1
|
Alif SM, Benke GP, Kromhout H, Vermeulen R, Tran C, Ronaldson K, Walker-Bone K, Woods R, Beilin L, Tonkin A, Owen AJ, McNeil JJ. Long-term occupational exposures on disability-free survival and mortality in older adults. Occup Med (Lond) 2023; 73:492-499. [PMID: 37948123 PMCID: PMC10756660 DOI: 10.1093/occmed/kqad105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND The impact of long-term occupational exposures on health in older adults is increasingly relevant as populations age. To date, no studies have reported their impact on survival free of disability in older adults. AIMS We aimed to investigate the association between long-term occupational exposure and disability-free survival (DFS), all-cause mortality and cause-specific mortality in initially healthy older adults. METHODS We analysed data from 12 215 healthy participants in the ASPirin in Reducing Events in the Elderly (ASPREE) study whose mean age was 75 years. Their work history was collated with the 'ALOHA-plus JEM' (Job Exposure Matrix) to assign occupational exposures. The primary endpoint, DFS, was a composite measure of death, dementia or persistent physical disability. The secondary endpoint, mortality, was classified according to the underlying cause. Cox proportional hazard models were used to calculate hazard ratios and 95% confidence intervals, adjusted for confounders. RESULTS A total of 1835 individuals reached the DFS endpoint during the median 4.7 years follow-up period. Both ever-high and cumulative exposure to all dusts and all pesticides during a person's working years were associated with reduced DFS. Compared to no exposure, men with high exposure to dusts and pesticides had a reduced DFS. Neither of these exposures were significantly associated with all-cause mortality. Men with high occupational exposure to solvents and women exposed to dusts experienced higher all-cause and cancer-related mortality. CONCLUSIONS Long-term occupational exposure to all dusts and pesticides was associated with a reduced DFS and increased mortality in community-dwelling healthy older adults.
Collapse
Affiliation(s)
- S M Alif
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria 3004, Australia
- School of Health Sciences, The University of Melbourne, Melbourne, Victoria 3000, Australia
- Institute of Health and Wellbeing, Federation University Australia, Berwick, Victoria 3806, Australia
| | - G P Benke
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria 3004, Australia
| | - H Kromhout
- Environmental Epidemiology Division, Institute for Risk Assessment Sciences, Utrecht University, 3584 CS Utrecht, The Netherlands
| | - R Vermeulen
- Environmental Epidemiology Division, Institute for Risk Assessment Sciences, Utrecht University, 3584 CS Utrecht, The Netherlands
| | - C Tran
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria 3004, Australia
| | - K Ronaldson
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria 3004, Australia
| | - K Walker-Bone
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria 3004, Australia
| | - R Woods
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria 3004, Australia
| | - L Beilin
- School of Medicine, The University of Western Australia, Perth, Western Australia 6009, Australia
| | - A Tonkin
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria 3004, Australia
| | - A J Owen
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria 3004, Australia
| | - J J McNeil
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria 3004, Australia
| |
Collapse
|
2
|
Coyle DJ, McArdle O, McClean B, Woods R, Duane F. Financial Implications of Evolving Breast Cancer Radiotherapy Treatment Protocols. Int J Radiat Oncol Biol Phys 2023; 117:e575-e576. [PMID: 37785752 DOI: 10.1016/j.ijrobp.2023.06.1911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Adjuvant radiotherapy for breast cancer represents a significant portion of radiotherapy (RT) treatments. The resource implications of evidence-based changes in treatment protocols must be defined to facilitate RT service planning. We designed a study to calculate the impact of past changes and create a model to allow prediction of costs implications for future changes. MATERIALS/METHODS Changes in RT treatment (shown in table 1) in the past 3 years were identified in consultation with clinical staff and by reviewing institutional treatment guidelines. Resource and infrastructure costs were calculated for each protocol. Staff time was calculated using standard time slots where known (e.g., CT simulation appointment) and estimates based on discussion with staff (e.g., time to plan whole breast RT). Cost / Gy was calculated based on Linac cost of €2.5M, 10% annual service charge over 12-year lifetime, 2.7 patients treated / hour (verified institutional metric) and standard 2Gy fraction, giving €37.72 / Gy. We did not include facilities costs nor account for differing treatment outcomes. We collected relevant data on a consecutive 6-month sample (Jan - Jun 2019) of women receiving adjuvant RT for breast cancer (n = 224). Total costs were calculated by applying costs for each protocol change to the women in this cohort eligible for the changes. RESULTS Protocol changes and costs are summarized in table 1. The use of DIBH for women <60 years receiving IMN RT (left and right sided) added a cost. The largest cost saving resulted from more selective tumor bed boost, a saving of €462,138. The potential impact of a 5-fraction boost for women with non-low risk DCIS was estimated. CONCLUSION In the cohort analyzed, identified changes in adjuvant breast radiotherapy resulted in overall savings due to updated indications for boost and the implementation of ultra-hypofractionated radiotherapy. We are now analyzing the impact of introducing simultaneous integrated boost and partial breast radiotherapy.
Collapse
Affiliation(s)
| | - O McArdle
- St.Luke's Radiation Oncology Network, Dublin, Ireland
| | - B McClean
- St Luke's Radiation Oncology Network, Dublin, Ireland
| | - R Woods
- St. Luke's Hospital, Dublin, Dublin, Ireland
| | - F Duane
- St. Luke's Hospital, Dublin, Dublin, Ireland
| |
Collapse
|
3
|
Phyo AZZ, Ryan J, Gonzalez-Chica D, Stocks N, Woods R, Murray A, Reid C, Nelson M, Tonkin A, Storey E, Gasevic D, Orchard, Shah R, Freak-Poli R. 1005 HEALTH-RELATED QUALITY OF LIFE AND FUTURE RISK OF HEALTH OUTCOMES AMONG OLDER ADULTS LIVING IN AUSTRALIA AND THE UNITED STATES. Age Ageing 2022. [DOI: 10.1093/ageing/afac124.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Poor health-related quality of life (HRQoL) is associated with higher morbidity and mortality in patient populations. However, whether HRQoL is associated with health outcomes among community-dwelling older people requires further investigation. This study aimed to examine whether HRQoL predicts cognitive decline, dementia, cardiovascular disease (CVD), and mortality in community-dwelling older people living in Australia and the United States.
