Search Results (22)

Background: Multiple immunologic parameters have provided useful prognostic and assessment significance in various cancers, including head-and-neck squamous cell carcinoma (scc). We sought to identify whether pretreatment inflammatory markers could prognosticate recurrence in patients with advanced (stage III or IV) head-and-neck scc who underwent therapy with curative intent in a tertiary care centre between January 2010 and December 2012. Methods: In a chart review, we recorded demographics; primary tumour characteristics; p16 status; pretreatment inflammatory markers, including body mass index (bmi), neutrophil-to-lymphocyte ratio (nlr), C-reactive protein (crp), and serum albumin; therapy received; and date of relapse, death, or last follow-up. The main outcome was relapse-free survival (rfs). Overall survival (os) was a secondary outcome. Results: From among 235 charts reviewed, 118 cases were included: 86 oropharyngeal (50 p16-positive, 18 p16-negative, 17 p16 unavailable, 1 p16 indeterminate), and 32 non-oropharyngeal (7 p16-positive, 19 p16-negative, 6 p16 unavailable). Median follow-up was 2.45 years (25%–75% interquartile range: 1.65–3.3 years). In univariate analysis, p16 status, bmi, modified Glasgow prognostic score, and crp were significant for rfs, but in multivariate analysis, only p16 status, bmi, and crp remained significant. For os, only crp and nlr were significant in both the univariate and multivariate analyses. After adjustment for p16 status, nlr did not remain significant. After adjustment for p16 status, crp remained significant for both rfs and os. Conclusions: In patients with head-and-neck scc, a stronger prognostic value is associated with human papillomavirus status than with nlr and many other factors, including bmi and albumin. However, even though few of our patients had high crp, serum crp remained significant despite p16-positive status. Full article

The development of evidence-based exercise guidelines for people with cancer represents a major achievement in research and provides direction to programming initiatives. The prevalence of sedentary cancer survivors and the risk posed by inactivity suggests a knowledge-to-action gap for which the evidence has not led to increased exercise levels in that population. To address that gap, researchers continue to explore opportunities to improve the understanding of exercise within the oncologic context—from tumour biology to behaviour-change theories—to drive improved access and participation in exercise and rehabilitative activity. In Canada, such efforts have largely been invested by individuals and small teams across the country rather than by unifying stakeholders to drive nationwide impact. Accordingly, a national group of leading researchers, clinicians, and other stakeholders convened a meeting to discuss and strategize initiatives on how to conduct innovative research into the effects of exercise and rehabilitation in cancer survivors, to increase access to exercise and rehabilitation services in cancer survivors, and to reduce sedentary behaviour in cancer survivors. The 2-day meeting, titled Ex/Cancer, was held April 2017 in Toronto, Ontario, and was attended by 83 stakeholders from across Canada, representing knowledge end-users (cancer survivors), clinicians (oncologists, nurses, counsellors), a provincial cancer care agency, community-based exercise and cancer organizations, and researchers. Attendees participated in networking events, roundtable discussions, and breakout sessions to identify, discuss, and develop clinical and research experiences and opportunities. In addition to knowledge exchange between attendees, the meeting set the foundation for the development of a collaborative network to support the development, dissemination, and support of clinical and research activity in exercise and rehabilitation for cancer survivors. With unanimous support from attendees, a major product of the Ex/Cancer meeting was the formation of the Canadian Oncology Rehabilitation and Exercise Network—COREN. Full article

Background Social support has been shown to buffer some difficulties of living with advanced cancer. The Palliative Rehabilitation Program (prp) was an interdisciplinary outpatient program offering post-treatment palliative rehabilitation to patients with advanced cancer. Social support was directly integrated into the program. The aim of the present study was to examine the types and sources of social support that patients found most beneficial. Methods Twelve patients participated in 30-minute semi-structured interviews. Thematic content analysis was used to explore the social support experiences of those patients in the prp. Patients were eligible to participate in the interview if they had completed the 8-week prp, spoke English, and did not have cognitive or auditory impairments affecting their ability to participate. Results The main sources of support reported by participants were team members and spouse, family, or close friends; peers attending the program; and spiritual beliefs. Social support varied based on sex and age, such that, compared with women, men reported relying less on social support, and the supportive needs of younger (≤50 years of age) and older participants differed. Team members were endorsed as frequently as family as social support. Discussion Emotional support was endorsed with the greatest frequency. The members of the interdisciplinary care team were also providers of emotional and informational support for patients, bolstering the support received from caregivers. Widowed or divorced women might rely on health care providers more readily than do married men, who chose their wives as support. Future rehabilitation programs might consider the importance of an interdisciplinary team, the formal integration of caregivers, and the incorporation of spirituality to meet the unique supportive needs of patients with advanced cancer. Full article

