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FISH cytogenetics, TP53 sequencing, and IGHV mutational status are increasingly used as prognostic and predictive markers in chronic lymphocytic leukemia (CLL), particularly as components of the CLL International Prognostic Index (CLL-IPI) and in directing therapy with novel agents. However, testing outside of clinical trials is not routinely available in Canada. As a centralized CLL clinic at CancerCare Manitoba, we are the first Canadian province to evaluate clinical outcomes and survivorship over a long period of time, incorporating the impact of molecular testing and the CLL-IPI score. We performed a retrospective analysis on 1315 patients diagnosed between 1960 and 2018, followed over a 12-year period, where 411 patients had molecular testing and 233 patients had a known CLL-IPI score at the time of treatment. Overall, 40.3% (n = 530) of patients received treatment, and 47.5% (n = 252) of patients received multiple lines of therapy. High-risk FISH and CLL-IPI (4-10) were associated with higher mortality (HR 2.03, p = 0.001; HR 2.64, p = 0.002), consistent with other studies. Over time, there was an increase in the use of targeted agents in treated patients. The use of Bruton’s tyrosine kinase inhibitors improved survival in patients with unmutated IGHV and/or TP53 aberrations (HR 2.20, p = 0.001). The major cause of death in patients who received treatment was treatment/disease-related (32%, n = 42) and secondary malignancies (57%, n = 53) in those who were treatment-naïve. Our data demonstrate the importance of molecular testing in determining survivorship in CLL and underpinning the likely immune differences in outcomes for those treated for CLL.

Cancer stage at diagnosis is important information for management and treatment of individual patients as well as in epidemiological studies to evaluate effectiveness of health care system in managing cancer patients. Population-based studies to examine international disparities on cancer survival by stage, however, has been challenging due to the lack of international standardization on recording stage information and variation in stage completeness across regions and countries. The International Cancer Benchmarking Partnership (ICBP) previously assessed the availability and comparability of staging information for colorectal, lung, female breast, and ovarian cancers. Stage conversion algorithms were developed to aggregate and map all stage information into a single staging system to allow international comparison by stage at diagnosis. In this paper, we developed stage conversion algorithms for three additional cancers, namely oesophageal, gastric, and pancreatic cancers. We examined all stage information available, evaluated stage completeness, applied each stage conversion algorithm, and assessed the magnitude of misclassification using data from six Canadian cancer registries (Alberta, Manitoba, Newfoundland, Nova Scotia, Prince Edward Island, and Saskatchewan). In addition, we discussed five recommendations for registries to improve international cancer survival comparison by stage: 1) improve collection and completeness of staging data; 2) promote a comparable definition for stage at diagnosis; 3) promote the use of a common stage classification system; 4) record versions of staging classifications; and 5) use multiple data sources for valid staging data. This article is protected by copyright. All rights reserved.

BACKGROUND High-grade gliomas impose substantial morbidity and mortality due to rapid cancer progression and recurrence. Factors such as surgery, chemotherapy and radiotherapy remain the cornerstones for treatment of brain cancer and brain cancer research. The role of anesthetics on glioma progression is largely unknown. METHODS This multicenter retrospective cohort study compared patients who underwent high-grade glioma resection with minimal sedation (awake craniotomy) and those who underwent craniotomy with general anesthesia (GA). Various perioperative factors, intraoperative and postoperative complications, and adjuvant treatment regimens were recorded. The primary outcome was progression-free survival (PFS); secondary outcomes were overall survival (OS), postoperative pain score, and length of hospital stay. RESULTS A total of 891 patients were included; 79% received GA, and 21% underwent awake craniotomy. There was no difference in median PFS between awake craniotomy (0.54, 95% confidence interval [CI]: 0.45-0.65 y) and GA (0.53, 95% CI: 0.48-0.60 y) groups (hazard ratio 1.05; P

In 2013, CancerCare Manitoba (CCMB) launched an urgent cancer care clinic (UCC) to meet the needs of individuals diagnosed with cancer experiencing acute complications of cancer or its treatment. This retrospective cohort study compared the characteristics of individuals diagnosed with cancer that visited the UCC to those who visited an emergency department (ED) and determined predictors of use. Multivariable logistic mixed models were run to predict an individual’s likelihood of visiting the UCC or an ED. Scaled Brier scores were calculated to determine how greatly each predictor impacted UCC or ED use. We found that UCC visits increased up to 4 months after eligibility to visit and then decreased. ED visits were highest immediately after eligibility and then decreased. The median number of hours between triage and discharge was 2 h for UCC visits and 9 h for ED visits. Chemotherapy had the strongest association with UCC visits, whereas ED visits prior to diagnosis had the strongest association with ED visits. Variables related to socioeconomic status were less strongly associated with UCC or ED visits. Future studies would be beneficial to planning service delivery and improving clinical outcomes and patient satisfaction.

Background:\ud Greater understanding of international cancer survival differences is needed. We aimed to identify predictors and consequences of cancer diagnosis through emergency presentation in different international jurisdictions in six high-income countries.\ud \ud Methods:\ud Using a federated analysis model, in this cross-sectional population-based study, we analysed cancer registration and linked hospital admissions data from 14 jurisdictions in six countries (Australia, Canada, Denmark, New Zealand, Norway, and the UK), including patients with primary diagnosis of invasive oesophageal, stomach, colon, rectal, liver, pancreatic, lung, or ovarian cancer during study periods from Jan 1, 2012, to Dec 31, 2017. Data were collected on cancer site, age group, sex, year of diagnosis, and stage at diagnosis. Emergency presentation was defined as diagnosis of cancer within 30 days after an emergency hospital admission. Using logistic regression, we examined variables associated with emergency presentation and associations between emergency presentation and short-term mortality. We meta-analysed estimates across jurisdictions and explored jurisdiction-level associations between cancer survival and the percentage of patients diagnosed as emergencies.\ud \ud Findings:\ud In 857 068 patients across 14 jurisdictions, considering all of the eight cancer sites together, the percentage of diagnoses through emergency presentation ranged from 24·0% (9165 of 38 212 patients) to 42·5% (12 238 of 28 794 patients). There was consistently large variation in the percentage of emergency presentations by cancer site across jurisdictions. Pancreatic cancer diagnoses had the highest percentage of emergency presentations on average overall (46·1% [30 972 of 67 173 patients]), with the jurisdictional range being 34·1% (1083 of 3172 patients) to 60·4% (1317 of 2182 patients). Rectal cancer had the lowest percentage of emergency presentations on average overall (12·1% [10 051 of 83 325 patients]), with a jurisdictional range of 9·1% (403 of 4438 patients) to 19·8% (643 of 3247 patients). Across the jurisdictions, older age (ie, 75–84 years and 85 years or older, compared with younger patients) and advanced stage at diagnosis compared with non-advanced stage were consistently associated with increased emergency presentation risk, with the percentage of emergency presentations being highest in the oldest age group (85 years or older) for 110 (98%) of 112 jurisdiction-cancer site strata, and in the most advanced (distant spread) stage category for 98 (97%) of 101 jurisdiction-cancer site strata with available information. Across the jurisdictions, and despite heterogeneity in association size (I2=93%), emergency presenters consistently had substantially greater risk of 12-month mortality than non-emergency presenters (odds ratio >1·9 for 112 [100%] of 112 jurisdiction-cancer site strata, with the minimum lower bound of the related 95% CIs being 1·26). There were negative associations between jurisdiction-level percentage of emergency presentations and jurisdiction-level 1-year survival for colon, stomach, lung, liver, pancreatic, and ovarian cancer, with a 10% increase in percentage of emergency presentations in a jurisdiction being associated with a decrease in 1-year net survival of between 2·5% (95% CI 0·28–4·7) and 7·0% (1·2–13·0).\ud \ud Interpretation:\ud Internationally, notable proportions of patients with cancer are diagnosed through emergency presentation. Specific types of cancer, older age, and advanced stage at diagnosis are consistently associated with an increased risk of emergency presentation, which strongly predicts worse prognosis and probably contributes to international differences in cancer survival. Monitoring emergency presentations, and identifying and acting on contributing behavioural and health-care factors, is a global priority for cancer control.\ud \ud Funding:\ud Canadian Partnership Against Cancer; Cancer Council Victoria; Cancer Institute New South Wales; Cancer Research UK; Danish Cancer Society; National Cancer Registry Ireland; The Cancer Society of New Zealand; National Health Service England; Norwegian Cancer Society; Public Health Agency Northern Ireland, on behalf of the Northern Ireland Cancer Registry; the Scottish Government; Western Australia Department of Health; and Wales Cancer Network.