Method
A cohort of 19,106 individuals from the ASPirin in Reducing Events in the Elderly (ASPREE) study, aged 65–98 years, initially free of dementia or CVD, and who completed the HRQoL 12-item short form (SF-12, version-2) at baseline (2010–2014), were followed until June 2017. The physical (PCS) and mental component scores (MCS) of SF-12 were generated using standardized norm-based method.
Results
Over a median of 4.7 years, there were 2,412 cognitive declines, 574 dementia, 922 incident CVD events, and 1,052 deaths. Using Cox proportional-hazard regression adjusted for a range of covariates, every 10-unit increase in PCS was associated with a 6% lower risk of cognitive decline, a 14% lower risk of incident CVD, and 17% lower risk of all-cause mortality, but was not associated with incident dementia. In contrast, higher MCS was only associated with a 12% and 15% lower risk of cognitive decline and dementia, respectively. Findings did not differ by sex.
Conclusion
Our study provides some of the first evidence that HRQoL can be used in combination with clinical data to identify the future risks of health outcomes among older individuals living in the community. Our findings support the decision of the Australian Commission on Safety and Quality in Health Care to incorporate the SF-12 into the annual Patient-Reported Outcome Measures (PROMs assessment.
Collapse
Affiliation(s)
| | - J Ryan
- Monash University , Australia
| | | | - N Stocks
- The University of Adelaide , Australia
| | - R Woods
- Monash University , Australia
| | - A Murray
- Berman Center for Outcomes and Clinical Research , Minneapolis, Minnesota, USA
| | - C Reid
- Monash University , Australia
- Curtin University , Australia
| | - M Nelson
- Monash University , Australia
- University of Tasmania , Australia
| | | | | | - D Gasevic
- Monash University , Australia
- University of Edinburgh , UK
| | - Orchard
- Monash University , Australia
| | - R Shah
- Rush University Medical Center , Chicago, Illinois, USA
| | | | | |
Collapse
|
4
|
Qaderi V, Ball J, Nehme Z, Neumann JT, Wolfe R, Woods R, Tonkin AM, Smith K, McNeil JJ. Out-of-hospital cardiac arrest in elderly individuals. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Out-of-hospital cardiac arrest (OHCA) is associated with poor outcome, particularly in elderly people. Due to the shift in global demographics towards an ageing population, understanding risk factors for OHCA is essential for the development of primary prevention strategies. Thus, we aimed to identify predictors for OHCA in a large, community-dwelling cohort of elderly individuals.
Methods
We analyzed data from 11,156 participants enrolled in a randomized, placebo-controlled primary prevention trial, investigating the effect of low-dose aspirin in individuals aged 70 years or above. At baseline all participants had no prior cardiovascular disease events, dementia or major physical disability. OHCA events occurring within 5 years were identified by probabilistic data-linkage with a state-wide out-of-hospital cardiac arrest registry. Possible predictors included age, sex, anthropometric measures, conventional cardiovascular risk factors, renal function and frailty. To evaluate the association with OHCA, we performed univariable and multivariable Cox regression analyses. In exploratory analyses we also evaluated the effect of low-dose aspirin on OHCA events.
Results
In the cohort 54.7% were female and median age was 74.1 years (Interquartile Range [IQR] 71.8–77.7). During a median follow up time of 4.7 years (IQR 3.4–6.0) we recorded 67 OHCA events with presumed cardiac cause. The incidence rate was 1.07 per 1,000 person-years (95% Confidence-Interval [CI] 0.80–1.40). The mortality rate following OHCA was 91.2% (n=62). Univariable Cox regression analyses identified age, sex, weight, abdominal circumference, serum creatinine, diabetes, arterial hypertension, intake of antihypertensive medication and pre-frailty as predictors for the outcome. In multivariable Cox regression analyses we identified age (Hazard Ratio [HR] 1.06, CI 1.00–1.13), female sex (HR 0.49, CI 0.26–0.94) and pre-frailty (HR 1.92, CI 1.03–3.58) to be independent predictors (Table). In exploratory analyses there was no effect of low-dose aspirin on OHCA (HR 1.52, CI 0.87–2.70).
Conclusion
In a large, contemporary cohort of healthy, elderly individuals we describe a significant incidence of OHCA events associated with a very high mortality. We identified age, sex and pre-frailty, but interestingly not conventional cardiovascular risk factors as independent predictors of OHCA. We could not show a benefit of low-dose aspirin treatment, although the number of events was small. Our findings emphasize the importance of preventive strategies for pre-frailty in elderly individuals.
Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): The ASPREE study was primarily funded by the National Institute of Aging and National Cancer Institute at the National Institutes of Health (grant number U01AG029824), the Australian National Health & Medical Research Council (grants 334047 & 1127060), Monash University (Australia) and the Victorian Cancer Agency (Australia). Multivariable Cox regression analyses
Collapse
Affiliation(s)
- V Qaderi
- Monash University, Department of Epidemiology and Preventive Medicine, Melbourne, Australia
| | - J Ball
- Ambulance Victoria, Centre for Research and Evaluation, Melbourne, Australia
| | - Z Nehme
- Ambulance Victoria, Centre for Research and Evaluation, Melbourne, Australia
| | - J T Neumann
- Monash University, Department of Epidemiology and Preventive Medicine, Melbourne, Australia
| | - R Wolfe
- Monash University, Department of Epidemiology and Preventive Medicine, Melbourne, Australia
| | - R Woods
- Monash University, Department of Epidemiology and Preventive Medicine, Melbourne, Australia
| | - A M Tonkin
- Monash University, Department of Epidemiology and Preventive Medicine, Melbourne, Australia
| | - K Smith
- Ambulance Victoria, Centre for Research and Evaluation, Melbourne, Australia
| | - J J McNeil
- Monash University, Department of Epidemiology and Preventive Medicine, Melbourne, Australia
| |
Collapse
|
5
|
Westrom S, Woods R, Hilliard E. Complementary Food Acceptance and Picky Eating. J Acad Nutr Diet 2020. [DOI: 10.1016/j.jand.2020.06.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
6
|
Schulze BC, Charan SM, Kenseth CM, Kong W, Bates KH, Williams W, Metcalf AR, Jonsson HH, Woods R, Sorooshian A, Flagan RC, Seinfeld JH. Characterization of Aerosol Hygroscopicity Over the Northeast Pacific Ocean: Impacts on Prediction of CCN and Stratocumulus Cloud Droplet Number Concentrations. Earth Space Sci 2020; 7:e2020EA001098. [PMID: 33225018 PMCID: PMC7676499 DOI: 10.1029/2020ea001098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 05/23/2020] [Indexed: 06/11/2023]
Abstract
During the Marine Aerosol Cloud and Wildfire Study (MACAWS) in June and July of 2018, aerosol composition and cloud condensation nuclei (CCN) properties were measured over the N.E. Pacific to characterize the influence of aerosol hygroscopicity on predictions of ambient CCN and stratocumulus cloud droplet number concentrations (CDNC). Three vertical regions were characterized, corresponding to the marine boundary layer (MBL), an above-cloud organic aerosol layer (AC-OAL), and the free troposphere (FT) above the AC-OAL. The aerosol hygroscopicity parameter (κ) was calculated from CCN measurements (κ CCN) and bulk aerosol mass spectrometer (AMS) measurements (κ AMS). Within the MBL, measured hygroscopicities varied between values typical of both continental environments (~0.2) and remote marine locations (~0.7). For most flights, CCN closure was achieved within 20% in the MBL. For five of the seven flights, assuming a constant aerosol size distribution produced similar or better CCN closure than assuming a constant "marine" hygroscopicity (κ = 0.72). An aerosol-cloud parcel model was used to characterize the sensitivity of predicted stratocumulus CDNC to aerosol hygroscopicity, size distribution properties, and updraft velocity. Average CDNC sensitivity to accumulation mode aerosol hygroscopicity is 39% as large as the sensitivity to the geometric median diameter in this environment. Simulations suggest CDNC sensitivity to hygroscopicity is largest in marine stratocumulus with low updraft velocities (<0.2 m s-1), where accumulation mode particles are most relevant to CDNC, and in marine stratocumulus or cumulus with large updraft velocities (>0.6 m s-1), where hygroscopic properties of the Aitken mode dominate hygroscopicity sensitivity.
