-80) months. At 5 years, estimated cumulative incidence of cancer death (20.7%; 95% CI, 20.4%-21.0%) exceeded noncancer death (16.5%; 95% CI, 16.2%-16.8%) among all patients. However, noncancer deaths exceeded cancer deaths starting at 3 years after surgery in breast, prostate, and melanoma skin cancers, patients older than 85 years, and those with frailty. Cancer type, advancing age, and frailty were independently associated with cause-specific death. Conclusions and relevance At the population level, the relative burden of cancer deaths exceeds noncancer deaths for older adults selected for surgery. No subgroup had a higher burden of noncancer death early after surgery, even in more vulnerable patients. This cause-specific overall prognosis information should be used for patient counseling, to assess patterns of over- or undertreatment in older adults with cancer at the system level, and to guide targets for system-level improvements to refine selection criteria and perioperative care pathways for older adults with cancer.
- Published
- 2021
45. Variation in receipt of therapy and survival with provider volume for medical oncology in non-curative esophago-gastric cancer: a population-based analysis
- Author
-
Laura E. Davis, Alyson L. Mahar, Ying Liu, Natalie G. Coburn, Victoria Zuk, Julie Hallet, Vaibhav Gupta, and Craig C. Earle
- Subjects
Male ,Oncology ,Cancer Research ,medicine.medical_specialty ,Esophageal Neoplasms ,Workload ,Disease ,Systemic therapy ,Insurance Coverage ,03 medical and health sciences ,0302 clinical medicine ,Case mix index ,Stomach Neoplasms ,Surgical oncology ,Internal medicine ,Antineoplastic Combined Chemotherapy Protocols ,Health care ,medicine ,Humans ,Prospective Studies ,Aged ,Quality of Health Care ,Retrospective Studies ,Aged, 80 and over ,Oncologists ,Insurance, Health ,business.industry ,Gastroenterology ,Cancer ,Retrospective cohort study ,General Medicine ,Middle Aged ,Prognosis ,medicine.disease ,Comorbidity ,Survival Rate ,030220 oncology & carcinogenesis ,Female ,030211 gastroenterology & hepatology ,business ,Hospitals, High-Volume ,Follow-Up Studies - Abstract
While surgical care by high-volume providers for esophago-gastric cancer (EGC) yields better outcomes, volume–outcome relationships are unknown for systemic therapy. We examined receipt of therapy and outcomes in the non-curative management of EGC based on medical oncology provider volume. We conducted a population based retrospective cohort study of non-curative EGC over 2005–2017 by linking administrative healthcare datasets. The volume of new EGC consultations per medical oncology provider per year was calculated and divided into quintiles. High-volume (HV) medical oncologists were defined as the 4–5th quintiles. Outcomes were receipt of chemotherapy and overall survival (OS). Multivariate logistic and Cox-proportional hazards regressions examined the association between management by HV medical oncologist, receipt of systemic therapy, and OS. 7011 EGC patients with non-curative management consulted with medical oncology. 1-year OS was superior for HV medical oncologists (> 11 patients/year), with 28.4% (95% CI 26.7–30.2%) compared to 25.1% (95% CI 23.8–26.3%) for low volume (p
- Published
- 2019
46. Economic Analysis of Adjuvant Chemoradiotherapy Compared with Chemotherapy in Resected Pancreas Cancer
- Author
-
Ying Liu, Craig C. Earle, Sten Myrehaug, Nivethan Vela, Laura E. Davis, Nicole Mittmann, Daniel J. Kagedan, Lev D. Bubis, Alyson L. Mahar, Lawrence Paszat, Ahmed Hammad, Natalie G. Coburn, and Stephanie Y. Cheng
- Subjects
Male ,Oncology ,medicine.medical_specialty ,medicine.medical_treatment ,Population ,Adenocarcinoma ,03 medical and health sciences ,0302 clinical medicine ,Surgical oncology ,Internal medicine ,Antineoplastic Combined Chemotherapy Protocols ,Humans ,Medicine ,education ,Survival rate ,Aged ,Retrospective Studies ,education.field_of_study ,business.industry ,Hazard ratio ,Cancer ,Retrospective cohort study ,Chemoradiotherapy, Adjuvant ,Middle Aged ,Prognosis ,medicine.disease ,Pancreaticoduodenectomy ,3. Good health ,Pancreatic Neoplasms ,Survival Rate ,Chemotherapy, Adjuvant ,030220 oncology & carcinogenesis ,Female ,030211 gastroenterology & hepatology ,Surgery ,business ,Chemoradiotherapy ,Follow-Up Studies - Abstract