Recent guidelines concerning exercise for people with cancer provide evidence-based direction for exercise assessment and prescription for clinicians and their patients. Although the guidelines promote exercise integration into clinical care for people with cancer, they do not support strategies for bridging the guidelines with related resources or programs. Exercise program accessibility remains a challenge in implementing the guidelines, but that challenge might be mitigated with conceptual frameworks (“pathways”) that connect patients with exercise-related resources. In the present paper, we describe a pathway model and related resources that were developed by an expert panel of practitioners and researchers in the field of exercise and rehabilitation in oncology and that support the transition from health care practitioner to exercise programs or services for people with cancer. The model acknowledges the nuanced distinctions between research and exercise programming, as well as physical activity promotion, that, depending on the available programming in the local community or region, might influence practitioner use. Furthermore, the pathway identifies and provides examples of processes for referral, screening, medical clearance, and programming for people after a cancer diagnosis. The pathway supports the implementation of exercise guidelines and should serve as a model of enhanced care delivery to increase the health and well-being of people with cancer. Full article

The cranberry fruitworm (Acrobasis vaccinii Riley), sparganothis fruitworm (Sparganothis sulfureana Clemens), and blackheaded fireworm (Rhopobota naevana Hübner) are historically significant pests of cranberries (Vaccinium macrocarpon Aiton) in the Upper Midwest (Wisconsin), USA. Their respective natural histories are well documented but correlations between developmental benchmarks (e.g., larval eclosion) and degree-day accruals are not yet known. Treatment timings are critical to the optimization of any given control tactic, and degree-day accrual facilitates optimization by quantifying the developmental status of pest populations. When key developmental benchmarks in the pest life cycle are linked to degree-days, real-time weather data can be used to predict precise treatment timings. Here, we provide the degree-day accumulations associated with discrete biological events (i.e., initiation of flight and peak flight) for the three most consistent moth pests of cranberries in Wisconsin. Moths were trapped each spring and summer from 2003 to 2011. To characterize flight dynamics and average timing of flight initiation, pheromone-baited trap-catch data were tallied for all three pest species within each of seven growing seasons. These flight dynamics were then associated with the corresponding degree-day accumulations generated using the cranberry plant’s developmental thresholds. Finally, models were fit to the data in order to determine the peak flight of each species. The initiation of the spring flight among all three moth species was highly synchronous, aiding in the timing of control tactics; however, there were substantial differences in the timing of peak flight among the moth species. Characterization of the relationship between temperature and pest development allows pest management professionals to target specific life stages, improving the efficacy of any given pest control tactic. Full article

Background: Cancer can affect many dimensions of a patient’s life, and in turn, it should be targeted using a multimodal approach. We tested the extent to which an interdisciplinary nutrition–rehabilitation program can improve the well-being of patients with advanced cancer. Methods: Between January 10, 2007, and September 29, 2010, 188 patients with advanced cancer enrolled in the 10–12-week program. Body weight, physical function, symptom severity, fatigue dimensions, distress level, coping ability, and overall quality of life were assessed at the start and end of the program. Results: Of the enrolled patients, 70% completed the program. Patients experienced strong improvements in the physical and activity dimensions of fatigue (effect sizes: 0.8–1.1). They also experienced moderate reductions in the severity of weakness, depression, nervousness, shortness of breath, and distress (effect sizes: 0.5–0.7), and moderate improvements in Six Minute Walk Test distance, maximal gait speed, coping ability, and quality of life (effect sizes: 0.5–0.7) Furthermore, 77% of patients either maintained or increased their body weight. Conclusions: Interdisciplinary nutrition–rehabilitation can be advantageous for patients with advanced cancer and should be considered an integrated part of standard palliative care. Full article