Collapse
Affiliation(s)
- B. C. Schulze
- Department of Environmental Science and Engineering, California Institute of Technology, Pasadena, CA, USA
| | - S. M. Charan
- Division of Chemistry and Chemical Engineering, California Institute of Technology, Pasadena, CA, USA
| | - C. M. Kenseth
- Division of Chemistry and Chemical Engineering, California Institute of Technology, Pasadena, CA, USA
| | - W. Kong
- Division of Chemistry and Chemical Engineering, California Institute of Technology, Pasadena, CA, USA
| | - K. H. Bates
- Center for the Environment, Harvard University, Cambridge, MA, USA
| | - W. Williams
- Department of Environmental Engineering and Earth Sciences, Clemson University, Anderson, SC, USA
| | - A. R. Metcalf
- Department of Environmental Engineering and Earth Sciences, Clemson University, Anderson, SC, USA
| | | | - R. Woods
- Naval Postgraduate School, Monterey, CA, USA
| | - A. Sorooshian
- Department of Chemical and Environmental Engineering, University of Arizona, Tucson, AZ, USA
- Department of Hydrology and Atmospheric Sciences, University of Arizona, Tucson, AZ, USA
| | - R. C. Flagan
- Division of Chemistry and Chemical Engineering, California Institute of Technology, Pasadena, CA, USA
- Division of Engineering and Applied Science, California Institute of Technology, Pasadena, CA, USA
| | - J. H. Seinfeld
- Division of Chemistry and Chemical Engineering, California Institute of Technology, Pasadena, CA, USA
- Division of Engineering and Applied Science, California Institute of Technology, Pasadena, CA, USA
| |
Collapse
|
7
|
Fielding A, Woods R, Moosvi SR, Wharton RQ, Speakman CTM, Kapur S, Shaikh I, Hernon JM, Lines SW, Stearns AT. Renal impairment after ileostomy formation: a frequent event with long-term consequences. Colorectal Dis 2020; 22:269-278. [PMID: 31562789 DOI: 10.1111/codi.14866] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Accepted: 09/02/2019] [Indexed: 02/06/2023]
Abstract
AIM High stoma output and dehydration is common following ileostomy formation. However, the impact of this on renal function, both in the short term and after ileostomy reversal, remains poorly defined. We aimed to assess the independent impact on kidney function of an ileostomy after rectal cancer surgery and subsequent reversibility after ileostomy closure. METHODS This retrospective single-site cohort study identified patients undergoing rectal cancer resection from 2003 to 2017, with or without a diverting ileostomy. Renal function was calculated preoperatively, before ileostomy closure, and 6 months after ileostomy reversal (or matched times for patients without ileostomy). Demographics, oncological treatments and nephrotoxic drug prescriptions were assessed. Outcome measures were deterioration from baseline renal function and development of moderate/severe chronic kidney disease (CKD ≥ 3). Multivariate analysis was performed to assess independent risk factors for postoperative renal impairment. RESULTS Five hundred and eighty-three of 1213 patients had an ileostomy. Postoperative renal impairment occurred more frequently in ileostomates (9.5% absolute increase in rate of CKD ≥ 3; P < 0.0001) vs no change in patients without an ileostomy (P = 0.757). Multivariate analysis identified ileostomy formation, age, anastomotic leak and renin-angiotensin system inhibitors as independently associated with postoperative renal decline. Despite stoma closure, ileostomates remained at increased risk of progression to new or worse CKD [74/438 (16.9%)] compared to patients without an ileostomy [36/437 (8.2%), P = 0.0001, OR 2.264 (1.49-3.46)]. CONCLUSIONS Ileostomy formation is independently associated with kidney injury, with an increased risk persisting after stoma closure. Strategies to protect against kidney injury may be important in higher risk patients (elderly, receiving renin-angiotensin system antihypertensives, or following anastomotic leakage).