IntroductionLung cancer has a poor prognosis that varies internationally when assessed by the two major histological subgroups (non-small cell (NSCLC) and small cell (SCLC)).Method236 114 NSCLC and 43 167 SCLC cases diagnosed during 2010–2014 in Australia, Canada, Denmark, Ireland, New Zealand, Norway and the UK were included in the analyses. One-year and 3-year age-standardised net survival (NS) was estimated by sex, histological type, stage and country.ResultsOne-year and 3-year NS was consistently higher for Canada and Norway, and lower for the UK, New Zealand and Ireland, irrespective of stage at diagnosis. Three-year NS for NSCLC ranged from 19.7% for the UK to 27.1% for Canada for men and was consistently higher for women (25.3% in the UK; 35.0% in Canada) partly because men were diagnosed at more advanced stages. International differences in survival for NSCLC were largest for regional stage and smallest at the advanced stage. For SCLC, 3-year NS also showed a clear female advantage with the highest being for Canada (13.8% for women; 9.1% for men) and Norway (12.8% for women; 9.7% for men).ConclusionDistribution of stage at diagnosis among lung cancer cases differed by sex, histological subtype and country, which may partly explain observed survival differences. Yet, survival differences were also observed within stages, suggesting that quality of treatment, healthcare system factors and prevalence of comorbid conditions may also influence survival. Other possible explanations include differences in data collection practice, as well as differences in histological verification, staging and coding across jurisdictions.

Small-cell lung cancer (SCLC) is highly responsive to chemotherapy (CT) and one of the few malignancies treated in hospitalized patients with poor Eastern Cooperative Oncology Group (ECOG) performance status (PS). Because of the little current information available on the outcomes experienced by hospitalized patients with SCLC receiving CT, we explored the outcomes for these patients to improve the evidence base for practice.We conducted a retrospective cohort study to evaluate patients with a diagnosis of SCLC and treated with CT during a 10-year period. Progression-free survival (PFS) and overall survival (OS) were evaluated according to site of first CT (inpatient vs. outpatient) and PS. Multivariable analysis was completed to assess for independent survival predictors.A total of 530 patients with SCLC were treated, with 82 (15%) receiving their first CT in hospital. Inpatients had a greater burden of disease and poorer PS. Neutropenia, thrombocytopenia, nephrotoxicity, and fatigue were all experienced less often by the inpatient cohort (P .001, P .001, P .001, and P = .007, respectively). For inpatients and outpatients, the OS rate at 12, 24, and 60 months was 22%, 9%, and 7% and 43%, 20%, and 9%, respectively (P .001 for all). The median PFS and OS were longer for outpatients and highly functional patients. On multivariable analysis, ECOG PS was an independent predictor of the outcome and the site of first CT was not (P = .04 and P = .49, respectively).Patients with SCLC initially treated as inpatients and those with poor functional status had shorter PFS and OS; however, some experienced long-term survival, including 5-year survival of 7% for the inpatient cohort and 5% for the ECOG PS 3-4 cohort. CT toxicities were less common in the inpatient cohort, validating that administration of CT in hospital should be considered for these patients because they could experience a meaningful long-term response to therapy.

ObjectivesAs part of the International Cancer Benchmarking Partnership (ICBP) SURVMARK-2 project, we provide the most recent estimates of colon and rectal cancer survival in seven high-income countries by age and stage at diagnosis.MethodsData from 386 870 patients diagnosed during 2010–2014 from 19 cancer registries in seven countries (Australia, Canada, Denmark, Ireland, New Zealand, Norway and the UK) were analysed. 1-year and 5-year net survival from colon and rectal cancer were estimated by stage at diagnosis, age and country,Results(One1-year) and 5-year net survival varied between (77.1% and 87.5%) 59.1% and 70.9% and (84.8% and 90.0%) 61.6% and 70.9% for colon and rectal cancer, respectively. Survival was consistently higher in Australia, Canada and Norway, with smaller proportions of patients with metastatic disease in Canada and Australia. International differences in (1-year) and 5-year survival were most pronounced for regional and distant colon cancer ranging between (86.0% and 94.1%) 62.5% and 77.5% and (40.7% and 56.4%) 8.0% and 17.3%, respectively. Similar patterns were observed for rectal cancer. Stage distribution of colon and rectal cancers by age varied across countries with marked survival differences for patients with metastatic disease and diagnosed at older ages (irrespective of stage).ConclusionsSurvival disparities for colon and rectal cancer across high-income countries are likely explained by earlier diagnosis in some countries and differences in treatment for regional and distant disease, as well as older age at diagnosis. Differences in cancer registration practice and different staging systems across countries may have impacted the comparisons.