Population-based survival and costs of pancreas adenocarcinoma patients receiving adjuvant chemoradiation and chemotherapy following pancreaticoduodenectomy are poorly understood. This retrospective cohort study used linked administrative and pathological datasets to identify all patients diagnosed with pancreas adenocarcinoma and undergoing pancreaticoduodenectomy in Ontario between April 2004 and March 2014, who received postoperative chemoradiation or chemotherapy. Stage and margin status were defined by using pathology reports. Kaplan–Meier and Cox proportional hazards regression survival analyses were used to determine associations between adjuvant treatment approach and survival, while stratifying by margin status. Median overall health system costs were calculated at 1 and 3 years for chemoradiation and chemotherapy, and differences were tested using the Kruskal–Wallis test. Among 709 patients undergoing pancreaticoduodenectomy for pancreas cancer during the study period, the median survival was 21 months. Median survival was 19 months for chemoradiation and 22 months for chemotherapy. Patients receiving chemoradiation were more likely to have positive margins: 47.7% compared with 19.2% in chemotherapy. After stratifying by margin status and controlling for confounders, adjusted hazard ratio of death were not statistically different between chemotherapy and chemoradiation [margin positive, hazard ratio (HR) = 0.99, 95% confidence interval (CI) = 0.88–1.27; margin negative, HR 0.95, 95% CI 0.91–1.18]. Overall 1-year health system costs were significantly higher for chemoradiation (USD $70,047) than chemotherapy (USD $54,005) (p ≤ 0.001). Chemotherapy and chemoradiation yielded similar survival, but chemoradiation resulted in higher costs. To create more sustainable healthcare systems, both the efficacy and costs of therapies should be considered.
- Published
- 2019
47. Late Gadolinium Hyperintensity of Suspected Colorectal Liver Metastases on Gadofosveset-Enhanced Magnetic Resonance Imaging: A Predictor of Benignity and a Potential Problem-Solving Tool
- Author
-
Paul J. Karanicolas, Natalie G. Coburn, Helen M. C. Cheung, Calvin Law, and Laurent Milot
- Subjects
Adult ,Male ,medicine.medical_specialty ,Colorectal cancer ,Clinical Decision-Making ,Contrast Media ,Gadolinium ,030218 nuclear medicine & medical imaging ,Gadobutrol ,Metastasis ,Diagnosis, Differential ,03 medical and health sciences ,0302 clinical medicine ,Organometallic Compounds ,Humans ,Medicine ,Radiology, Nuclear Medicine and imaging ,Prospective Studies ,Aged ,Receiver operating characteristic ,medicine.diagnostic_test ,business.industry ,Benignity ,Liver Neoplasms ,Gadofosveset ,Reproducibility of Results ,Magnetic resonance imaging ,General Medicine ,Middle Aged ,Image Enhancement ,medicine.disease ,Magnetic Resonance Imaging ,Hyperintensity ,Liver ,030220 oncology & carcinogenesis ,Female ,Radiology ,Colorectal Neoplasms ,business ,medicine.drug - Abstract
PurposeLate gadolinium hyperintensity (LGH) is sometimes seen in colorectal liver metastasis (CRLM) and represents a significant diagnostic pitfall due to overlap with LGH in benign hemangiomas; therefore, the objective of this study was to determine the prevalence of LGH and the ability of LGH to differentiate between CRLM and benign lesions with intravascular (gadofosveset) vs extracellular contrast agents (gadobutrol).MethodsPatients with known colorectal cancer and suspected liver lesions were prospectively recruited into this institutional review board–approved, single institution study and received magnetic resonance imaging of the liver with gadofosveset and gadobutrol. The prevalence of LGH for CRLMs and solid benign lesions was determined. Receiver operating characteristics curves were determined for the presence of LGH as a predictor of benignity. The utility of LGH to differentiate between CRLM and solid benign lesions using gadofosveset vs gadobutrol was compared using the generalized estimating equation.ResultsTwenty-five patients with 131 solid focal liver lesions were recruited. The prevalence of LGH of CRLMs was 11.2% (95% confidence interval [CI]: 0.5%–21.8%) with gadofosveset vs 63.7% (95% CI: 45.7%–81.7%) with gadobutrol. The area under the receiver operating characteristic curve for the presence of LGH as a predictor of benignity was 0.86 using gadofosveset vs 0.75 using gadobutrol. Both LGH ( P = .003) and the interaction of contrast agent and LGH ( P = .003) statistically significantly differentiated CRLM from benign lesions.ConclusionLGH is more common with extracellular than with intravascular contrast agents and is statistically significantly associated with benign lesions rather than metastases.