Collapse
Affiliation(s)
- A Fielding
- Department of Colorectal Surgery, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK.,Norwich Surgical Training and Research Academy, Norfolk and Norwich University Hospital, Norwich, UK
| | - R Woods
- Department of Colorectal Surgery, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK.,Norwich Surgical Training and Research Academy, Norfolk and Norwich University Hospital, Norwich, UK
| | - S R Moosvi
- Department of Colorectal Surgery, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - R Q Wharton
- Department of Colorectal Surgery, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK.,Norwich Surgical Training and Research Academy, Norfolk and Norwich University Hospital, Norwich, UK.,Norwich Medical School, University of East Anglia, Norwich, UK
| | - C T M Speakman
- Department of Colorectal Surgery, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK.,Norwich Surgical Training and Research Academy, Norfolk and Norwich University Hospital, Norwich, UK.,Norwich Medical School, University of East Anglia, Norwich, UK
| | - S Kapur
- Department of Colorectal Surgery, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK.,Norwich Surgical Training and Research Academy, Norfolk and Norwich University Hospital, Norwich, UK
| | - I Shaikh
- Department of Colorectal Surgery, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK.,Norwich Surgical Training and Research Academy, Norfolk and Norwich University Hospital, Norwich, UK.,Norwich Medical School, University of East Anglia, Norwich, UK
| | - J M Hernon
- Department of Colorectal Surgery, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK.,Norwich Surgical Training and Research Academy, Norfolk and Norwich University Hospital, Norwich, UK.,Norwich Medical School, University of East Anglia, Norwich, UK
| | - S W Lines
- Department of Nephrology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK.,Department of Nephrology, St Bernard's Hospital, Gibraltar, Gibraltar
| | - A T Stearns
- Department of Colorectal Surgery, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK.,Norwich Surgical Training and Research Academy, Norfolk and Norwich University Hospital, Norwich, UK.,Norwich Medical School, University of East Anglia, Norwich, UK
| |
Collapse
|
8
|
Woods R, Geyer L, Mehanna R, Russell J. Pediatric tracheostomy first tube change: When is it safe? Int J Pediatr Otorhinolaryngol 2019; 120:78-81. [PMID: 30772616 DOI: 10.1016/j.ijporl.2019.02.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 02/03/2019] [Accepted: 02/05/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The first tracheostomy tube change is typically performed on days 5-7 post-operatively, however recent international consensus guidelines suggested that, with maturation sutures, days 3-5 is appropriate. We evaluate whether a first tube change on day 2 post-operatively is safe and effective. METHODS We carried out a retrospective review of all patients undergoing tracheostomy between 2009 and 2018. Exclusion criteria were patients on whom the senior authors did not operate, operations done elsewhere, cases where maturation sutures were not used or a patient died prior to first tube change. We noted patient details, indication for tracheostomy, the need for long-term ventilation, timing of the first tube change, decannulation and need for surgical closure of persistent tracheocutaneous fistula. RESULTS 93 patients were identified, of which 83 were included. The age range was 0-16 years, with the youngest day one of life and an overall mean age of 1.91 years. 59% of patients required long-term ventilation due to various co-morbidities. 26 patients (31%) underwent a first tube change on day 2 post-operatively. All these were uneventful and were irrespective of the patient's need for ventilation. Of the 42 patients who have subsequently been decannulated, 33 (79%) were noted to have a persistent tracheocutaneous fistula requiring surgical closure, four of whom needed revision closure. CONCLUSIONS This study shows that a first tube change on day 2 post-operatively is safe, facilitating earlier discharge from intensive care, allowing shorter length of sedation, earlier start to parent/carer training and wound assessment.
Collapse
Affiliation(s)
- R Woods
- Department of Pediatric Otorhinolaryngology, Our Lady's Children's Hospital Crumlin, Dublin, Ireland.
| | - L Geyer
- Department of Pediatric Otorhinolaryngology, Our Lady's Children's Hospital Crumlin, Dublin, Ireland
| | - R Mehanna
- Department of Pediatric Otorhinolaryngology, Our Lady's Children's Hospital Crumlin, Dublin, Ireland
| | - J Russell
- Department of Pediatric Otorhinolaryngology, Our Lady's Children's Hospital Crumlin, Dublin, Ireland
| |
Collapse
|
9
|
Singh N, Grosshuesch C, Johnson W, DeVogel N, Yin Z, Wang T, Kindel S, Woods R. Prolonged Management in Donors with Reduced Ejection Fraction is a Risk Factor for Graft Loss in Pediatric Heart Transplantation. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
|
10
|
Clegg R, Woods R, Bennett P. Vascular Access: Patency and Interventions - A Retrospective Study. Int J Surg 2017. [DOI: 10.1016/j.ijsu.2017.08.539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
11
|
Woods R, Duggan E, Bennett P. Why do Vascular Patients Not Attend Outpatient Appointments at Norfolk and Norwich University Hospitals NHS Foundation Trust? Int J Surg 2017. [DOI: 10.1016/j.ijsu.2017.08.537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
12
|
Mountain G, Windle G, Hind D, Walters S, Keertharuth A, Chatters R, Sprange K, Craig C, Cook S, Lee E, Chater T, Woods R, Newbould L, Powell L, Shortland K, Roberts J. A preventative lifestyle intervention for older adults (lifestyle matters): a randomised controlled trial. Age Ageing 2017; 46:627-634. [PMID: 28338849 PMCID: PMC5860501 DOI: 10.1093/ageing/afx021] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 11/11/2016] [Indexed: 11/14/2022] Open
Abstract
Objectives to test whether an occupation-based lifestyle intervention can sustain and improve the mental well-being of adults aged 65 years or over compared to usual care, using an individually randomised controlled trial. Participants 288 independently living adults aged 65 years or over, with normal cognition, were recruited from two UK sites between December 2011 and November 2015. Interventions lifestyle Matters is a National Institute for Health and Care Excellence recommended multi-component preventive intervention designed to improve the mental well-being of community living older people at risk of decline. It involves weekly group sessions over 4 months and one to one sessions. Main outcome measures the primary outcome was mental well-being at 6 months (mental health (MH) dimension of the SF-36). Secondary outcomes included physical health dimensions of the SF-36, extent of depression (PHQ-9), quality of life (EQ-5D) and loneliness (de Jong Gierveld Loneliness Scale), assessed at 6 and 24 months. Results data on 262 (intervention = 136; usual care = 126) participants were analysed using intention to treat analysis. Mean SF-36 MH scores at 6 months differed by 2.3 points (95 CI: -1.3 to 5.9; P = 0.209) after adjustments. Conclusions analysis shows little evidence of clinical or cost-effectiveness in the recruited population with analysis of the primary outcome revealing that the study participants were mentally well at baseline. The results pose questions regarding how preventive interventions to promote well-being in older adults can be effectively targeted in the absence of proactive mechanisms to identify those who at risk of decline. Trial Registration ISRCTN67209155.
