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Leggett C.,Epidemiology and Cancer Registry | Griffith J.,University of Manitoba | Xue L.,CancerCare Manitoba | Fradette K.,CancerCare Manitoba
International Journal of Public Health | Year: 2012

Objectives Identifying multi-level factors affecting physical activity (PA) levels among adolescents is essential to increasing activity to promote health within this population. This study examines the associations between PA and 11 independent factors among Manitoba high school students. Methods The sample included 31,202 grade 9-12 students who completed the Manitoba Youth Health Survey. Associations between PA and independent factors were examined separately and through multivariate regression. Analyses were stratified by gender. Results Perception of athletic ability, school location, parental encouragement and number of active friends were strong predictors of activity for moderately active and active males and females. Grade was a significant predictor of PA for females at both levels of activity but only significant for males when comparing active to inactive students. Perception of schoolwork and means of transport were minimally associated with PA. Conclusions Results highlight the importance of targeting multiple levels of influence to increase PA among youth. Programs should focus on older students, females and those who are inactive or moderately active. In addition, social modeling of PA and increasing self-efficacy around activity should be encouraged. © Swiss School of Public Health 2011.


Campbell H.S.,University of Waterloo | Sanson-Fisher R.,University of Newcastle | Turner D.,Epidemiology and Cancer Registry | Turner D.,University of Manitoba | And 3 more authors.
Supportive Care in Cancer | Year: 2010

Purpose: This study aims to develop a psychometrically rigorous instrument to measure the unmet needs of adult cancer survivors who are 1 to 5 years post-cancer diagnosis. "Unmet needs" distinguishes between problems which survivors experience and problems which they desire help in managing. Methods: The survey was developed from a comprehensive literature review, qualitative analysis of the six most important unmet needs of 71 cancer survivors, review of the domains and items by survivors and experts, cognitive interviews and a pilot test of 100 survivors. A stratified random sample of 550 cancer survivors, selected from a population-based Cancer Registry, completed a mailed survey to establish reliability and validity. Results: The final 89-item Survivors Unmet Needs Survey (SUNS) has high acceptability, item test-retest reliability and internal consistency (Chronbach's alpha 0.990), face, content and construct validity. Five subscales measure Emotional Health needs (33 items, 19.4% of variance), Access and Continuity of Care (22 items, 15.1%), Relationships (15 items, 12.1%), Financial Concerns (11 items, 10.3%) and Information needs (eight items, 8.1% of the variance). Conclusions: This instrument has strong psychometric properties and is useful for determining the prevalence and predictors of cancer survivors' unmet needs across types of cancer, length of survivorship and socio-demographic characteristics. Use of the SUNS will enable more effective targeting of programmes and services and guide policy and health planning decisions. Relevance: This study is an important step toward evidence-based planning and management of problems which the growing survivor population requires assistance in managing. © 2010 Springer-Verlag.


Myers C.,Speech Language Pathology | Kerr P.,University of Manitoba | Cooke A.,Radiation Oncology | Bammeke F.,University of Manitoba | And 2 more authors.
Journal of Otolaryngology - Head and Neck Surgery | Year: 2012

Purpose: To report survival and longitudinal functional outcomes after radiation or chemoradiation in advanced-stage cancers of the oropharynx. Methods: A population-based cohort of 89 patients with stage III and IV oropharygeal carcinoma treated from 2003 to 2008 with conformal radiation or chemoradiation was followed. Patients were assessed with a standardized prospective clinical functional outcomes protocol pretreatment and at regular intervals posttreatment. The standard clinical functional outcomes protocol followed: performance status (Karnofsky Performance Status [KPS], Eastern Cooperative Oncology Group [ECOG]); swallowing status (performance status scale for head and neck cancer patients [PSS-HN] and Royal Brisbane Hospital Swallowing Scale [RBHOMS]); and speech (PSS-HN and Voice Handicap Index-10 [VHI-10]). Results: The primary site was the base of the tongue in 38 (43%) and tonsil or soft palate in 51 (57%) patients. Chemotherapy was used in 73%. The median follow-up was 3.4 years. At 3 years, overall survival was 72.3% and disease-free survival was 71.8%. Function reached a nadir at 3 months. At 36 months, the KPS was 90 or better in 76% and the ECOG was 0 in 75%. Total or partial feeding tube dependency ranged from 46% at 3 months to 3% at 2 years. Oral diet texture showed prolonged impairment, with 85% of survivors requiring a soft or semisolid diet with fluids at 36 months. Sixty-two percent were able to eat in public without restriction. Conclusions: The majority of patients will have a good functional outcome after radiation or chemoradiation for advanced oropharyngeal carcinoma. We now have a functional benchmark to which we can compare the results of primary surgery and newer treatment techniques, such as intensity-modulated radiation treatment. © 2012 The Canadian Society of Otolaryngology-Head & Neck Surgery.