- Published
- 2019
48. Patterns of Symptoms Burden in Neuroendocrine Tumors: A Population-Based Analysis of Prospective Patient-Reported Outcomes
- Author
-
Julie Hallet, Sten Myrehaug, Laura E. Davis, Natalie G. Coburn, Simron Singh, Kaitlyn Beyfuss, Lev D. Bubis, Calvin Law, Haoyu Zhao, Lesley Moody, Elie Isenberg-Grzeda, and Alyson L. Mahar
- Subjects
Adult ,Male ,Cancer Research ,Pediatrics ,medicine.medical_specialty ,Adolescent ,Disease ,Cohort Studies ,Young Adult ,03 medical and health sciences ,symbols.namesake ,0302 clinical medicine ,Quality of life ,medicine ,Humans ,Patient Reported Outcome Measures ,Prospective Studies ,030212 general & internal medicine ,Poisson regression ,Socioeconomic status ,Aged ,Retrospective Studies ,Aged, 80 and over ,business.industry ,Middle Aged ,medicine.disease ,Comorbidity ,Identified patient ,Neuroendocrine Tumors ,Oncology ,Symptom Management and Supportive Care ,030220 oncology & carcinogenesis ,symbols ,Anxiety ,Female ,medicine.symptom ,business ,Cohort study - Abstract
Background How to best support patients with neuroendocrine tumors (NETs) remains unclear. Improving quality of care requires an understanding of symptom trajectories. Objective validated assessments of symptoms burden over the course of disease are lacking. This study examined patterns and risk factors of symptom burden in NETs, using patient-reported outcomes. Subjects, Materials, and Methods A retrospective, population-based, observational cohort study of patients with NETs diagnosed from 2004 to 2015, who survived at least 1 year, was conducted. Prospectively collected patient-reported Edmonton Symptom Assessment System scores were linked to provincial administrative health data sets. Moderate-to-severe symptom scores were presented graphically for both the 1st year and 5 years following diagnosis. Multivariable Poisson regression identified factors associated with record of moderate-to-severe symptom scores during the 1st year after diagnosis. Results Among 2,721 included patients, 7,719 symptom assessments were recorded over 5 years following diagnosis. Moderate-to-severe scores were most frequent for tiredness (40%–51%), well-being (37%–49%), and anxiety (30%–40%). The proportion of moderate-to-severe symptoms was stable over time. Proportion of moderate-to-severe anxiety decreased by 10% within 6 months of diagnosis, followed by stability thereafter. Changes were below 5% for other symptoms. Similar patterns were observed for the 1st year after diagnosis. Primary tumor site, metastatic disease, younger age, higher comorbidity burden, lower socioeconomic status, and receipt of therapy within 30 days of assessment were independently associated with higher risk of elevated symptom burden. Conclusion Patients with NETs have a high prevalence of moderate-to-severe patient-reported symptoms, with little change over time. Patients remain at risk of prolonged symptom burden following diagnosis, highlighting potential unmet needs. Combined with identified patient and disease factors associated with moderate-to-severe symptom scores, this information is important to support symptom management strategies to improve patient-centered care. Implications for Practice This study used population-level, prospectively collected, validated, patient-reported outcome measures to appraise the symptoms burden and trajectory of patients with neuroendocrine tumors (NETs) after diagnosis. It is the largest and most detailed analysis of patient-reported symptoms for NETs. Patients with NETs present a high burden of symptoms at diagnosis that persists up to 5 years later, highlighting unmet needs. Early and comprehensive symptom screening and management programs are needed. This information should serve to devise pathways and policies to better support patients, evaluate supportive interventions, and assess the effectiveness of symptom management at the provider, institutional, and system levels.