Collapse
Affiliation(s)
- Gail Mountain
- School of Health and Related Research, University of Sheffield, Regent Court 30 Regent Street, Sheffield S1 4DA, UK
| | - Gill Windle
- Dementia Services Development Centre, University of Bangor, Wales, Bangor, UK
| | - Daniel Hind
- School of Health and Related Research, University of Sheffield, Regent Court 30 Regent Street, Sheffield S1 4DA, UK
| | - Stephen Walters
- School of Health and Related Research, University of Sheffield, Regent Court 30 Regent Street, Sheffield S1 4DA, UK
| | - Anju Keertharuth
- School of Health and Related Research, University of Sheffield, Regent Court 30 Regent Street, Sheffield S1 4DA, UK
| | - Robin Chatters
- School of Health and Related Research, University of Sheffield, Regent Court 30 Regent Street, Sheffield S1 4DA, UK
| | - Kirsty Sprange
- School of Medicine, University of Nottingham, Nottingham, Nottinghamshire, UK
| | - Claire Craig
- Centre for Health and Social Care Research, Sheffield Hallam University, Sheffield, South Yorkshire, UK
| | - Sarah Cook
- Centre for Health and Social Care Research, Sheffield Hallam University, Sheffield, South Yorkshire, UK
| | - Ellen Lee
- School of Health and Related Research, University of Sheffield, Regent Court 30 Regent Street, Sheffield S1 4DA, UK
| | - Tim Chater
- School of Health and Related Research, University of Sheffield, Regent Court 30 Regent Street, Sheffield S1 4DA, UK
| | - R. Woods
- Dementia Services Development Centre, University of Bangor, Wales, Bangor, UK
| | - Louise Newbould
- School of Health and Related Research, University of Sheffield, Regent Court 30 Regent Street, Sheffield S1 4DA, UK
| | - Lauren Powell
- School of Health and Related Research, University of Sheffield, Regent Court 30 Regent Street, Sheffield S1 4DA, UK
| | - Katy Shortland
- Sheffield NIHR Clinical Research Facility, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Jennifer Roberts
- Dementia Services Development Centre, University of Bangor, Wales, Bangor, UK
| |
Collapse
|
13
|
Ward S, Newman A, Murray A, Woods R, McNeil J. EVIDENCE FOR THE POTENTIAL ROLE OF ASPIRIN IN THE PREVENTION OF FRAILTY. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- S. Ward
- Monash University, Melbourne, Victoria, Australia,
| | - A. Newman
- University of Pittsburgh, Pittsburgh, Pennsylvania,
| | - A.M. Murray
- Hennepin County Medical Center, Minneapolis, Minnesota,
- University of Minnesota, Minneapolis, Minnesota
| | - R. Woods
- Monash University, Melbourne, Victoria, Australia,
| | - J. McNeil
- Monash University, Melbourne, Victoria, Australia,
| |
Collapse
|
14
|
Woods R, Colville N, Blazquez J, Cooper A, Whitehead MI. Effects of red clover isoflavones (Promensil) versus placebo on uterine endometrium, vaginal maturation index and the uterine artery in healthy postmenopausal women. ACTA ACUST UNITED AC 2016. [DOI: 10.1258/1362180042721346] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- R Woods
- Gynaecology and Endocrine Clinic, Kings College Hospital, London, UK
| | - N Colville
- Gynaecology and Endocrine Clinic, Kings College Hospital, London, UK
| | - J Blazquez
- Gynaecology and Endocrine Clinic, Kings College Hospital, London, UK
| | - A Cooper
- Gynaecology and Endocrine Clinic, Kings College Hospital, London, UK
| | - MI Whitehead
- Gynaecology and Endocrine Clinic, Kings College Hospital, London, UK
| |
Collapse
|
15
|
Grillo VL, Arzey KE, Hansbro PM, Hurt AC, Warner S, Bergfeld J, Burgess GW, Cookson B, Dickason CJ, Ferenczi M, Hollingsworth T, Hoque M, Jackson RB, Klaassen M, Kirkland PD, Kung NY, Lisovski S, O'Dea MA, O'Riley K, Roshier D, Skerratt LF, Tracey JP, Wang X, Woods R, Post L. Avian influenza in Australia: a summary of 5 years of wild bird surveillance. Aust Vet J 2016; 93:387-93. [PMID: 26503532 DOI: 10.1111/avj.12379] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Revised: 05/20/2015] [Accepted: 05/25/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Avian influenza viruses (AIVs) are found worldwide in numerous bird species, causing significant disease in gallinaceous poultry and occasionally other species. Surveillance of wild bird reservoirs provides an opportunity to add to the understanding of the epidemiology of AIVs. METHODS This study examined key findings from the National Avian Influenza Wild Bird Surveillance Program over a 5-year period (July 2007-June 2012), the main source of information on AIVs circulating in Australia. RESULTS The overall proportion of birds that tested positive for influenza A via PCR was 1.9 ± 0.1%, with evidence of widespread exposure of Australian wild birds to most low pathogenic avian influenza (LPAI) subtypes (H1-13, H16). LPAI H5 subtypes were found to be dominant and widespread during this 5-year period. CONCLUSION Given Australia's isolation, both geographically and ecologically, it is important for Australia not to assume that the epidemiology of AIV from other geographic regions applies here. Despite all previous highly pathogenic avian influenza outbreaks in Australian poultry being attributed to H7 subtypes, widespread detection of H5 subtypes in wild birds may represent an ongoing risk to the Australian poultry industry.
Collapse
Affiliation(s)
- V L Grillo
- Wildlife Health Australia, Mosman, New South Wales, Australia.