ObjectiveTo provide the first international comparison of oesophageal and gastric cancer survival by stage at diagnosis and histological subtype across high-income countries with similar access to healthcare.MethodsAs part of the ICBP SURVMARK-2 project, data from 28 923 patients with oesophageal cancer and 25 946 patients with gastric cancer diagnosed during 2012–2014 from 14 cancer registries in seven countries (Australia, Canada, Denmark, Ireland, New Zealand, Norway and the UK) were included. 1-year and 3-year age-standardised net survival were estimated by stage at diagnosis, histological subtype (oesophageal adenocarcinoma (OAC) and oesophageal squamous cell carcinoma (OSCC)) and country.ResultsOesophageal cancer survival was highest in Ireland and lowest in Canada at 1 (50.3% vs 41.3%, respectively) and 3 years (27.0% vs 19.2%) postdiagnosis. Survival from gastric cancer was highest in Australia and lowest in the UK, for both 1-year (55.2% vs 44.8%, respectively) and 3-year survival (33.7% vs 22.3%). Most patients with oesophageal and gastric cancer had regional or distant disease, with proportions ranging between 56% and 90% across countries. Stage-specific analyses showed that variation between countries was greatest for localised disease, where survival ranged between 66.6% in Australia and 83.2% in the UK for oesophageal cancer and between 75.5% in Australia and 94.3% in New Zealand for gastric cancer at 1-year postdiagnosis. While survival for OAC was generally higher than that for OSCC, disparities across countries were similar for both histological subtypes.ConclusionSurvival from oesophageal and gastric cancer varies across high-income countries including within stage groups, particularly for localised disease. Disparities can partly be explained by earlier diagnosis resulting in more favourable stage distributions, and distributions of histological subtypes of oesophageal cancer across countries. Yet, differences in treatment, and also in cancer registration practice and the use of different staging methods and systems, across countries may have impacted the comparisons. While primary prevention remains key, advancements in early detection research are promising and will likely allow for additional risk stratification and survival improvements in the future.

We evaluated the impact of COVID-19 on cancer screening in Manitoba, Canada using an interrupted time series (ITS) design and data from Manitoba's population-based, organized cancer screening programs from April 2020 to August 2021. In June 2020 (breast screening was suspended during April and May 2020), there was a 54% decrease between the predicted (i.e., observed data produced from regression models) and expected (i.e., counterfactual values produced for the COVID-19 period by assuming COVID-19 did not occur) number of screening mammograms (ratio = 0.46, 95% Confidence Interval (CI) 0.28–0.64). By December 2020, there was no significant difference between predicted and expected number of screening mammograms (ratio = 0.95, 95% CI 0.80–1.10). In April 2020, there was an 83% decrease in the number of Pap tests (ratio = 0.17, 95% CI 0.04–0.30). By January 2021, there was no significant difference between predicted and expected number of Pap tests (ratio = 0.93, 95% CI 0.81–1.06). In April 2020, there was an 81% decrease in the number of screening program fecal occult blood tests (FOBTs) (ratio = 0.19, 95% CI 0.0–0.44). By September 2020, there was no significant difference between predicted and expected number of FOBTs (ratio = 0.95, 95% CI 0.65–1.24). The estimated cumulative deficit (i.e., backlog) from April 2020 to August 2021 was 17,370 screening mammograms, 22,086 Pap tests, and 5253 screening program FOBTs. Overall, screening programs adapted quickly to the COVID-19 pandemic. Additional strategies may be needed to address remaining backlogs.

Frailty impacts outcomes for patients with lung cancer, but no brief tools have been assessed in patients with metastatic disease. We evaluated the impact of the Modified Frailty Index (mFI) on clinical outcomes for patients with metastatic non-small cell lung cancer (NSCLC).We conducted a retrospective cohort study of all patients with Stage IV NSCLC diagnosed in Manitoba between 2011 and 2016 who then received first-line cytotoxic chemotherapy. We assigned mFI scores based on documented comorbidities and collected data on toxicity, progression, and survival. Descriptive statistics characterized the cohort and toxicity experienced. Kaplan-Meier methods were used to evaluate progression-free survival (PFS) and overall survival (OS), followed by multivariable Cox proportional hazards models.Our cohort of 426 (mFI 0/1-2/3+ = 175/196/55) patients, showed no significant association between higher mFI score and incidence of overall chemotherapy toxicity. Patients with mFI 0 experienced more frequent thromboses (p=0.022) and a trend towards less nausea or vomiting (p = 0.059). There was no significant difference in PFS or OS among frailty groups. Poorer performance status, number of metastatic sites, and the absence of a driver mutation were independently associated with poorer PFS and OS. Male sex and not completing chemotherapy were also associated with worse OS.This study is the first to investigate the use of the mFI as a frailty tool in patients with metastatic NSCLC receiving cytotoxic chemotherapy. The mFI does not appear to be strongly associated with treatment-related toxicities, PFS, or OS in patients with metastatic NSCLC receiving first-line cytotoxic chemotherapy.

International comparison of liver cancer survival has been hampered due to varying standards and degrees for morphological verification and differences in coding practices. This article aims to compare liver cancer survival across the International Cancer Benchmarking Partnership's (ICBP) jurisdictions whilst trying to ensure that the estimates are comparable through a range of sensitivity analyses. Liver cancer incidence data from 21 jurisdictions in 7 countries (Australia, Canada, Denmark, Ireland, New Zealand, Norway and the United Kingdom) were obtained from population-based registries for 1995-2014. Cases were categorised based on histological classification, age-groups, basis of diagnosis and calendar period. Age-standardised incidence rate (ASR) per 100 000 and net survival at 1 and 3 years after diagnosis were estimated. Liver cancer incidence rates increased over time across all ICBP jurisdictions, particularly for hepatocellular carcinoma (HCC) with the largest relative increase in the United Kingdom, increasing from 1.3 to 4.4 per 100 000 person-years between 1995 and 2014. Australia had the highest age-standardised 1-year and 3-year net survival for all liver cancers combined (48.7% and 28.1%, respectively) in the most recent calendar period, which was still true for morphologically verified tumours when making restrictions to ensure consistent coding and classification. Survival from liver cancers is poor in all countries. The incidence of HCC is increasing alongside the proportion of nonmicroscopically verified cases over time. Survival estimates for all liver tumours combined should be interpreted in this context. Care is needed to ensure that international comparisons are performed on appropriately comparable patients, with careful consideration of coding practice variations.

We sought to understand the role of stage at diagnosis in observed age disparities in colon cancer survival among people aged 50 to 99 years using population-based cancer registry data from seven high-income countries: Australia, Canada, Denmark, Ireland, New Zealand, Norway and the United Kingdom. We used colon cancer incidence data for the period 2010 to 2014. We estimated the 3-year net survival, as well as the 3-year net survival conditional on surviving at least 6 months and 1 year after diagnosis, by country and stage at diagnosis (categorised as localised, regional or distant) using flexible parametric excess hazard regression models. In all countries, increasing age was associated with lower net survival. For example, 3-year net survival (95% confidence interval) was 81% (80-82) for 50 to 64 year olds and 58% (56-60) for 85 to 99 year olds in Australia, and 74% (73-74) and 39% (39-40) in the United Kingdom, respectively. Those with distant stage colon cancer had the largest difference in colon cancer survival between the youngest and the oldest patients. Excess mortality for the oldest patients with localised or regional cancers was observed during the first 6 months after diagnosis. Older patients diagnosed with localised (and in some countries regional) stage colon cancer who survived 6 months after diagnosis experienced the same survival as their younger counterparts. Further studies examining other prognostic clinical factors such as comorbidities and treatment, and socioeconomic factors are warranted to gain further understanding of the age disparities in colon cancer survival.

