Winnipeg, Canada
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Ramphal R.,Childrens Hospital of Eastern Ontario | Meyer R.,Queen's University | Schacter B.,CancerCare Manitoba | Rogers P.,BC Childrens Hospital | Pinkerton R.,Royal Childrens Hospital
Cancer | Year: 2011

The reduction in the cancer mortality rate in adolescents and young adults (AYA) with cancer has lagged behind the reduction noted in children and older adults. Studies investigating reasons for this are limited but causes appear to be multifactorial. Host factors such as developmental stage, compliance, and tolerance to therapy; provider factors such as lack of awareness of cancer in AYA and referral patterns; differences in disease biology and treatment strategies; low accrual onto clinical trials; and lack of psychosocial support and education programs for AYA all likely play a role. Recommendations for change from a recent international workshop include education of physicians and patients concerning AYA cancer, improved cooperation between pediatric and adult centers, age-appropriate psychosocial support services, programs to help AYA with issues relevant to them, dedicated AYA hospital space, improved accrual to clinical trials, the use of technology to educate patients and enhance communication between patients and the health care team, and ensuring that resident and fellowship training programs provide adequate education in AYA oncology. The longer term goal is to develop AYA oncology into a distinct subspecialist discipline within oncology. The ideal model of care would incorporate medical care, psychosocial support services, and a physical environment that are age-appropriate. When this is not feasible, the development of "virtual units" connecting patients to the health care team or a combination of physical and virtual models are alternative options. The assessment of outcome measures is necessary to determine whether the interventions implemented result in improved survival and better quality of life, and are cost-effective. Copyright © 2011 American Cancer Society.

Elbakri I.A.,CancerCare Manitoba | Elbakri I.A.,University of Manitoba
Radiation Protection Dosimetry | Year: 2014

Dose-area product-to-effective dose (E) conversion factors for chest, abdomen and abdomen-chest neonatal radiographs were computed. Seven patient models in the Monte Carlo software, PCXMC, were defined, representing neonates ranging in weight from 0.5 to 6.0 kg. Conversion factors for a tube potential range of 50-80 kVp at two beam filtrations (3.0 mm Al and 3.0 mm Al10.1 mm Cu) were calculated. For 133 neonatal radiographs, effective dose values determined using these conversion factors were compared with those obtained from PCXMC simulations customised for each radiograph. For a 3.0-kg newborn irradiated at 60 kVp/3.0 mm Al beam filtration, the conversion factors were 2.58, 1.90 and 1.91 mSv (mGy cm2)21 for chest, chest-abdomen and abdomen radiographs, respectively. Average dose difference between the conversion factors and customised dose calculations was 16 %. Disagreement in effective dose was most strongly correlated with under-collimation in the lateral direction.

Schultz A.S.H.,University of Manitoba | Nowatzki J.,CancerCare Manitoba | Ronson G.,University of Manitoba
American Journal of Public Health | Year: 2013

A Canadian biennial youth survey facilitated repeating investigation of susceptibility to smoke and household socialization. We operationalized susceptibility to smoke by 3 levels on the basis of intention and behavior. Variables consistently predicting greater susceptibility across time and age groups were sibling smoking, household restrictions, and vehicle smoke exposure. Gender was predictive among older youths. Household restrictions and emerging legislation to ban smoking in vehicles with youth passengers provide protection against secondhand smoke exposure and sustained resolve to remain smoke-free. Copyright © 2012 by the American Public Health Association®.

Holmes S.,University of Manitoba | Griffith E.J.,CancerCare Manitoba | Musto G.,CancerCare Manitoba | Minuk G.Y.,University of Manitoba
Cancer Epidemiology | Year: 2013