| | - K E Arzey
- Virology Laboratory, Elizabeth Macarthur Agricultural Institute, New South Wales Department of Primary Industries, Camden, NSW, Australia
| | - P M Hansbro
- Centre for Asthma and Respiratory Disease, Hunter Medical Research Institute and University of Newcastle, Newcastle, NSW, Australia
| | - A C Hurt
- WHO Collaborating Centre for Reference and Research on Influenza, North Melbourne, VIC, Australia
| | - S Warner
- Department of Economic Development, Jobs, Transport and Resource, Bundoora, VIC, Australia
| | - J Bergfeld
- Australian Animal Health Laboratory, CSIRO Animal Food and Health Sciences, Geelong, VIC, Australia
| | - G W Burgess
- One Health Research Group, College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD, Australia
| | - B Cookson
- Australian Government Department of Agriculture, Cairns, QLD, Australia
| | - C J Dickason
- Biosecurity SA, Primary Industries & Regions, Adelaide, SA, Australia
| | - M Ferenczi
- Centre for Integrative Ecology, Deakin University, Geelong, VIC, Australia
| | | | - Mda Hoque
- One Health Research Group, College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD, Australia
| | - R B Jackson
- Department of Primary Industries, Parks, Water and Environment, Launceston, TAS, Australia
| | - M Klaassen
- Centre for Integrative Ecology, Deakin University, Geelong, VIC, Australia
| | - P D Kirkland
- Virology Laboratory, Elizabeth Macarthur Agricultural Institute, New South Wales Department of Primary Industries, Camden, NSW, Australia
| | - N Y Kung
- Biosecurity Queensland, Department of Agriculture and Fisheries, Brisbane, QLD, Australia
| | - S Lisovski
- Centre for Integrative Ecology, Deakin University, Geelong, VIC, Australia
| | - M A O'Dea
- Department of Agriculture and Food, South Perth, WA, Australia
| | - K O'Riley
- Department of Economic Development, Jobs, Transport and Resource, Bundoora, VIC, Australia
| | - D Roshier
- Centre for Integrative Ecology, Deakin University, Geelong, VIC, Australia
| | - L F Skerratt
- One Health Research Group, College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD, Australia
| | - J P Tracey
- Vertebrate Pest Research Unit, New South Wales Department of Primary Industries, Forest Road, Orange, NSW, Australia
| | - X Wang
- Department of Economic Development, Jobs, Transport and Resource, Bundoora, VIC, Australia
| | - R Woods
- Wildlife Health Australia, Mosman, New South Wales, Australia
| | - L Post
- Australian Government Department of Agriculture, Canberra, ACT, Australia
| |
Collapse
|
16
|
Olson R, Maas B, Gondara L, Woods R, Speers C, Truong P, Lo A, Olivotto I, Tyldesley S, Nichol A, Weir L. Impact of Internal Mammary Node Radiation on Survival of Patients With Breast Cancer: Extended Follow-Up of a Population-Based Analysis. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
17
|
Woods R, Mavroidis P, Lehman-Davis M, Kostich M, Cook T, Chera B, Das S, Lian J. SU-F-T-523: Radiobiological Comparison of Helical Tomotherapy and VMAT in the Treatment of Head and Neck Tumors. Med Phys 2016. [DOI: 10.1118/1.4956708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
|
18
|
Roth T, Dooley J, Zhu T, Woods R, Mavroidis P, Lian J. SU-F-T-592: A Delivery QA-Free Approach for Adaptive Therapy of Prostate Cancer with Static Intensity Modulated Radiotherapy. Med Phys 2016. [DOI: 10.1118/1.4956777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
|
19
|
Flaugher B, Diehl HT, Honscheid K, Abbott TMC, Alvarez O, Angstadt R, Annis JT, Antonik M, Ballester O, Beaufore L, Bernstein GM, Bernstein RA, Bigelow B, Bonati M, Boprie D, Brooks D, Buckley-Geer EJ, Campa J, Cardiel-Sas L, Castander FJ, Castilla J, Cease H, Cela-Ruiz JM, Chappa S, Chi E, Cooper C, da Costa LN, Dede E, Derylo G, DePoy DL, de Vicente J, Doel P, Drlica-Wagner A, Eiting J, Elliott AE, Emes J, Estrada J, Fausti Neto A, Finley DA, Flores R, Frieman J, Gerdes D, Gladders MD, Gregory B, Gutierrez GR, Hao J, Holland SE, Holm S, Huffman D, Jackson C, James DJ, Jonas M, Karcher A, Karliner I, Kent S, Kessler R, Kozlovsky M, Kron RG, Kubik D, Kuehn K, Kuhlmann S, Kuk K, Lahav O, Lathrop A, Lee J, Levi ME, Lewis P, Li TS, Mandrichenko I, Marshall JL, Martinez G, Merritt KW, Miquel R, Muñoz F, Neilsen EH, Nichol RC, Nord B, Ogando R, Olsen J, Palaio N, Patton K, Peoples J, Plazas AA, Rauch J, Reil K, Rheault JP, Roe NA, Rogers H, Roodman A, Sanchez E, Scarpine V, Schindler RH, Schmidt R, Schmitt R, Schubnell M, Schultz K, Schurter P, Scott L, Serrano S, Shaw TM, Smith RC, Soares-Santos M, Stefanik A, Stuermer W, Suchyta E, Sypniewski A, Tarle G, Thaler J, Tighe R, Tran C, Tucker D, Walker AR, Wang G, Watson M, Weaverdyck C, Wester W, Woods R, Yanny B. THE DARK ENERGY CAMERA. ACTA ACUST UNITED AC 2015. [DOI: 10.1088/0004-6256/150/5/150] [Citation(s) in RCA: 580] [Impact Index Per Article: 64.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
20
|
De Cruz P, Kamm MA, Hamilton AL, Ritchie KJ, Krejany EO, Gorelik A, Liew D, Prideaux L, Lawrance IC, Andrews JM, Bampton PA, Jakobovits S, Florin TH, Gibson PR, Debinski H, Gearry RB, Macrae FA, Leong RW, Kronborg I, Radford-Smith G, Selby W, Johnston MJ, Woods R, Elliott PR, Bell SJ, Brown SJ, Connell WR, Desmond PV. Efficacy of thiopurines and adalimumab in preventing Crohn's disease recurrence in high-risk patients - a POCER study analysis. Aliment Pharmacol Ther 2015; 42:867-79. [PMID: 26314275 DOI: 10.1111/apt.13353] [Citation(s) in RCA: 91] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Revised: 06/12/2015] [Accepted: 07/17/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND Crohn's disease recurs in the majority of patients after intestinal resection. AIM To compare the relative efficacy of thiopurines and anti-TNF therapy in patients at high risk of disease recurrence. METHODS As part of a larger study comparing post-operative management strategies, patients at high risk of recurrence (smoker, perforating disease, ≥2nd operation) were treated after resection of all macroscopic disease with 3 months metronidazole together with either azathioprine 2 mg/kg/day or mercaptopurine 1.5 mg/kg/day. Thiopurine-intolerant patients received adalimumab induction then 40 mg fortnightly. Patients underwent colonoscopy at 6 months with endoscopic recurrence assessed blind to treatment. RESULTS A total of 101 patients [50% male; median (IQR) age 36 (25-46) years] were included. There were no differences in disease history between thiopurine- and adalimumab-treated patients. Fifteen patients withdrew prior to 6 months, five due to symptom recurrence (of whom four were colonoscoped). Endoscopic recurrence (Rutgeerts score i2-i4) occurred in 33 of 73 (45%) thiopurine vs. 6 of 28 (21%) adalimumab-treated patients [intention-to-treat (ITT); P = 0.028] or 24 of 62 (39%) vs. 3 of 24 (13%) respectively [per-protocol analysis (PPA); P = 0.020]. Complete mucosal endoscopic normality (Rutgeerts i0) occurred in 17/73 (23%) vs. 15/28 (54%) (ITT; P = 0.003) and in 27% vs. 63% (PPA; P = 0.002). The most advanced disease (Rutgeerts i3 and i4) occurred in 8% vs. 4% (thiopurine vs. adalimumab). CONCLUSIONS In Crohn's disease patients at high risk of post-operative recurrence adalimumab is superior to thiopurines in preventing early disease recurrence.
Collapse
Affiliation(s)
- P De Cruz
- St Vincent's Hospital and University of Melbourne, Melbourne, Vic
| | - M A Kamm
- St Vincent's Hospital and University of Melbourne, Melbourne, Vic
| | - A L Hamilton
- St Vincent's Hospital and University of Melbourne, Melbourne, Vic
| | | | - E O Krejany
- St Vincent's Hospital and University of Melbourne, Melbourne, Vic
| | - A Gorelik
- Melbourne EpiCentre, Royal Melbourne Hospital, Melbourne
| | - D Liew
- Melbourne EpiCentre, Royal Melbourne Hospital, Melbourne
| | - L Prideaux
- St Vincent's Hospital and University of Melbourne, Melbourne, Vic
| | | | | | - P A Bampton
- Flinders Medical Centre and Flinders University, Bedford Park, SA, Australia
| | - S Jakobovits
- Alfred Health and Monash University, Melbourne, Vic., Australia
| | | | - P R Gibson
- Alfred Health and Monash University, Melbourne, Vic., Australia
| | | | - R B Gearry
- Christchurch Hospital, Christchurch, New Zealand
| | - F A Macrae
- Colorectal Medicine and Genetics, Royal Melbourne Hospital, Melbourne
| | - R W Leong
- Gastroenterology and Liver Services, Concord Hospital, Sydney
| | | | - G Radford-Smith
- Queensland Institute of Medical Research and University of Queensland School of Medicine, Herston Campus, Brisbane
| | - W Selby
- Royal Prince Alfred Hospital, Sydney
| | | | - R Woods
- St Vincent's Hospital, Melbourne
| | | | - S J Bell
- St Vincent's Hospital and University of Melbourne, Melbourne, Vic
| | | | | | | |
Collapse
|
21
|
Coxon G, Freer J, Westerberg IK, Wagener T, Woods R, Smith PJ. A novel framework for discharge uncertainty quantification applied to 500 UK gauging stations. Water Resour Res 2015; 51:5531-5546. [PMID: 26924859 PMCID: PMC4755227 DOI: 10.1002/2014wr016532] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 06/19/2015] [Indexed: 05/29/2023]
Abstract
A generalized framework for discharge uncertainty estimation is presentedAllows estimation of place-specific discharge uncertainties for many catchmentsLocal conditions dominate in determining discharge uncertainty magnitudes.
Collapse
Affiliation(s)
- G. Coxon
- School of Geographical SciencesUniversity of BristolBristolUK
| | - J. Freer
- School of Geographical SciencesUniversity of BristolBristolUK
| | - I. K. Westerberg
- Department of Civil EngineeringUniversity of BristolBristolUK
- IVL Swedish Environmental Research InstituteStockholmSweden
| | - T. Wagener
- Department of Civil EngineeringUniversity of BristolBristolUK
| | - R. Woods
- Department of Civil EngineeringUniversity of BristolBristolUK
| | - P. J. Smith
- Lancaster Environment Centre, Lancaster UniversityLancasterUK
| |
Collapse
|
22
|
Abstract
BACKGROUND Adjuvant chemotherapy started more than 56 days after colon cancer resection has been associated with lesser overall survival among patients with stage iii colon cancer. The objective of the present population-based study was to determine, in referred patients with resected stage iii colon cancer, factors associated with delayed time to adjuvant chemotherapy (ttac), defined as more than 56 days from the date of surgery. METHODS Eligible patients had been diagnosed with stage iii colon cancer and had received at least 1 cycle of adjuvant chemotherapy at one of the four regional cancer treatment sites during 2008-2009. Prognostic and treatment information was prospectively collected through the BC Cancer Agency's GI Cancers Outcomes Unit, and Charlson comorbidity score was retrospectively determined by chart review. Chi-square and Wilcoxon rank-sum tests were used to measure associations between the timing of adjuvant chemotherapy and select prognostic and treatment variables. RESULTS Median ttac from surgery for the 395 included patients was 58 days, with 54% of the patients receiving adjuvant chemotherapy beyond the recommended 56 days. On multivariate analysis, only treatment at the highest-volume site was independently associated with delayed ttac. Comorbidity index, age, performance status, T stage, tumour location, and oral chemotherapy (compared with intravenous) were not independently associated with delayed ttac. Delays were observed during each interval associated with the patient's transition from surgery to first cycle of adjuvant chemotherapy. CONCLUSIONS More than half the patients failed to receive adjuvant chemotherapy within the recommended ttac of 56 days. Delayed ttac was associated with process-related delays rather than with patient- or disease-related factors. Efforts to improve timely referral, triage of consultations, and chemotherapy wait lists are required.
Collapse
Affiliation(s)
- A Chan
- BC Cancer Agency, Vancouver, BC
| | - R Woods
- BC Cancer Agency, Vancouver, BC
| | | | - S Gill
- BC Cancer Agency, Vancouver, BC
| |
Collapse
|
23
|
|
24
|
Zhang J, Woods R, Alger J, Thomas A, Espinoza R, Narr K. TU-G-134-09: Human Brain GABA J-Difference Editing Spectral Quantification with the Fast Pade Transform. Med Phys 2013. [DOI: 10.1118/1.4815487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
|
25
|
Zangwill S, Berger S, Shah T, Schiller J, Ellis T, Stendahl G, Cole A, Mitchell M, Woods R, Tweddell J. The Virtual Crossmatch at Children’s Hospital of Wisconsin – Outcomes for Predicted Positive Crossmatches. J Heart Lung Transplant 2013. [DOI: 10.1016/j.healun.2013.01.242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
|
26
|
De Cruz P, Bernardi MP, Kamm MA, Allen PB, Prideaux L, Williams J, Johnston MJ, Keck J, Brouwer R, Heriot A, Woods R, Brown S, Bell SJ, Elliott R, Connell WR, Desmond PV. Postoperative recurrence of Crohn's disease: impact of endoscopic monitoring and treatment step-up. Colorectal Dis 2013; 15:187-97. [PMID: 22757652 DOI: 10.1111/j.1463-1318.2012.03168.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
AIM Eighty per cent of patients with Crohn's disease require surgery, of whom 70% will require a further operation. Recurrence occurs at the anastomosis. Although often recommended, the impact of postoperative colonoscopy and treatment adjustment is unknown. METHOD Patients with a bowel resection over a 10-year period were reviewed and comparison made between those who did and did not have a postoperative colonoscopy within 1 year of surgery, and those who did or did not have a step-up in drug therapy. RESULTS Of 222 patients operated on, 136 (65 men, mean age 33 years, mean disease duration 8 years, median follow-up 4 years) were studied. Of 70 patients with and 66 without postoperative colonoscopy, clinical recurrence occurred in 49% and 48% (NS) and further surgery in 9% and 5% (NS). Eighty-nine per cent of colonoscoped patients had a decision based on the colonoscopic findings: of these, 24% had a step-up of drug therapy [antibiotics (n =10), aminosalicylates (n=2), thiopurine (n=5), methotrexate (n=1)] and 76% had no step-up in drug therapy. In colonoscoped patients clinical recurrence occurred in 9 (60%) of 15 patients with, and 23 (49%) of 47 without step-up and surgical recurrence in 2 (13%) of 15 and 4 (9%) of 47 (NS). CONCLUSION Clinical recurrence occurs in a majority of patients soon after surgery. In this cohort, there was no clinical benefit from colonoscopy or increased drug therapy within 1 year after operation. However, the response to the endoscopic findings was not standardized and immunosuppressive therapy was uncommon. Standardizing timing of colonoscopy and drug therapy, including more intense therapy, may improve outcome, although this remains to be proven.
Collapse
Affiliation(s)
- P De Cruz
- St Vincent's Hospital and University of Melbourne, Melbourne, Vic., Australia
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
27
|
Chan EK, Tabarsi N, Tyldesley S, Khan M, Woods R, Speers C, Weir L. Abstract P4-16-01: Accelerated hypofractionated whole breast radiotherapy for localized breast cancer: the effect of a boost on patient reported long-term cosmetic outcome. Cancer Res 2012. [DOI: 10.1158/0008-5472.sabcs12-p4-16-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
PURPOSE: Equivalent long-term local control and cosmetic outcomes between conventional and accelerated, hypofractionated whole breast radiotherapy (AWBRT) for early-stage breast cancer have been demonstrated. However, there is uncertainty about the long-term cosmetic outcome of a boost to the tumor bed following AWBRT (AWBRT+B). The primary outcome of this study was to evaluate the cosmetic effect of a boost using a patient reported questionnaire. The cosmetic subscale in the questionnaire was used to compare the appearance of the treated versus non treated breast between the boost and non-boost groups.
MATERIALS AND METHODS: Between 2000 and 2005, 4392 women 75 years and under with unilateral early-stage breast cancer received AWBRT alone or AWBRT+B. Random samples of 800 women treated with AWBRT alone and 800 women treated with AWBRT+B were identified from the 3960 women still alive at least 5 years after treatment without contralateral disease. The women were contacted by mail to complete a questionnaire based on the Breast Cancer Treatment Outcomes Scale (22 questions regarding cosmetic, pain and functional outcomes). Cochrane-Armitage (CA) trend test and Wilcoxon Rank-sum (WR) were used to compare baseline patient and treatment variables to long-term cosmetic outcomes between the two treatment groups.
RESULTS: 312 women (154 received AWBRT alone and 158 received AWBRT+B) completed the questionnaire. The median (range) age of respondents was 57 (40–75) years in the AWBRT alone group and 52 (32–75) years in the AWBRT+B group (p < 0.001). The median (range) follow-up time after radiotherapy treatment was 8.7 (5.5–11.5) years in the AWBRT alone group and 7.8 (5.5–11.5) years in the AWBRT+B group (p < 0.001). Boost doses ranged between 7.5 Gy in 3 fractions to 16 Gy in 8 fractions. The most commonly used boost regimen was 10 Gy in 4 fractions (70% of respondents). Women treated with AWBRT+B also had higher T stage, higher grade, were more likely to have had chemotherapy and trended towards having an increased number of positive nodes compared to the AWBRT alone group. Current weight, ER status, and use of hormonal therapy were similar between both groups.
When comparing the overall appearance of the treated to untreated breast, there was no significant difference between the women who received AWBRT alone and those who received AWBRT+B (42% stating no or slight difference vs. 41%) (p = 0.87 CA). Focusing on the cosmetic subscale in the questionnaire, the average summed score for the AWBRT alone group was slightly worse to the score for the AWBRT+B group (2.3 vs. 2.1, p = 0.02 WR). On the functional subscale, the average summed score for the AWBRT alone group was worse than the AWBRT+B group (1.8 versus 1.5, p < 0.001 WR). On the pain subscale, the average summed score for the AWBRT alone group was better than the AWBRT+B group (1.6 versus 2.0, p < 0.0001 WR). However, when the pain subscale was only applied to the area around the scar, the two groups were similar (2.0 for AWBRT alone and 2.0 for AWBRT+B, p = 0.71).
CONCLUSION: Similar to conventionally fractionated WBRT, patients who receive a boost after AWBRT self-report long-term slightly worse cosmetic and pain outcomes compared AWBRT alone.
Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P4-16-01.
Collapse
Affiliation(s)
- EK Chan
- British Columbia Cancer Agency, Vancouver Centre, Vancouver, BC, Canada; University of British Columbia, Vancouver, BC, Canada
| | - N Tabarsi
- British Columbia Cancer Agency, Vancouver Centre, Vancouver, BC, Canada; University of British Columbia, Vancouver, BC, Canada
| | - S Tyldesley
- British Columbia Cancer Agency, Vancouver Centre, Vancouver, BC, Canada; University of British Columbia, Vancouver, BC, Canada
| | - M Khan
- British Columbia Cancer Agency, Vancouver Centre, Vancouver, BC, Canada; University of British Columbia, Vancouver, BC, Canada
| | - R Woods
- British Columbia Cancer Agency, Vancouver Centre, Vancouver, BC, Canada; University of British Columbia, Vancouver, BC, Canada
| | - C Speers
- British Columbia Cancer Agency, Vancouver Centre, Vancouver, BC, Canada; University of British Columbia, Vancouver, BC, Canada
| | - L Weir
- British Columbia Cancer Agency, