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Vickers M.M.,Tom Baker Cancer Center | Karapetis C.S.,Flinders Medical Center | Tu D.,Queen's University | O'Callaghan C.J.,Queen's University | And 15 more authors.
Annals of Oncology | Year: 2013

Background: Cetuximab-induced hypomagnesemia has been associated with improved clinical outcomes in advanced colorectal cancer (CRC). We explored this relationship from a randomized clinical trial of cetuximab plus best supportive care (BSC) versus BSC alone in patients with pretreated advanced CRC. Patients and methods: Day 28 hypomagnesemia grade (0 versus ≥1) and percent reduction (<20% versus ≥20%) of Mg from baseline was correlated with outcome. Results: The median percentage Mg reduction at day 28 was 10% (-42.4% to 63.0%) for cetuximab (N = 260) versus 0% (-21.1% to 25%) for BSC (N = 251) [P < 0.0001]. Grade ≥1 hypomagnesemia and ≥20% reduction from baseline at day 28 were associated with worse overall survival (OS) [hazard ratio, HR 1.61 (95% CI 1.12-2.33), P = 0.01 and 2.08 (95% CI 1.32-3.29), P = 0.002, respectively] in multivariate analysis including grade of rash (0-1 versus 2+). Dyspnea (grade ≥3) was more common in patients with ≥20% versus < 20% Mg reduction (68% versus 45%; P = 0.02) and grade 3/4 anorexia were higher in patients with grade ≥1 hypomagnesemia (81% versus 63%; P = 0.02). Conclusions: In contrast to prior reports, cetuximab-induced hypomagnesemia was associated with poor OS, even after adjustment for grade of rash. © The Author 2012. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved.

Wu J.,BCCA | Waldron J.,Provincial Health Services Authority PHSA | Hood S.,Provincial Health Services Authority PHSA | Kahnamelli A.,BCCA | And 6 more authors.
Studies in Health Technology and Informatics | Year: 2013

Prompt and efficient access to patient records is vital in providing optimal patient care. The Cancer Agency Information System (CAIS) is the primary patient record repository for the British Columbia Cancer Agency (BCCA) but is only accessible on traditional computer workstations. The BCCA clinics have significant space limitations resulting in multiple health care professionals sharing each workstation. Furthermore, workstations are not available in examination rooms. A novel and cost efficient solution is necessary to improve clinician access to CAIS. This prompted the BCCA and IMITS to embark on an innovative provincial collaboration to introduce and evaluate the impact of a mobile device to improve access to CAIS. The project consisted of 2 phases with over 50 participants from multiple clinical disciplines across BCCA sites. Phase I evaluated the adoptability, effectiveness and costs associated with providing access to CAIS using a generic viewer (Citrix). Phase II incorporated the feedback and findings from Phase I to make available a customized mobile device-specific application. Phase II also addressed privacy and security requirements. © 2013 ITCH 2013 Steering Committee and IOS Press. All rights reserved.

Hoehr C.,TRIUMF Laboratory Particle and Nuclear Physics | Trinczek M.,TRIUMF Laboratory Particle and Nuclear Physics | Li F.,TRIUMF Laboratory Particle and Nuclear Physics | Dinelle K.,UBC | And 8 more authors.
IEEE Nuclear Science Symposium Conference Record | Year: 2012

In an effort to understand the possibility of using PET as a tool for dose verification after proton therapy in ocular melanomas, a Lucite phantom was irradiated at the proton therapy facility at TRIUMF with a raw and spread-out Bragg peak of 74 MeV protons and scanned in two different PET scanners at UBC. A tantalum clip, used as a marker during patient treatment, was attached to the phantom. Irradiation with the raw Bragg peak results in a different activation profile than with the spread-out Bragg peak. The difference is easily observable in the PET scan. In addition, one patient treated for choroidal melanoma was scanned. In the patient scan the activity in the irradiated tumor is clearly visible. A FLUKA simulation of the facility is currently being validated against experimental measurements. © 2012 IEEE.

Hoehr C.,TRIUMF Laboratory Particle and Nuclear Physics | Morley T.,TRIUMF Laboratory Particle and Nuclear Physics | Buckley K.,TRIUMF Laboratory Particle and Nuclear Physics | Trinczek M.,TRIUMF Laboratory Particle and Nuclear Physics | And 4 more authors.
Applied Radiation and Isotopes | Year: 2012

Solutions containing a high concentration (0.325-0.995g/ml) of natural-abundance ammonium heptamolybdate tetrahydrate ((NH 4) 6Mo 7O 24)·4H 2O were irradiated at 13MeV on a proton-beam cyclotron using a standard liquid target. 94mTc was produced via the 94Mo(p,n) 94mTc reaction with measured yields of 110±20MBq for the highest concentrated solution using 5μA proton beams for 60min. Saturation yields of up to 40±6MBq/μA were achieved. Pertechnetate was isolated from the target mixture with 70.9±0.7% efficiency using a solid-phase extraction resin. © 2012 Elsevier Ltd.