- Published
- 2019
49. Management of asymptomatic, well-differentiated PNETs: results of the Delphi consensus process of the Americas Hepato-Pancreato-Biliary Association
- Author
-
Kenneth D. Chavin, Ajay V. Maker, Scott Celinski, James R. Howe, Kenneth Cardona, Susanne G. Warner, Natalie G. Coburn, Robert S. Warren, Quan P. Ly, Gareth Morris-Stiff, Steven K. Libutti, Charles R. St. Hill, Zhi Fong, Philippa Newell, and John C. Mansour
- Subjects
medicine.medical_specialty ,Consensus ,Delphi Technique ,Biopsy ,MEDLINE ,Delphi method ,Extent of resection ,Asymptomatic ,medicine ,Humans ,Neuroectodermal Tumors, Primitive ,Tumor location ,Societies, Medical ,computer.programming_language ,Hepatology ,business.industry ,General surgery ,Gastroenterology ,Hepato pancreato biliary ,Well differentiated ,Splenectomy ,Lymph Node Excision ,Americas ,medicine.symptom ,business ,computer ,Delphi - Abstract
Variation in the management of PNETs exist due to the limited high-level evidence to guide clinical practice. The aim of this work is to generate consensus guidelines with a Delphi process for managing PNETs.A panel of experts reviewed the surgical literature and scored a set of clinical case statements using a web-based survey to identify areas of agreement and disagreement. Results of the survey were discussed after each round of review. This cycle was repeated until no further likelihood of reaching consensus existed.Twenty-two case statements related to surgical indications, preoperative biopsy, extent of resection, type of surgery, and tumor location were scored. Using a pre-defined definition of consensus, the panel achieved consensus on the following: i) resection is not recommended for1 cm lesions; ii) resection is recommended for lesions greater than 2 cm; iii) lymph node dissection is recommended for radiographically-suspicious nodes with splenectomy for distal lesions; iv) tumor enucleation and central pancreatectomy are acceptable when technically feasible. No consensus was reached regarding issues of preoperative biopsy or 1-2 cm tumors.Using a structured, validated system for identifying consensus, an expert panel identified areas of agreement regarding critical management decisions for patients with PNET. Issues without consensus warrant additional clinical investigation.
- Published
- 2019
50. Late gadolinium MRI enhancement of colorectal liver metastases is associated with overall survival among nonsurgical patients
- Author
-
Helen M. C. Cheung, Calvin Law, Natalie G. Coburn, Laurent Milot, Jin K Kim, Paul J. Karanicolas, and John M. Hudson
- Subjects
Adult ,Male ,medicine.medical_specialty ,Rectum ,Gadolinium ,Kaplan-Meier Estimate ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Survival analysis ,Aged ,Proportional Hazards Models ,Retrospective Studies ,Neuroradiology ,medicine.diagnostic_test ,Proportional hazards model ,business.industry ,Liver Neoplasms ,Hazard ratio ,Confounding ,Magnetic resonance imaging ,Retrospective cohort study ,General Medicine ,Middle Aged ,Magnetic Resonance Imaging ,Carcinoembryonic Antigen ,body regions ,medicine.anatomical_structure ,Female ,Radiology ,Colorectal Neoplasms ,business - Abstract
To determine if late gadolinium MRI enhancement of colorectal liver metastases (CRCLM) is associated with overall survival among nonsurgical patients. This retrospective study was approved by the institutional research ethics board. Late gadolinium enhancement was measured using target tumour enhancement (TTE) in all nonsurgical patients with CRCLM who received a 10-min delayed phase gadobutrol-enhanced liver MRI between March 1, 2006, and August 31, 2014. A total of 122 patients met inclusion/exclusion criteria. Patients were dichotomized into strong and weak TTE. Kaplan-Meier and Cox regression statistics were used to determine whether TTE was associated with overall survival. Noncontributory potential confounding variables (age, sex, number and size of metastases, carcinoembryonic (CEA) level, and presence of extrahepatic disease) were excluded from the final Cox regression model using the backward Wald elimination. Subgroup Kaplan-Meier survival analyses were performed on patients who were chemotherapy-naive and chemotherapy-treated at the time of MRI. Strong TTE had increased survival compared with those with weak TTE on Kaplan-Meier analysis (2-year survival: 69.8% vs. 43.5%, p = 0.002). Among 96 patients where data was available for multivariable analysis, weak TTE was associated with death (adjusted hazard ratio 0.25, 95% CI 0.11–0.59, p = 0.002), after adjusting for CEA level. Other potential confounders were noncontributory. Subgroup analyses demonstrated that strong TTE had increased survival compared with those with weak TTE in both the chemotherapy-naive (p = 0.047) and chemotherapy-treated (p = 0.008) groups. Strong late gadolinium MRI enhancement of CRCLM is associated with overall survival among nonsurgical patients. • MRI enhancement of colorectal liver metastases is associated with overall survival in nonsurgical patients. • MRI enhancement of colorectal liver metastases is associated with overall survival in both chemotherapy-naive and chemotherapy-treated subgroups.
- Published
- 2019
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.