Liu H.-W.,University of Calgary | Nugent Z.,Epidemiology and Cancer Registry | Clayton R.,University of Calgary | Dunscombe P.,University of Calgary | And 2 more authors.
Acta Oncologica | Year: 2014

Purpose. To evaluate the clinical impact of using the deterministic dose calculation algorithm, Acuros XB, for early stage lung cancer patients undergoing stereotactic body radiotherapy (SBRT). Material and methods. Seventy-seven stage I non-small cell lung cancer patients who underwent lung SBRT from 2008 to 2012 at our center were included in this study. All treatment plans originally calculated by the anisotropic analytical algorithm (AAA) were recalculated using the AAA and Acuros XB algorithms with identical monitor units and beam arrangements. The dose, dose distribution, conformality number (CN) and heterogeneity index (HI) of the target were determined for each plan. A paired matched t-test was used to evaluate the difference between the mean dose, the dose distribution, and the CN and HI for the target. The importance of tumor (volume, location), patient (pulmonary functional, body mass index) and treatment (number of SBRT beams) on the dose distributions obtained from the two algorithms was statistically determined using linear regression analyses. Results. The mean target dose was same for both algorithms. Compared to AAA, a small and significant difference in dose distribution in the target was found for the Acuros XB algorithm, resulting in lower conformity (-2.1%, p < 0.0001) and higher heterogeneity (p < 0.0001) of dose. Single logistic regression identified pulmonary function, number of beams and target location as being correlated with the difference of CN between the two calculations. Multivariate analysis indicated that the patient's pulmonary function (p = 0.0296) was the only predictor for the difference in conformality between the two dose calculation algorithms. Conclusions. In lung SBRT, the patient's pulmonary function is responsible for the difference in target dose distribution between the Acuros XB and AAA algorithms. The Acuros XB algorithm could be used to advantage in patients with compromised pulmonary function based on its accurate modeling of lung tissue in comparison to AAA. © 2014 Informa Healthcare.


Navaratnam S.,University of Manitoba | Kliewer E.V.,Epidemiology and Cancer Registry | Kliewer E.V.,University of Manitoba | Butler J.,Australian National University | And 4 more authors.
Lung Cancer | Year: 2010

Background: The aim of this study was to examine the patterns and costs of management of non-small cell lung cancer (NSCLC) after completion of chemotherapy until death in a population of patients in Manitoba, Canada. Patients and methods: Stage IIIB and IV NSCLC patients diagnosed between January 1997 and June 2000 who received chemotherapy as the primary treatment, completed their chemotherapy and survived for at least 28 days since their last treatment, and were on best supportive care (BSC) were selected. Treatment, services received, costs, and survival were determined by chart review and examining various databases including the Manitoba Cancer Registry, medical claims, hospitalizations, and prescription drugs. Costs of treatment, average cost per patient, and lifetime treatment costs were calculated. Results: Of the 2463 patients diagnosed with NSCLC over the study period, 150 patients matched our study criteria. From the beginning of the first chemotherapy treatment, the median survival time was 31.8 weeks, while from the date of BSC the median survival time was 13.8 weeks. The average cost per case was $10,805 from last date of chemotherapy and $8654 during the BSC period. The average cost per patient-month ranged from $1645 to $1792 in current prices. Lifetime treatment costs ranged from $8702 to $11,057. Hospitalizations accounted for 80% of the total treatment costs. Conclusion: The largest overall component of cost after the end of chemotherapy was hospitalizations. Effective new therapies that reduce the episodes of hospitalizations would have a significant impact on decreasing aggregate costs. © 2010.


Schultz A.S.H.,University of Manitoba | Nowatzki J.,Epidemiology and Cancer Registry | Dunn D.A.,Kwantlen Polytechnic University | Griffith E.J.,Epidemiology and Cancer Registry | Griffith E.J.,University of Manitoba
Chronic Diseases in Canada | Year: 2010

Objective: To determine associations between younger youths' susceptibility to smoking and four household variables related to tobacco socialization: parental and sibling smoking, restrictions on smoking in the home and exposure to smoking in vehicles. Methods: A secondary analysis of the 2004/05 Canadian Youth Smoking Survey used logistic regression to investigate the relationships between youth susceptibility to smoking, gender, and four household variables related to tobacco socialization. Susceptibility to smoking was operationalized by three levels of smoking experience and intention: non-susceptible non-smoker, susceptible non-smoker and experimenter/smoker. The national survey included 29 243 grade 5 to 9 students from randomly sampled public and private schools in ten provinces. Results: For non-smokers, the odds of being susceptible to smoking increased with having a sibling who smokes, a lack of a total household smoking ban and riding in a vehicle with a smoker in the previous week, when adjusting for all other variables in the model. These variables also increased the odds of being an experimenter/smoker versus a susceptible non-smoker. Parent smoking status was not significant in these models. Conclusion: Denormalization messages, through enforced home and vehicle smoking bans, appear to support youth in maintaining a resolve to not smoke, regardless of parental smoking status.


Decker K.M.,University of Manitoba | Demers A.A.,University of Manitoba | Nugent Z.,Epidemiology and Cancer Registry | Nugent Z.,University of Manitoba | And 2 more authors.
American Journal of Gastroenterology | Year: 2015

OBJECTIVES:We examined trends in colorectal cancer (CRC) screening (fecal occult blood test (FOBT), colonoscopy, and flexible sigmoidoscopy (FS)) and differences in CRC screening by income in a population with an organized CRC screening program and universal health-care coverage.METHODS:Individuals who had an FOBT, colonoscopy, or FS were identified from the provincial Physician Claims database and the population-based colon cancer screening registry. Trends in age-standardized rates were determined. Logistic regression was performed to explore the association between CRC screening and income quintiles by year.RESULTS:Up-to-date CRC screening (FOBT, colonoscopy, or FS) increased over time for men and women, all age groups, and all income quintiles. Up-to-date CRC screening was very high among 65- to 69- and 70- to 74-year-olds (70% and 73%, respectively). There was a shift toward the use of an FOBT for CRC screening for individuals in the lower income quintiles. The disparity in colonoscopy/FS coverage by income quintile was greater in 2012 than in 1995. Overall, there was no reduction in disparities by income in up-to-date CRC screening nor did the rate of increase in up-to-date CRC screening or FOBT use change after the introduction of the organized provincial CRC screening program.CONCLUSIONS:CRC screening is increasing over time for both men and women and all age groups. However, a disparity in up-to-date CRC screening by income persisted even with an organized CRC screening program in a universal health-care setting. © 2015 by the American College of Gastroenterology.


Kujath M.,University of Winnipeg | Kerr P.,University of Winnipeg | Myers C.,Speech Language Pathology | Bammeke F.,University of Winnipeg | And 3 more authors.
Journal of Otolaryngology - Head and Neck Surgery | Year: 2011

Objective: To compare the functional and oncologic outcomes of transoral CO2 laser microsurgery relative to radiotherapy for early-stage glottic carcinoma. Design: Functional analysis: population-based, prospective, nonrandomized consecutive series of stage 1 and 2 glottic carcinoma treated with laser surgery (n = 54) or radiotherapy (n = 25). Oncologic analysis: population-based, historical cohort comparing laser surgery (n = 54) and radiotherapy (n = 76). Setting: Academic cancer centre. Methods and Outcome Measures: Functional results were prospectively collected prior to treatment and at 3, 6, 12, and 24 months following treatment using validated performance scales assessing general level of function, speech, and swallowing. Oncologic results were collected from a larger cohort from the cancer registry of CancerCare MB. Results: Laser surgery resulted in a voice that was less likely to be understood all the time (Performance Status Scale for Head and Neck Cancer Patients: understandability score < 100; OR = 12.2; p = .03) and a higher likelihood of having a Voice Handicap Index (VHI-10) score of 10 or more (OR = 16.2; p =.001). Five-year laryngectomy-free survival rates for laser versus radiation were 87 versus 76% (p = .16). Subset analysis revealed that stage 1 5-year laryngeal preservation rates for laser (n = 51) versus radiation (n = 46) were 100 versus 86% (p = .02). Conclusions: There is a higher likelihood of hoarseness after laser surgery, but the severity of this handicap is mild in most patients. Laser microsurgery results in excellent laryngeal preservation rates, which may exceed those of radiation. © 2011 The Canadian Society of Otolaryngology-Head & Neck Surgery.


Nowatzki J.,Epidemiology and Cancer Registry | Schultz A.S.H.,University of Manitoba | Griffith E.J.,Epidemiology and Cancer Registry | Griffith E.J.,University of Manitoba
Chronic Diseases in Canada | Year: 2010

Objective: To compare the perceptions of youth in grades 5 to 9 and parents regarding their household environment relevant to smoking socialization. Methods: We conducted secondary analysis of the 2004/05 Canadian Youth Smoking Survey and corresponding parent survey, and used the McNemar Test to compare youth and parent responses. Results: Results showed statistically significant patterns of disagreement between youth and parent responses at most levels of youth smoking uptake regarding parental smoking, household rules around smoking, and smoking in the home and vehicles. When youth and parents disagreed, the following patterns emerged: non-susceptible, nonsmoking youth perceived their parents as non-smokers and youth with more smoking experience perceived their parents as smokers; youth at all levels of smoking uptake perceived fewer rules in the home than parents indicated, more smoking in the home than parents indicated, and exposure to smoking in vehicles in contrast to vehicle smoking bans indicated by parents. Conclusion: To the best of our knowledge, this is the first study to compare the perceptions of youth and parents regarding household variables related to the socialization of tobacco use. The discrepancies between youth and parent responses suggest that there is room to improve on establishing household environments that clearly condemn the use of tobacco, which may affect youth susceptibility to future smoking.


Kerr P.,University of Manitoba | Taylor S.M.,Dalhousie University | Rigby M.,Dalhousie University | Myers C.,Speech Language Pathology | And 4 more authors.
Journal of Otolaryngology - Head and Neck Surgery | Year: 2012

Objective: To compare the laryngeal preservation rates and voice outcomes after treatment of early glottic cancer between transoral laser microsurgery (TLM) and radiotherapy (RT). Design: Multicenter, retrospective consecutive cohort of stage 1 and 2 glottic carcinoma treated with TLM or RT. Setting: Three Canadian academic cancer centres. Methods and Main Outcome Measures: The patients were those of the regional cancer registries associated with each of the participating universities between 2002 and 2010. The primary oncologic end point was organ preservation. The primary functional outcome measure was the Voice Handicap Index (VHI-10). Results: A total of 234 patients were treated for early glottic cancer (143 TLM, 91 RT). At 2 years, the laryngeal preservation rate for stage 1 disease was 100% TLM and 92% RT (p < .004); for stage 2 disease, it was 100% TLM and 88% RT (p = not significant). There was only one laryngectomy in the TLM group over 5 years posttreatment. There were functional data on 132 patients (83 TLM, 49 RT). Median VHI-10 scores were inferior for laser patients at all three time intervals (6, 12, and 24-48 months posttreament) despite a stage bias in favour of TLM (range of median VHI score over time intervals: TLM = 9.5-12, RT = 3.5-8; p = .01-.08). However, theses scores represent mild disability in both groups. Conclusions: TLM patients have poorer voice quality than RT patients. However, the advantages of TLM in most patients outweigh the degree of voice handicap. Organ preservation rates for TLM were better than or equal to those of RT for both stage 1 and 2 glottic cancer. © 2012 The Canadian Society of Otolaryngology-Head & Neck Surgery.

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