As cancer survivorship increases, there is a need for additional and more complex rehabilitation services. The Partners in Cancer Rehabilitation Research group held a 3-day invitational working meeting aimed at defining the state of the science in cancer rehabilitation research and identifying key areas for development of research and education. In May 2012, 29 participants gathered to present their current work, review a synthesis of the current literature, generate ideas about research and education gaps, and develop consensus on priority areas. The conclusion of the meeting was that a main research priority is to develop and test personalized rehabilitation interventions and brief measures to identify the presence and severity of disabling sequelae. The education consensus statement concluded that a clear description of cancer rehabilitation and its mandate should be developed as a precursor to education activities, including both a conceptualization of complex interdisciplinary rehabilitation and the roles of individual professions, and further, that there is a great need to increase awareness among health professionals, patients, and families of the need for and general effectiveness of cancer rehabilitation. Numerous specific recommendations were also put forward, and it is hoped that those recommendations will provide the foundation for a new and productive era of research and will play a role in the improvement of functional health and participation outcomes for cancer survivors. Full article

Background: Approximately 10% of new breast cancer patients will present with overt synchronous metastatic disease. The optimal local management of those patients is controversial. Several series suggest that removal of the primary tumour is associated with a survival benefit, but the retrospective nature of those studies raises considerable methodologic challenges. We evaluated our clinical experience with the management of such patients and, more specifically, the impact of surgery in patients with synchronous metastasis. Methods: We reviewed patients with primary breast cancer and concurrent distant metastases seen at our centre between 2005 and 2007. Demographic and treatment data were collected. Study endpoints included overall survival and symptomatic local progression rates. Results: The 111 patients identified had a median follow-up of 40 months (range: 0.6–71 months). We allocated the patients to one ot two groups: a nonsurgical group (those who did not have breast surgery, n = 63) and a surgical group (those who did have surgery, n = 48, 29 of whom had surgery before the metastatic diagnosis). When compared with patients in the nonsurgical group, patients in the surgical group were less likely to present with T4 tumours (23% vs. 35%), N3 nodal disease (8% vs. 19%), and visceral metastasis (67% vs. 73%). Patients in the surgical group experienced longer overall survival (49 months vs. 33 months, p = 0.01) and lower rates of symptomatic local progression (14% vs. 44%, p < 0.001). Conclusions: In our study, improved overall survival and symptomatic local control were demonstrated in the surgically treated patients; however, this group had less aggressive disease at presentation. The optimal local management of patients with metastatic breast cancer remains unknown. An ongoing phase iii trial, E2108, has been designed to assess the effect of breast surgery in metastatic patients responding to first-line systemic therapy. If excision of the primary tumour is associated with a survival benefit, then the preselected subgroup of patients who have responded to initial systemic therapy is the desired population in which to put this hypothesis to the test. Full article

Breast or chest-wall pain (bcp) is prevalent in 20%–50% of breast cancer survivors, and it affects quality of life (qol). To determine the feasibility and potential efficacy of an exercise program to improve patient qol and bcp, such a program was offered to breast cancer patients suffering from bcp. The study enrolled 10 breast cancer patients with moderate-to-severe bcp at 3–6 months after completion of all adjuvant treatments. These patients participated in a 12-week comprehensive health improvement program (chip). Intensity was adjusted to reach 65%–85% of the patient’s maximal heart rate. Before the chip and at 1 and 6 months after completion of the chip, qol and pain were measured using questionnaires [European Organisation for Research and Treatment of Cancer Quality of Life core and breast cancer modules (qlq-C30, -BR23) and the McGill Pain Questionnaire short form] completed by the patients. Results were compared with those from case-matched control subjects from another study at McGill University. After the chip, patients reported significant and clinically important improvements in qol and symptoms. At 1 and 6 months post-chip, patients in the study felt, on average, better in overall qol than did historical control subjects. Our study suggests that patients who experience chronic bcp may benefit from an exercise program. A randomized controlled trial is warranted. Full article