Background Data from population-based cancer registries are often used to compare cancer survival between countries or regions. The ICBP SURVMARK-2 study is an international partnership aiming to quantify and explore the reasons behind survival differences across high-income countries. However, the magnitude and relevance of differences in cancer survival between countries have been questioned, as it is argued that observed survival variations may be explained, at least in part, by differences in cancer registration practice, completeness and the availability and quality of the respective data sources. Methods As part of the ICBP SURVMARK-2 study, we used a simulation approach to better understand how differences in completeness, the characteristics of those missed and inclusion of cases found from death certificates can impact on cancer survival estimates. Results Bias in 1- and 5-year net survival estimates for 216 simulated scenarios is presented. Out of the investigated factors, the proportion of cases not registered through sources other than death certificates, had the largest impact on survival estimates. Conclusion Our results show that the differences in registration practice between participating countries could in our most extreme scenarios explain only a part of the largest observed differences in cancer survival.

Introduction The standard of care for early-stage non-small cell lung cancer (NSCLC) is surgery. However, for medical inoperable patients stereotactic body radiation therapy (SBRT) is an alternative method. The aim of the study is to assess the overall survival (OS), progression-free survival (PFS) and local control (LC) of patients diagnosed with NSCLC in Manitoba, Canada, between 2013 and 2017 and managed with SBRT. Materials and methods This retrospective study included a total of 158 patients (60.13% of the population were females) that were diagnosed with stage I-II NSCLC and were treated with lung SBRT between 2013 and 2017 in Manitoba. Demographics and clinical data were retrospectively extracted from the electronic patient record. Kaplan-Meier and Cumulative incidence curves were used to describe the OS, PFS, and LC outcomes. Results From the 158 patients, 32 patients were treated with 60 Gy in eight fractions, while 121 patients were treated with 48 Gy in four fractions. Only 85 patients had biopsy-proven NSCLC. The median OS was 2.87 years (95% confidence interval [CI] 2.16-3.43). OS rates at one and two years were 85% and 66%, respectively. The median PFS was 2.03 years (95% CI 1.65-2.77). Furthermore, one-year and two-year PFS rates were 77% and 51%, respectively. Only 10 patients progressed locally at one year and 17 at two years, making the LC rate 93% at the one-year and 87% at the two-year mark. Conclusion These findings add to a growing evidence base supporting SBRT in the treatment of clinically suspected and biopsy-proven early-stage NSCLC patients.

BACKGROUND: Population-based cancer registries strive to cover all cancer cases diagnosed within the population, but some cases will always be missed and no register is 100 % complete. Many cancer registries use death certificates to identify additional cases not captured through other routine sources, to hopefully add a large proportion of the missed cases. Cases notified through this route, who would not have been captured without death certificate information, are referred to as Death Certificate Initiated (DCI) cases. Inclusion of DCI cases in cancer registries increases completeness and is important for estimating cancer incidence. However, inclusion of DCI cases will generally lead to biased estimates of cancer survival, but the same is often also true if excluding DCI cases. Missed cases are probably not a random sample of all cancer cases, but rather cases with poor prognosis. Further, DCI cases have poorer prognosis than missed cases in general, since they have all died with cancer mentioned on the death certificates.METHODS: We performed a simulation study to estimate the impact of including or excluding DCI cases on cancer survival estimates, under different scenarios.RESULTS: We demonstrated that including DCI cases underestimates survival. The exclusion of DCI cases gives unbiased survival estimates if missed cases are a random sample of all cancer cases, while survival is overestimated if these have poorer prognosis.CONCLUSION: In our most extreme scenarios, with 25 % of cases initially missed, the usual practice of including DCI cases underestimated 5-year survival by at most 3 percentage points.

Summary Background The overall incidence of colorectal cancer is decreasing in many high-income countries, yet analyses in the USA and other high-income countries such as Australia, Canada, and Norway have suggested increasing incidences among adults younger than 50 years. We aimed to examine longitudinal and generational changes in the incidence of colon and rectal cancer in seven high-income countries. Methods We obtained data for the incidence of colon and rectal cancer from 20 population-based cancer registries in Australia, Canada, Denmark, Norway, New Zealand, Ireland, and the UK for the earliest available year until 2014. We used age–period–cohort modelling to assess trends in incidence by age group, period, and birth cohort. We stratified cases by tumour subsite according to the 10th edition of the International Classification of Diseases. Age-standardised incidences were calculated on the basis of the world standard population. Findings An overall decline or stabilisation in the incidence of colon and rectal cancer was noted in all studied countries. In the most recent 10-year period for which data were available, however, significant increases were noted in the incidence of colon cancer in people younger than 50 years in Denmark (by 3·1%; per year), New Zealand (2·9% per year), Australia (2·9% per year), and the UK (1·8% per year). Significant increases in the average annual percentage change in the incidence of rectal cancer were also noted in this age group in Canada (by 3·4% per year), Australia (2·6% per year), and the UK (1·4% per year). Contemporaneously, in people aged 50–74 years, the average annual percentage change in the incidence of colon cancer decreased significantly in Australia (by 1·6% per year), Canada (1·9% per year), and New Zealand (3·4% per year) and of rectal cancer in Australia (2·4% per year), Canada (1·2% per year), and the UK (1·2% per year). Increases in the incidence of colorectal cancer in people younger than 50 years were mainly driven by increases in distal (left) tumours of the colon. In all countries, we noted non-linear cohort effects, which were more pronounced for rectal than for colon cancer. Interpretation We noted a substantial increase in the incidence of colorectal cancer in people younger than 50 years in some of the countries in this study. Future studies are needed to establish the root causes of this rising incidence to enable the development of potential preventive and early-detection strategies. Funding Canadian Partnership Against Cancer, Cancer Council Victoria, Cancer Institute New South Wales, Cancer Research UK, Danish Cancer Society, National Cancer Registry Ireland, the Cancer Society of New Zealand, NHS England, Norwegian Cancer Society, Public Health Agency Northern Ireland, Scottish Government, Western Australia Department of Health, and Wales Cancer Network.

IntroductionSurvival from oesophageal cancer remains poor, even across high-income countries. Ongoing changes in the epidemiology of the disease highlight the need for survival assessments by its two main histological subtypes, adenocarcinoma (AC) and squamous cell carcinoma (SCC).MethodsThe ICBP SURVMARK-2 project, a platform for international comparisons of cancer survival, collected cases of oesophageal cancer diagnosed 1995 to 2014, followed until 31st December 2015, from cancer registries covering seven participating countries with similar access to healthcare (Australia, Canada, Denmark, Ireland, New Zealand, Norway and the UK). 1-year and 3-year age-standardised net survival alongside incidence rates were calculated by country, subtype, sex, age group and period of diagnosis.Results111 894 cases of AC and 73 408 cases of SCC were included in the analysis. Marked improvements in survival were observed over the 20-year period in each country, particularly for AC, younger age groups and 1 year after diagnosis. Survival was consistently higher for both subtypes in Australia and Ireland followed by Norway, Denmark, New Zealand, the UK and Canada. During 2010 to 2014, survival was higher for AC compared with SCC, with 1-year survival ranging from 46.9% (Canada) to 54.4% (Ireland) for AC and 39.6% (Denmark) to 53.1% (Australia) for SCC.ConclusionMarked improvements in both oesophageal AC and SCC survival suggest advances in treatment. Less marked improvements 3 years after diagnosis, among older age groups and patients with SCC, highlight the need for further advances in early detection and treatment of oesophageal cancer alongside primary prevention to reduce the overall burden from the disease.