Background: The association between antihypertensive medications and survival in cancer patients remains unclear. Objectives: To explore the association between classes of antihypertensive drugs and survival in cancer patients. Methods: Provincial Cancer Registry data was linked with a Provincial Drug Program Information Network (DPIN) for patients with lung (n= 4241), colorectal (n= 3967), breast (n= 4019) or prostate (n= 3355) cancer between the years of 2004 and 2008. Cox regression analyses were used to compare survival of patients using beta blockers (BBs), angiotensin-converting enzyme inhibitors/receptor blockers (ACEi/ARB), calcium channel blockers (CCBs) or thiazide diuretics (TDs) to survival of patients who did not use any of these antihypertensive drugs. Survival of patients using only one class of antihypertensive drugs were compared to each other, with BBs as the reference class. Results: Compared to the antihypertensive drug non-user cohort, BBs had no effect on survival for any of the cancers. ACEi/ARBs use was weakly associated with increased deaths for breast cancer (HR: 1.22, 95% CI: 1.04-1.44) and lung cancer (HR: 1.11, 95% CI: 1.03-1.21) patients. Deaths were also increased with CCB use in patients with breast cancer (HR: 1.22, 95% CI: 1.02-1.47) and with TD use in lung cancer patients (HR: 1.1, 95% CI: 1.01-1.19). There was strong evidence (p-value <0.0001) of an increase in deaths with TD use for colorectal (HR: 1.28, 95% CI: 1.15-1.42), and prostate (HR 1.41, 1.2-1.65) cancer patients. When including only antihypertensive drug users prescribed one drug class, lung cancer patients receiving CCBs had improved survival compared to BBs (HR 0.79, 95% CI: 0.64-0.98). Conclusions: Some classes of antihypertensive agents are associated with a decreased survival in certain cancers. The decrease could be due to more comorbidities in antihypertensive drug users. However, CCB use was associated with improved survival in lung cancer patients. © 2013.

Flores-Tapia D.,CancerCare Manitoba | Flores-Tapia D.,University of Manitoba | Pistorius S.,University of Manitoba
Medical Physics | Year: 2011

Purpose: The purpose of this paper is to assess the experimental feasibility of a novel breast microwave radar reconstruction approach, circular holography, using realistic experimental datasets recorded using a preclinical experimental setup. The performance of this approach was quantitatively evaluated by calculating the signal to noise ratio, contrast to noise ratio, spatial accuracy, and reconstruction time. Methods: Six datasets were recorded, three corresponding to fatty cases and three containing synthetic dense tissue structures. Five of these datasets contained an 8 mm inclusion that emulated a malignant lesion. The data were acquired from synthetic phantoms that mimic the dielectric properties of breast tissues in the 1-6 GHz range using a custom experimental breast microwave radar system. The spatial accuracy and signal to noise ratio of the reconstructed was calculated for all the reconstructed images. The contrast to noise ratio of the reconstructed images corresponding to the datasets containing fibroglandular tissue regions was determined. This was done to evaluate the ability of the circular holographic method to provide images in which the responses from tumors can be distinguished from adjacent dense tissue structures. The execution time required to form the images was also measured to evaluate the data throughput of the holographic approach. Results: For all the reconstructed datasets, the location of the synthetic tumors in the experimental setup was consistent with its position in the reconstructed image. The average spatial error was 2.2 mm, which is less than half the spatial resolution of the data acquisition system. The average signal to noise ratio of the reconstructed images containing an artificial malignant lesion was 8.5 dB, while the average contrast to noise ratio was 6.7 dB. The reconstructed images presented no artifacts. The average execution time of the images formed using the proposed approach was 5 ms, which is six orders of magnitude faster than current state of the art breast microwave radar (BMR) reconstruction algorithms. Conclusions: The results show that circular holography is capable of forming accurate images with signal to noise levels higher than 8 dB in quasi real time. Compared to BMR reconstruction algorithms tested on datasets containing dense tissue structures, the holographic approach generated images of similar spatial accuracy with higher signal to noise ratios and an acceleration factor of one order of magnitude. © 2011 American Association of Physicists in Medicine.

Olujohungbe A.,CancerCare Manitoba | Burnett A.L.,Johns Hopkins Hospital
British Journal of Haematology | Year: 2013

Priapism due to sickle cell disease is a common but less well characterized complication of the disorder. It represents a "medical emergency" with the key determinant of outcome being the duration of penile ischaemia and time to detumescence of <4 h associated with a successful treatment outcome. Management can be outpatient-based and consists of pre-emptive strategies for early stuttering attacks based on prior health education of the association between the 2 disorders, non pharmacological management, outpatient penile aspiration and irrigation with or without instillation of alpha and beta adrenergic agonists for acute episodes and secondary prophylaxis to prevent the high rates of recurrences. The evidence to recommend medical prophylaxis is sparse but based on a consensus of experts and small phase 2 or III clinical trials. A clearer understanding of the molecular mechanism(s) involving normal and dysregulated erectile physiology, scavenger haemolysis and nitric oxide pathway paves way for the use of phosphodiesterase type 5 inhibitors in medical prophylaxis of stuttering attacks. These agents will need to be studied in multi-centre randomized phase III trials before they become standard of care. A multidisciplinary team approach is required to enhance "sexual wellness" and prevent erectile dysfunction in this sexually vulnerable group. © 2013 Blackwell Publishing Ltd.