Absolon N.S.A.,British Columbia Cancer Agency BCCA | Balneaves L.G.,University of Toronto | Truant T.L.O.,University of British Columbia | Cashman R.L.,BCCA | And 3 more authors.
Clinical Journal of Oncology Nursing | Year: 2016

Background: Sleep-wake disturbances are experienced by as many as 75% of patients with cancer and are associated with poor symptom management, lower functionality, and decreased quality of life. Although promising sleep interventions exist, they require extensive resources and time. Objectives: The objectives of this study were to develop a brief, self-administered sleep intervention and to evaluate the feasibility and potential efficacy of its implementation with adult patients with cancer who were about to receive, were receiving, or had received radiation therapy in an ambulatory cancer care setting. Methods: Pre- and postintervention surveys and qualitative interviews were conducted with patients with cancer experiencing insomnia (N = 28) and receiving radiation treatment within the past six months. Patients received instruction on breathing, visualization, and intonation. Adherence and sleep quality were primary study outcomes. Analyses included descriptive statistics and repeated measure regression analysis. Thematic analysis was conducted on qualitative data. Findings: Adherence to the sleep intervention was high (75%), and significant improvement was found in global sleep quality (p < 0.0001) regardless of level of adherence. Sleep onset latency (p = 0.0005), sleep duration (p = 0.0016), and sleep quality (p < 0.0001) were significantly improved. Age was significantly correlated with sleep quality (p = 0.0094), with older participants reporting greater benefit from the intervention. Participants reported that the intervention was easy to learn and implement and that it “calmed the mind.”. © 2016 by the Oncology Nursing Society.

Wong J.C.T.,University of British Columbia | Chan S.K.,British Columbia Cancer Agency Cancer Research Center | Schaeffer D.F.,University of British Columbia | Sagaert X.,University Hospitals | And 7 more authors.
Clinical Cancer Research | Year: 2011

Purpose: Treatments for colorectal cancer (CRC) are primarily disease stage based. However, heterogeneity in outcome within even a single stage highlights its limitations in predicting disease behavior. Recently, the role of gene expression as predictive and prognostic markers has been explored. Our objectives were to identify consistently differentially expressed genes through meta-analysis of high-throughput gene-expression studies, and evaluate their predictive and prognostic significance in colon (CC) and rectal (RC) cancers. Experimental Design: Publications applying high-throughput gene- expression technologies to specific CRC stages were identified. A vote counting strategy was used to identify the most significant differentially expressed genes. Their predictive and prognostic values were independently assessed in a tissuemicroarray of 191cases of stage II-IVCC/RCfromtwotertiary care centers.Their biological effectswere also examinedin vitro. Results: MMP1 and MMP2 were identified as consistently underexpressed in liver metastasis compared with primary CRC. Shorter time to distant metastasis and overall survival occurred in stage III CC lacking MMP1 expression, and in stage III RC lacking MMP2. MMP1 levels in stage II and III CC were associated with increased likelihood of distant metastasis, whereas the risk of local recurrence in stage III RC could be stratified by MMP2. Promotion of cell invasion of CRC cell lines exposed to MMP1/2 inhibitors were confirmed in vitro. Conclusions: MMP1 and MMP2 may be useful biomarkers that can help stratify patients at higher risk of developing recurrence in colorectal cancer, and guide individualized treatment decisions to achieve better outcomes. ©2011 AACR.

Lo A.C.,British Columbia Cancer Agency BCCA | Lo A.C.,University of British Columbia | Truong P.T.,British Columbia Cancer Agency BCCA | Truong P.T.,Breast Cancer Outcomes Unit | And 17 more authors.
Annals of Oncology | Year: 2015

Background: In 1999, the National Surgical Adjuvant Breast and Bowel Project (NSABP)-B24 trial demonstrated that tamoxifen reduced relapse risk in women with ductal carcinoma in situ (DCIS) treated with breast-conserving surgery (BCS) and radiotherapy (RT). In 2002, Allred's subgroup analysis showed that tamoxifen mainly benefitted estrogen receptor (ER)-positive disease. This study evaluates the impact and generalizability of these trial findings at the population level. Patients and methods: From 1989 to 2009, 2061 women with DCIS underwent BCS + RT in British Columbia. The following cohorts were analyzed: (1) pre-NSABP-B24 era (1989-1998, N = 417); (2) post-NSABP-B24 era (2000-2009, N = 1548). Cohort 2 was further divided into pre- and post-Allred eras. Results: Endocrine therapy (ET) was used in 404/2061 (20%) patients. Median age of patients treated with compared with without ET, was 53 versus 57 years, (P < 0.0005). One of 417 (0.2%) versus 399/1548 (26%) patients took ET before versus after NSABP-B24. Among the post-Allred era cohort treated with ET (N = 227), tumors were ER-positive in 65%, ER-negative in 1%, and ER-unknown in 33%; whereas of those treated without ET (N = 801), ER was positive in 43%, negative in 15%, and unknown in 42% (P < 0.0005). On multivariable analysis of the post-NSABP-B24 era, ET was associated with improved event-free survival (EFS) (hazard ratio 0.6; P = 0.02); 5-year EFS were 96.9% with ET versus 94.5% without ET. Conclusion(s): ET use in DCIS patients treated with BCS + RT increased significantly after the NSABP-B24 study. ER+ disease and younger age were associated with increased ET use. ET was associated with improved EFS, confirming the generalizability of trial data at a population level. © The Author 2015. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved.

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