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Metcalfe K.A.,University of Toronto | Metcalfe K.A.,Womens College Research Institute | Semple J.,Womens College Research Institute | Quan M.-L.,Foothills Medical Center | And 6 more authors.
Annals of Surgical Oncology | Year: 2012

Background: In this study, we report on the changes in psychosocial functioning over 1 year following breast cancer surgery in 3 groups of women, including those with mastectomy alone, those with mastectomy and immediate reconstruction, and those with delayed reconstruction. Methods: Women with breast cancer at 2 teaching hospitals in Ontario who were undergoing mastectomy alone, mastectomy with immediate reconstruction, or delayed reconstruction were asked to complete a battery of psychosocial questionnaires at their preoperative appointment and 1 year following surgery. Results: A total of 190 women consented to participate in the study and completed the presurgical questionnaires. There were no presurgical differences between the 3 groups in quality of life, anxiety, depression, or sexual functioning. However, women who were undergoing delayed breast reconstruction (i.e., already had a mastectomy) had higher levels of body stigma (P = 0.01), body concerns (P = 0.002), and transparency (P = 0.002) than women who were undergoing mastectomy alone or mastectomy with immediate reconstruction. Of these women, 158 (83.2%) completed the 1-year follow-up. There were no significant differences in any of the psychosocial functioning scores between the 3 groups. Discussion: Contrary to the assumed psychological benefits of breast reconstruction, psychological distress was evident among women regardless of reconstruction or timing of reconstruction. Further, psychosocial functioning (including quality of life, sexual functioning, cancer-related distress, body image, depression, and anxiety) was not different at 1-year postsurgery between women with mastectomy alone, mastectomy with immediate reconstruction, and delayed reconstruction. These results suggest that women need psychosocial support after breast cancer diagnosis, even if they have breast reconstruction. © 2011 Society of Surgical Oncology. Source

Phelan C.M.,Moffitt Cancer Center | Iqbal J.,Familial Breast Cancer Research | Lynch H.T.,Creighton University | Lubinski J.,Pomeranian Medical University | And 16 more authors.
British Journal of Cancer | Year: 2014

Background:The BRCA1 and BRCA2 genes confer increased susceptibility to breast and ovarian cancer and to a spectrum of other cancers. There is controversy regarding the risk of colorectal cancer conferred by germline mutations in these two genes.Methods:We followed 7015 women with a BRCA mutation for new cases of colorectal cancer. Incidence rates in carriers were compared with population-specific incidence rates, and standardised incidence ratios (SIRs) were estimated. The expected numbers of cancers were computed by multiplying person-years at risk by the appropriate age-, sex-and country-specific incidence rates from the five countries.Results:Twenty-one incident colorectal cancer cases were observed among all mutation carriers, compared with 23.6 cases expected. The SIR for BRCA1 carriers was 0.92 (95% confidence interval (CI), 0.54-1.40, P=0.7) and for BRCA2 carriers was 0.82 (95% CI, 0.30-1.81, P=0.7). The SIR for colon cancer was 3.81 (95% CI 1.77-7.23) for women below the age of 50 years (both genes combined) and was 0.60 (95% CI 0.33-1.00) for women aged 50 years and above.Conclusion:The risk of colorectal cancer is increased in female carriers of BRCA1 mutations below the age of 50 years but not in women with BRCA2 mutations or in older women. © 2014 Cancer Research UK. Source

Kupets R.,Sunnybrook Regional Cancer Center | Fernandes K.,Institute for Clinical Evaluative science | Miroshnichenko G.,University of Toronto | Paszat L.,Institute for Clinical Evaluative science
Journal of Obstetrics and Gynaecology Canada | Year: 2013

Objective: To evaluate the patterns of radiologic imaging requested by family physicians and gynaecologists in the work-up of women found to have an adnexal mass on pelvic ultrasound, and to evaluate whether advanced imaging tests are associated with more appropriate referral of women with a high-risk adnexal mass to gynaecologic oncologists. Methods: Centralized provincial databases of health care usage were used to identify women aged 45 and older who had a pelvic ultrasound examination between 2006 and 2008 Subsequent imaging tests ordered were identified according to physician specialty For women who proceeded to laparotomy, logistic regression was performed to determine which imaging tests enabled primary physicians to make appropriate referrals of women with high risk adnexal tumours to a gynaecologic oncologist. Results: We identified 193 261 women aged 45 and older who had a pelvic ultrasound Of these, 19 949 (10 3%) had a subsequent laparotomy; 2223 women were categorized as having a benign adnexal mass, 627 were categorized as having a malignant adnexal mass, and the remainder had another diagnosis such as uterine fibroid. Up to 12% of women had a pelvic MRI, and 58% of women had a CT scan after a pelvic ultrasound Family physicians referred 95% of women with a high-risk ovarian mass to a gynaecologic surgeon rather than to a gynaecologic oncologist, and gynaecologists referred 47% of such women to a gynaecologic oncologist after imaging Gynaecologic oncologists operated on 55% of women with a malignant adnexal mass On multivariate analysis, a preoperative CT scan (OR 3.58; P < 0.001) and a CT scan and MRI (OR 7.78; P < 0.001) were associated with surgery performed by a gynaecologic oncologist, but a preoperative MRI alone was not significantly associated (OR 1. 86; P = 0.09). After ultrasound alone the mean time to surgery was 100 days; this increased significantly when further imaging tests were performed (with additional CT to 131 days, with MRI to 170 days, and with CT and MRI to 179 days; P = 0.002). Conclusion: Performing a pelvic MRI after a pelvic ultrasound does not increase the rate of referral of women with a high-risk adnexal mass to a gynaecologic oncologist. A consensus on appropriate imaging and triage is needed when an adnexal mass is identified on ultrasound. © 2013 Society of Obstetricians and Gynaecologists of Canada. Source