Carcass chilling is a critical control point for Campylobacter spp. during the primary processing of broiler chickens. Our objective was to evaluate chilling intervention research that measured the change in Campylobacter prevalence and concentration on broiler chicken carcasses during primary processing using systematic review-meta-analysis (SR-MA) methodology. Experimental and observational research published in English that investigated impacts of chilling on Campylobacter spp. during primary processing of broiler chicken carcasses were considered. Random-effects MA of air chilling resulted in heterogenous summary effect estimates (mean reduction = 0.74 log10 CFU/carcass, 95% CI: 0.32–1.17, I2 = 91.3%; and odds ratio = 7.42, 95% CI: 0.32–174.05, I2 = 92.3%). Random-effects MA of immersion chilling with chlorine resulted in heterogenous summary effect estimates (mean reduction = 1.74 log10 CFU/carcass, 95% CI: 1.32–2.16, I2 = 86.4%; and odds ratio = 0.50, 95% CI: 0.20–1.28, I2 = 90.6%). Effects of immersion chilling with unspecified disinfectants were also determined and varied depending on study design. The SR-MA indicated that air chilling and immersion chilling reduce Campylobacter concentrations. Due to conflicting results across studies, the estimated average effect of air chilling on Campylobacter prevalence is not informative. Immersion chilling with chlorine demonstrated a trend towards reduced Campylobacter prevalence, but this result was not significant; results should be interpreted with caution because the overall methodological soundness of included studies was low. Existing research on the effectiveness of broiler carcass chilling on Campylobacter concentration or prevalence is limited and heterogenous. Results generated herein can inform decisions makers and stakeholders on potential effective chilling interventions, and can be used to inform quantitative microbial risk assessment to estimate processing measure impacts on public health.

4 Background: Advanced care planning (ACP) in oncology requires effective communication and coordination. Early and regular ACP discussions are endorsed by ESMO and can help facilitate quality, patient-centered care. Methods: An ACP curriculum was created at CancerCare Manitoba that included health care provider (HCP) engagement, HCP and patient education, improved ACP clinical workflow, and improved ease of ACP documentation in the medical record. We evaluated the occurrence and frequency of ACP discussions before implementation of the ACP curriculum using a random sample of 100 adult patients diagnosed with stage IV solid tumors in Manitoba, Canada during 2014. We compared this group to a similar group of patients from 2017 after ACP curriculum implementation. Differences between the two cohorts were tested using Chi-square and Fisher’s Exact tests. The time from a patient’s first clinic visit with an oncologist to their first ACP conversation was described using cumulative incidence curves with K-sample tests used to test for significant differences between the 2014 and 2017 cohorts. Results: Of the 200 patients selected, 153 were assessed at our provincial cancer center (76 in 2014 and 77 in 2017). The median age for this group was 68. 59% were male. 56% received at least 1 line of chemotherapy. ACP documentation increased from 29% in 2014 to 42% in 2017 (p = 0.10). Between 2014 and 2017, initial ACP discussions occurred at: Initial visit (18% vs. 41%), disease progression (27% vs. 31%) and referral to palliative care (55% vs. 28%). After curriculum implementation ACP documentation occurred earlier in the patient’s cancer journey (p = 0.04). Conclusions: After implementation of an ACP curriculum at our cancer center, ACP discussions occurred more often and earlier, but the difference was only significant for earlier ACP discussions. Even after ACP curriculum implementation, a significant proportion of patients did not have ACP documented in their patient record. Understanding and overcoming barriers related to ACP at our institution will be critical for further ACP documentation improvement.

ObjectiveDifferences in time intervals to diagnosis and treatment between jurisdictions may contribute to previously reported differences in stage at diagnosis and survival. The International Cancer Benchmarking Partnership Module 4 reports the first international comparison of routes to diagnosis and time intervals from symptom onset until treatment start for patients with lung cancer.DesignNewly diagnosed patients with lung cancer, their primary care physicians (PCPs) and cancer treatment specialists (CTSs) were surveyed in Victoria (Australia), Manitoba and Ontario (Canada), Northern Ireland, England, Scotland and Wales (UK), Denmark, Norway and Sweden. Using Wales as the reference jurisdiction, the 50th, 75th and 90th percentiles for intervals were compared using quantile regression adjusted for age, gender and comorbidity.ParticipantsConsecutive newly diagnosed patients with lung cancer, aged ≥40 years, diagnosed between October 2012 and March 2015 were identified through cancer registries. Of 10 203 eligible symptomatic patients contacted, 2631 (27.5%) responded and 2143 (21.0%) were included in the analysis. Data were also available from 1211 (56.6%) of their PCPs and 643 (37.0%) of their CTS.Primary and secondary outcome measuresInterval lengths (days; primary), routes to diagnosis and symptoms (secondary).ResultsWith the exception of Denmark (−49 days), in all other jurisdictions, the median adjusted total interval from symptom onset to treatment, for respondents diagnosed in 2012–2015, was similar to that of Wales (116 days). Denmark had shorter median adjusted primary care interval (−11 days) than Wales (20 days); Sweden had shorter (−20) and Manitoba longer (+40) median adjusted diagnostic intervals compared with Wales (45 days). Denmark (−13), Manitoba (−11), England (−9) and Northern Ireland (−4) had shorter median adjusted treatment intervals than Wales (43 days). The differences were greater for the 10% of patients who waited the longest. Based on overall trends, jurisdictions could be grouped into those with trends of reduced, longer and similar intervals to Wales. The proportion of patients diagnosed following presentation to the PCP ranged from 35% to 75%.ConclusionThere are differences between jurisdictions in interval to treatment, which are magnified in patients with lung cancer who wait the longest. The data could help jurisdictions develop more focused lung cancer policy and targeted clinical initiatives. Future analysis will explore if these differences in intervals impact on stage or survival.

Context Broiler chicken carcass spray and dip treatments are just two of many different interventions investigated to address the need to reduce Salmonella prevalence and concentration on broiler chicken carcasses during processing. However the results of published research are inconsistent and sometimes contradictory creating a need to formally evaluate, synthesize and summarize available research to avoid recommending ineffective treatments and identify key knowledge gaps for future work. Objective Evaluate intervention research that measured the efficacy of various spray and dip treatments, applied on broiler chicken carcasses during primary processing, as Salmonella prevalence or concentration on broiler carcasses, using systematic review–meta-analysis (SR–MA). Data sources A comprehensive electronic search was implemented in six databases and verified through a manual search of topic-related reference lists, related reviews or book chapters, and through consultations with selected topic experts. Study inclusion Control and challenge trials, cohort and before-and-after intervention research published in English that investigated the efficacy of any spray or dip treatments, applied to broiler chicken carcasses or carcass parts during processing, on Salmonella prevalence or concentration measured at the same level under laboratory, pilot plant and commercial conditions. Risk of bias assessment and data extraction Relevant research was evaluated for methodological soundness and completeness of reporting. The main characteristics of each study included in the review were extracted. Data analysis Random-effects MA of trisodium phosphate and lactic acid dip treatments (n = 12 and n = 32 trials with prevalence outcomes, respectively) resulted in homogeneous (p-value = 0.469; I2 = 0.0% and p-value = 0.284; I2 = 11.4%, respectively) summary effect estimates (OR = 1.16; 95% CI: 0.59–2.26 and OR = 0.05; 95% CI: 0.03–0.10, respectively). Visual evaluation of MA forest plots indicated overall reduction trends for six spray treatments reporting concentration outcomes: trisodium phosphate (n = 48 trials), acidic electrolyzed oxidizing water (n = 2), cetylpyridinium chloride (n = 43), lactic acid (n = 24), sodium bisulfate (n = 11) and potable water (n = 36). Moderate to considerable heterogeneity (p-value ≤ 0.1 and I2 > 25%) was observed for these treatments. Methodological soundness of included studies was poor and a lack of studies conducted under commercial conditions was observed. Conclusions Existing research on the efficacy of broiler carcass dips or sprays on Salmonella prevalence or concentration is limited and heterogeneous, precluding the full benefits of robust meta-analyses. Larger randomized controlled trials conducted under commercial conditions are needed.

Eating inappropriately prepared poultry meat is a major cause of foodborne salmonellosis. Our objectives were to determine the efficacy of feed and water additives (other than competitive exclusion and antimicrobials) on reducing Salmonella prevalence or concentration in broiler chickens using systematic review-meta-analysis and to explore sources of heterogeneity found in the meta-analysis through meta-regression. Six electronic databases were searched (Current Contents (1999-2009), Agricola (1924-2009), MEDLINE (1860-2009), Scopus (1960-2009), Centre for Agricultural Bioscience (CAB) (1913-2009), and CAB Global Health (1971-2009)), five topic experts were contacted, and the bibliographies of review articles and a topic-relevant textbook were manually searched to identify all relevant research. Study inclusion criteria comprised: English-language primary research investigating the effects of feed and water additives on the Salmonella prevalence or concentration in broiler chickens. Data extraction and study methodological assessment were conducted by two reviewers independently using pretested forms. Seventy challenge studies (n=910 unique treatment-control comparisons), seven controlled studies (n=154), and one quasi-experiment (n=1) met the inclusion criteria. Compared to an assumed control group prevalence of 44 of 1000 broilers, random-effects meta-analysis indicated that the Salmonella cecal colonization in groups with prebiotics (fructooligosaccharide, lactose, whey, dried milk, lactulose, lactosucrose, sucrose, maltose, mannanoligosaccharide) added to feed or water was 15 out of 1000 broilers; with lactose added to feed or water it was 10 out of 1000 broilers; with experimental chlorate product (ECP) added to feed or water it was 21 out of 1000. For ECP the concentration of Salmonella in the ceca was decreased by 0.61 log(10)cfu/g in the treated group compared to the control group. Significant heterogeneity (Cochran's Q-statistic p≤0.10) was observed among studies examining all organic acids (controlled or challenge experiments), butyric acid, formic acid, a formic/propionic acid mixture, fermented liquid feed, and D-mannose. Meta-regressions were conducted to examine the source of heterogeneity among studies. For prevalence outcomes, 36% and 60% of the total variance was within and between studies, respectively. For concentration outcomes, 39% and 33% of the total variance was within and between studies, respectively. Inadequate blinding and randomization was common, and no studies undergoing meta-analysis or meta-regression were conducted on a commercial farm. The strength of evidence of the effect of these additives was very low. Studies conducted under commercial conditions are needed to understand the potential benefit of these interventions for the poultry industry and to improve the strength of evidence of the effectiveness of these additives.

Our objective was to estimate the effectiveness of vaccination and biosecurity on the prevalence of Salmonella spp. in broiler chickens using systematic review and meta-analysis. A comprehensive search of the global primary literature was conducted in: Current Contents (1999–2009), Agricola (1924–2009), MEDLINE (1860–2009), Scopus (1960–2009), CAB (1913–2009), and Centre for Agricultural Bioscience Global Health (1971–2009). The search algorithm was (Salmonell*) AND (chicken* OR chick* OR poultry* OR broiler* OR gallus*). Additional studies were identified by contacting five topic experts and hand-scanning bibliographies of recent review articles and a recently published textbook. Studies were included if they were English language and investigated the effects of vaccination and biosecurity on the prevalence of Salmonella spp. in broiler chickens. All study design types were included. Data extraction and methodological assessment were conducted by two reviewers independently. All meta-analyses were based on random-effects models. For biosecurity, sixteen challenge studies ( n = 137 treatment-control comparisons) and one controlled study ( n = 2) met the inclusion criteria. Significant heterogeneity (Cochran's Q -statistic, p n = 226) and three controlled studies ( n = 10) met the inclusion criteria. Among live Salmonella Typhimurium vaccine challenge studies heterogeneity was not significant ( p = 0.138). Vaccination with a live Salmonella Typhimurium reduced the risk of Salmonella cecal colonization in the treated broiler group by 35 out of 1000 broilers when compared to the control group (OR = 0.21; 95% CI = 0.06–0.77) and this effect was significant ( p = 0.018). One biosecurity study ( n = 2 treatment-control comparisons) and three vaccination studies ( n = 10) were conducted in a commercial setting. The two included studies in the vaccination meta-analysis were both conducted at research facilities. The live Salmonella Typhimurium vaccine showed the most promise in reducing the prevalence of Salmonella in broiler ceca. However, the meta-analysis included few studies, and these studies challenged the birds with different serotypes. We recommend that more large-scale randomized, blinded trials be conducted with a live Salmonella Typhimurium vaccine on commercial farms.

Background:Chronic lymphocytic leukemia (CLL) is the most prevalent leukemia in North America with the majority of patients being over the age of 70 (Goede et al, 2014). CLL is a heterogeneous disease with some patients undergoing treatment at time of diagnosis, while others follow along a more indolent, asymptomatic course. When indicated, the choice of treatment is based on the patient's functional status, renal function and other comorbidities (Shanafelt, 2013). Previous studies have shown that unfit patients treated with Obinutuzumab plus Chlorambucil have shown prolongation of progression free survival and higher rates of complete response compared to other monoclonal based regimens (Goede et al, 2014). The aim of this study is to investigate the clinical use and uptake of Obinutuzumab in combination with Chlorambucil in a Canadian based population. Methods:All patients receiving Obinutuzumab were identified using the CLL CAISIS database. Then a retrospective chart review was conducted for patients approved for first-line antibody treatment with Obinutuzumab from January 1, 2014 to December 31, 2017. Data including patient characteristics, patterns of treatment, reported toxicities, response rates and survival data were collected and analyzed. This data was used to determine the overall safety and efficacy of this treatment regimen. Results: There were a total of 66 patients that met the inclusion criteria for this study. This cohort consisted of 54.5% males and 45.5% females, with a median age at diagnosis of 68 years (range: 46-94). Within this population 47 patients underwent florescence in situ hybridization testing, which identified 32 patients with chromosomal abnormalities. The immunoglobulin heavy chain variable region gene mutation was also tested in 41 patients, and identified 22 patients that were unmutated. At the time of treatment the median age was 73 (range: 55-98) with a median Cumulative Illness Rating Scale (CIRS) score of 8 (range: 3-15). Of the 66 patients who started treatment with Obinutuzumab, 50 patients (76%) achieved a partial response and 5 patients (8%) had no response. Of note, 21 patients (31.8%) discontinued treatment prior to completion of all six cycles due to cytopenias (4), other comorbidities (4), progression of CLL (2), decline in functional/mental status (2), patient request (2) and other (7). In regards to their treatment there was a high incidence of infusion related reactions (IRRs) on the first day of treatment, with 30 patients (45.5%) requiring intervention. There was a subset of 15 patients that had received low dose Chlorambucil prior to treatment with Obinutuzumab which resulted in a lower average lymphocyte count (38.1) and lower rate of IRRs (33%) compared to those with no prior Chlorambucil (average lymphocyte count: 66.5, rate of IRR: 42%). Due to toxicity and tolerability of Chlorambucil, dose reduction was observed in 37 patients (56%) throughout all six cycles of treatment. In the end, only 18 patients (27.3%) received all doses of Obinutuzumab and Chlorambucil while 37 patients (56%) received all doses of Obinutuzumab. Within the entire cohort, 12 patients have relapsed and 9 of these patients have required additional therapy. This relapse rate can be attributed to lack of response to Obinutuzumab (3), a 17p del (1), poor prognostic markers (5), and inadequate Obinutuzumab (1). Conclusion:In this current study, our results demonstrate that the majority of patients in this cohort were able to complete treatment with Obinutuzumab. Although our demographics were similar to previous studies, we found higher partial response rates (76%) likely due to differences in standards of practice, such as imaging studies after treatment. Disclosures Whiteside: Roche: Membership on an entity's Board of Directors or advisory committees, Other: teaching sessions. Dawe:AstraZeneca: Membership on an entity's Board of Directors or advisory committees; Merck: Membership on an entity's Board of Directors or advisory committees. Johnston:Roche: Other: unrestricted grant received in the past; Abbvie: Other: unrestricted grant received in the past; Teva: Other: unrestricted grant received in the past; Gilead: Other: unrestricted grant received in the past; Janssen: Other: unrestricted grant received in the past. Banerji:Roche: Other: Unrestricted grant received in the past; Janssen: Other: Unrestricted grant received in the past; Abbvie: Other: Unrestricted grant received in the past; Gilead: Other: Unrestricted grant received in the past; Teva: Other: Unrestricted grant received in the past.

Access to Allogeneic Transplant in Canada: A Canadian Blood and Marrow Transplant Group/Canadian National Transplant Research Program Study Introduction: Allogeneic hematopoietic stem cell transplant (aHSCT) is a potentially curative treatment for patients with blood cancers and disorders of blood/immune system, but due to the complexity of the procedure, is only offered in a limited number of medical centres. Many barriers might exist that prevent patients from receiving an aHSCT, including physical and social geographic barriers. We sought to understand how access patterns to aHSCT varied across Canada, a country with a government-funded universal health care system. Methods: The Canadian Institute for Health Information (CIHI) Discharge Abstract Database (DAD) is a national record of all hospital admissions in all Canadian provinces other than Quebec. We identified all Canadians under the age of 65 admitted to hospital in provinces other than Quebec with a diagnosis of acute myeloid leukemia (AML) between 2004 and 2015, using the CIHI DAD and ICD-9 diagnosis codes for AML. We determined which of these patients subsequently were admitted to hospital for an aHSCT, using ICD-9 procedure and diagnosis codes for AML. Residence at the time of admission with AML was identified using their forward sorting area (FSA) component of the postal code. Socio-demographic attributes of the FSAs were identified using data from the 2006 Canadian Census, including whether the FSA was rural or urban, the proportion of the population that was a visible minority, aboriginal, or low income after tax . Logistic regression was used to investigate potential associations between these factors and the odds of receiving a transplant. Two sensitivity analyses were conducted (age less than 18 at time of diagnosis, and age between 18 and 65 at the time of diagnosis). Results: 6119 non-Quebec Canadians were admitted to hospital with a diagnosis of AML between 2004 and 2015. Of these, 1745 (28.5%) received aHSCT. Several variables were significantly associated with receiving a transplant in univariable analyses (Table 1; time period, province of residence, gender, age, and proportion of low income families), but after accounting for other variables in the model, only time period, province of residence, gender, and age remained significantly associated. In the pediatric subgroup, similar results were seen, except province of residence and gender were not significant. The results of the adult sensitivity analysis were identical to the main cohort, with province of residence, time period, gender, and age predictive of receiving a aHSCT. Discussion: In contrast to previous studies done in the United States with similar methodology, in non-Quebec Canada, low income level was not associated with inferior access to aHSCT. This might suggest that Canada's universal health care insurance program is protective against socioeconomic barriers. In addition, in contrast to previous studies, rural location was not associated with the odds of receiving a transplant, and reassuringly, the proportion identifying as aboriginal was not significantly associated with the odds of receiving a transplant. Dramatic differences were seen in aHSCT rates by province, with residents of Alberta (third largest province in this cohort) diagnosed with AML more than twice as likely to receive an aHSCT compared to residents of Ontario, the most populous province in Canada (OR 0.45, p < 0.01). The reasons for this are unclear, but likely include practice patterns at the leukemia/transplant sites, center resources, and provincial health care budgets. Notably, the province with the highest per-capita GDP (Alberta) had the highest proportion of individuals receiving a aHSCT. Thus, is it possible that in Canada, regional wealth is more predictive of access to health care than individual wealth. The reasons for these dramatic regional differences in access to transplant in Canada should be studied further. Disclosures No relevant conflicts of interest to declare.

Raw, frozen chicken nuggets/strips available at retail and prepared at home before consumption have been identified as a significant risk factor in contracting food-borne salmonellosis. Cases of salmonellosis from consumption of these products may be due, in part, to Salmonella strains originating in broiler feed. In this study the thermal resistances of Salmonella strains isolated from chicken nuggets and strips, chicken nugget/strip meat and broiler feed were determined to assess whether they exhibited enhanced thermal resistance. Thermal resistances (D- and z- values) of 7 cocktails (25 isolates, 4 serovars) were determined in commercially prepared irradiation-treated chicken nugget/strip meat blend, and heated in a constant temperature waterbath. The thermal resistances found were lower than those reported for similar strains in the literature. D-values ranged from 6.93 to 0.12 min at 55 and 62 degrees C respectively, with z-values from 4.10 to 5.17 degrees C. Two strains of S. Enteritidis separately isolated from pelleted feed and chicken nugget meat blend, with indistinguishable geno- and phenotypes, had lower (and probably identical) thermal resistances than the other isolates. Results indicated that the strains of Salmonella isolated from raw, frozen chicken nuggets/strips and pelleted broiler feed did not exhibit unusually high thermal resistance, and that normal heating (71 degrees C) prior to consumption should eliminate these organisms from chicken nuggets/strips.

The aim of this study was to investigate the effect of single-pulse transcranial magnetic stimulation on the triggering of saccades. The right frontal eye field was stimulated during modified gap and overlap paradigms with flashed presentation of the lateral visual target of 80 ms. In order to examine possible facilitating or inhibitory effects on saccade triggering, three different time intervals of stimulation were chosen, i.e. simultaneously with onset of the target, during the presentation and after target end. Stimulation applied simultaneously with target onset significantly decreased the latency of contralateral saccades in the gap but not in the overlap paradigm. Stimulation after target end significantly increased saccade latency for both sides in the gap paradigm and for the contralateral side in the overlap paradigm. Stimulation during presentation had no effect in either paradigm. The results show that, depending on the time interval and the paradigm tested, a facilitation or inhibition of saccade triggering can be achieved. The results are discussed in a context of two probable transcranial magnetic stimulation effects, a direct interference with the frontal eye field on the one hand and a remote interference with the superior colliculus on the other hand.

Background Radical prostatectomy (RP) is a common treatment for prostate cancer (PCa). Morbidity, mortality and pathological outcomes may be superior in academic institutions. One explanation may be the involvement of oncology fellowship trained urologists within academic institutions. The literature examining pathological outcomes often lacks individual surgeon data. The objective of this study was to compare pathological outcomes following RP between fellowship trained and non-fellowship trained urologists. Methods Population-based, retrospective chart review of men diagnosed with PCa between 2003 and 2008, the majority treated with open approach RP (>99%). Pathological outcomes were compared between oncology fellowship trained academic (FTA), non-fellowship trained academic (NFTA) and non-academic (NA) urologists. Relationships with pathological outcomes were examined utilizing multivariable logistic regression. Results 83.1% of eligible patients were included in our analysis resulting in 1075 patients. In multivariable analysis, surgeon group was an independent predictor of positive surgical margin (PSM) (p

Ein gesundes, korperlich sehr aktives, achtjahriges Madchen wird vom Kinderarzt zugewiesen zur sonografischen Abklarung einer asymptomatischen Schwellung beider Axillae. Zwei Wochen zuvor im Turnunterricht war dem Madchen beim Hockstrecken der Arme erstmals eine Masse in beiden Achseln aufgefallen.

The effectiveness of various competitive exclusion (CE) products for reducing Salmonella colonization in broiler chickens was evaluated using systematic review-meta-analysis-meta-regression (SR-MA-MR). Relevance screening identified 201 relevant studies that were subjected to methodological assessment. Of these studies, 159 were suitable for data extraction, 66 were presented in a number of MAs and 130 were examined in a meta-regression (MR). Fourteen different CE products were identified, 9 of them commercial products, and the most common route of administration was oral gavage (63.7% of trials). Meta-analyses indicated that a number of CE products reduce Salmonella colonization in broilers, the most effective one being Preempt™ which was formerly known as CF-3. Five study characteristics (publication year, CE type, CE route, sample origin, and Salmonella serovar administered/recovered) and three methodological soundness characteristics (treatment assignment, intervention and laboratory methods description) were retained as statistically significant (p

Introduction: Prompt diagnosis and treatment are key requirements to improving cancer patients' survival and quality of life. This is particularly relevant in diseases such as the aggressive lymphomas, which are potentially curable with appropriate therapy. The province of Manitoba (MB), Canada, has set a goal of reducing time from suspicion of any cancer to treatment to sixty days. Objectives: To establish a provincial baseline this study examined time intervals in lymphoma patients' journey from high suspicion (HS) to diagnosis date (dx_dt) and treatment (tx). The aims were to determine the portion of patients achieving the goal of sixty days and compare this to other major cancers (Breast, Colorectal and Lung). The effect of place of residence at diagnosis, gender, age and lymphoma subtype on delays were also of interest. Methods: Patients with a first diagnosis of any type of lymphoma between 01/2010 to 12/2013 were identified from the Manitoba Cancer Registry (MCR). Those with a prior cancer diagnosis, diagnosed by autopsy or death certificate only, or incomplete/pending MCR registration were excluded. We accessed provincial health insurance billing claims and hospital registration databases in the year prior to dx_dt. Working backwards from dx to determine the HS point, an algorithm was built using an iterative consultative process referencing chart reviews as a framework for milestones in the patient pathway. The index event for high suspicion (HS) was defined as the first event including: imaging ranked likely related to subsequent lymphoma diagnosis, diagnostic procedure/biopsy, or specialist consultation. Using this index event, the claims data were searched for a referring provider, the last visit with this provider was defined as the date of HS. The influence of lymphoma subtype was explored by examining intervals in patients with Diffuse large B-cell Lymphoma (DLBCL) and classical Hodgkin Lymphoma (HL). Results: The entire cohort included a total of 1182 patients with 338 DLBCL (36.2%), 96 HL (10.3%) and 53.5% other types of lymphoma. The index event for HS was imaging in 477 (51.1%), specialist consult in 92 (9.9%), diagnostic procedure/biopsy in 42 (4.5%), ER visit in 24 (2.6%) and multiple index events in 274 (29.3%). HS-tx was less than sixty days in only 14.8% of patients. 31.3% of patients did not receive any treatment. In patients who received chemotherapy at diagnosis (n=682) HS-tx was less than sixty days in 22.3%. A parallel analysis for Breast, Colorectal and Lung cancers revealed that 29%, 33% and 38% met the target of HS-tx in less than sixty days at baseline. HS-tx was less than sixty days in 84 patients with DLBCL (24.9%) and 25 with HL (26%), p=0.06. Conclusion: In this population based Canadian study, the proportion of lymphoma patients who meet the target for timely commencement of systemic therapy is low, even more than other major solid tumors. There is no difference between the proportion of HL and DLBCL patients meeting this target, which is in contrast to previously published literature that suggests longer delays in HL. In patients treated with chemotherapy a large portion of the delay appears to be after diagnostic biopsy (dx_dt). As part of this initiative clinical advisors have developed a lymphoma pathway with target timelines for milestones which will serve as a reference tool. This study describes the methodology that can be adopted in other jurisdictions treating lymphoma, and also serves as a baseline from which to direct process improvement. Disclosures No relevant conflicts of interest to declare.