Streu E.,CancerCare Manitoba
Clinical Journal of Oncology Nursing | Year: 2016

The administration of gammaglobulin as replacement therapy to boost immune function in patients with immunodeficiency secondary to malignancy is traditionally given in the IV formulation. A pilot program at a large Canadian cancer center led by an advanced practice nurse (APN) demonstrated that transitioning patients to homebased, self-administered subcutaneous infusions (subcutaneous immunoglobulin [SCIG]) led to savings and benefits for patients and the institution. The implementation of SCIG in oncology by an APN is a novel and innovative patient-centered approach to supportive care. At a Glance • Replacement therapy of gammaglobulin may be safely administered via slow subcutaneous infusions in the home setting. • Transitioning patients from IV gammaglobulin to SCIG promotes patient engagement, independence, and autonomy. • Development, implementation, and evaluation of an SCIG program represents one role an APN can play in oncology clinical care. © 2016 by the Oncology Nursing Society.

Flores-Tapia D.,CancerCare Manitoba
Conference proceedings : ... Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Conference | Year: 2010

Currently, prostate cancer is the third leading cause of cancer-related deaths among men in North America. As with many others types of cancer, early detection and treatment greatly increases the patient's chance of survival. Combined Magnetic Resonance Imaging and Spectroscopic Imaging (MRI/MRSI) techniques have became a reliable tool for early stage prostate cancer detection. Nevertheless, their performance is strongly affected by the determination of the region of interest (ROI) prior to data acquisition process. The process of executing prostate MRI/MRSI techniques can be significantly enhanced by segmenting the whole prostate. A novel method for segmentation of the prostate in MRI datasets is presented. This method exploits the different behavior presented by signal singularities and noise in the wavelet domain in order to accurately detect the borders around the prostate. The prostate contour is then traced by using a set of spatially variant rules that are based on prior knowledge about the general shape of the prostate. The proposed method yielded promising results when applied to clinical datasets.

Kliewer E.V.,CancerCare Manitoba
Health reports / Statistics Canada, Canadian Centre for Health Information = Rapports sur la santé / Statistique Canada, Centre canadien d'information sur la santé | Year: 2010

BACKGROUND: With the recent introduction of a human papillomavirus (HPV) vaccine in Canada, it is important to establish surveillance and evaluation programs that not only track the uptake of the vaccine, but also assess its safety and its impact on: distribution of HPV type, cervical cancer screening programs, the incidence of anogenital warts, precancerous lesions and various cancers, and sexual behaviour. DATA SOURCES AND METHODS: Administrative databases, registries and questionnaire information are being linked to identify people receiving the HPV vaccine and to develop an evaluation system. INTERPRETATION: The availability of extensive linkable databases in Manitoba allows for the development of a comprehensive HPV vaccine surveillance and evaluation system that can address many of the questions related to the HPV vaccine. Aspects of the Manitoba surveillance and evaluation system could be implemented in other provinces that have similar databases.

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 < 0.0001). NFTA and NA urologists were more likely to have PSM compared to FTA urologists (OR 2.50; 95% CI: 1.44-4.35 and OR 2.10; 95% CI: 1.53-2.88, respectively). However, the proportion of PSM between NFTA and NA urologists was not significant (p = 0.492). In addition, pathological stage (p = 0.0004), Gleason sum (p < 0.0001), and surgeon volume (p = 0.017) were associated with PSM. Limitations include retrospective design and lack of clinical and functional outcomes.CONCLUSIONS: Uro-oncology fellowship trained surgeons had significantly lower rates of PSM than non-fellowship trained surgeons in this population based cohort. This study demonstrates the importance of surgeon-related variables on pathological outcomes and highlights the value of additional urologic oncology fellowship training.

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