Ashworth A.,Queens University | Kong W.,Queens University | Chow E.,Sunnybrook Regional Cancer Center | MacKillop W.J.,Queens University
International Journal of Radiation Oncology Biology Physics | Year: 2016

Purpose To evaluate the effect of a provincial practice guideline on the fractionation of palliative radiation therapy for bone metastases (PRT.B) in Ontario. Methods and Materials The present retrospective study used electronic treatment records linked to Ontario's population-based cancer registry. Hierarchical multivariable regression analysis was used to evaluate temporal trends in the use of single fractions (SFs), controlling for patient-related factors associated with the use of SFs. Results From 1984 to 2012, 43.9% of 161,835 courses of PRT.B were administered as SFs. The percentage of SF courses was greater for older patients (age <50 years, 39.8% vs age >80 years, 52.5%), those with a shorter life expectancy (survival >12 months, 36.9% vs < 1 month, 53.6%), and those who lived farther from a radiation therapy center (<10 km, 42.1% vs > 50 km, 47.3%). The percentage of SFs to spinal fields was lower than that to other skeletal sites (31.5% vs 57.1%). The percentage of SFs varied among the cancer centers (range, 26.0%-67.8%). These differences were all highly significant in the multivariable analysis (P<.0001). In 2004, Cancer Care Ontario released a practice guideline endorsing the use of SFs for uncomplicated bone metastases. The rate of use of SFs increased from 42.3% in the pre-guideline period (1999-2003) to 52.6% in the immediate post-guideline period (2004-2007). However, it subsequently decreased again to 44.0% (2009-2012). These temporal trends were significant after controlling for patient-related factors in the multivariable analysis (P<.0001). Large intercenter variations in the use of SFs persisted after publication of the guideline. Conclusions The publication of an Ontario practice guideline endorsing the use of SF PRT.B was associated with only a transient increase in the use of SFs in Ontario and did little to reduce intercenter variations in fractionation. © 2016 Elsevier Inc. Source

Mackay H.J.,Princess Margaret Phase II Consortium | Hirte H.,Princess Margaret Phase II Consortium | Colgan T.,Sunnybrook Regional Cancer Center | Covens A.,Princess Margaret Phase II Consortium | And 9 more authors.
European Journal of Cancer | Year: 2010

Aim: Micropapillary/borderline (LMP) ovarian tumours are rarely included in clinical trials and are intrinsically resistant to radiation and chemotherapy. Platinum resistant epithelial ovarian cancer (EOC) has a poor prognosis. The histone deacetylase inhibitor belinostat demonstrated antitumour activity in pre-clinical ovarian cancer models. Methods: A phase II study was performed to evaluate the activity of belinostat in two patient populations: women with metastatic or recurrent platinum resistant (progression within 6 months) EOC and LMP ovarian tumours, both groups had received no more than 3 prior lines of chemotherapy. Belinostat 1000 mg/m2/d was administered iv days 1-5 of a 21 d cycle. Peripheral blood mononuclear cells (PBMCs) and tumour biopsies, where possible, for correlative studies were obtained prior to and following treatment. Results: Eighteen patients with EOC and 14 patients with LMP tumours were enrolled on study. Belinostat was well tolerated with no grade four toxicity (179 cycles). Grade 3 toxicity consisted of thrombosis (3 patients), hypersensitivity (1) and elevated ALP (1). One patient with LMP tumour had a partial response (unconfirmed) and 10 had stable disease (SD), 3 were non-evaluable. Median progression-free survival (PFS) was 13.4 months (95% confidence interval (CI), 5.6 - not reached). Best response in patients with EOC was SD (nine patients) and median PFS was 2.3 months (95% CI, 1.2-5.7 months). An accumulation of acetylated histones H3 and H4 was noted in PBMCs and in tumour tissue. Conclusions: Belinostat is well tolerated in both patient groups and shows some activity in patients with micropapillary (LMP) disease. © 2010 Elsevier Ltd. Source

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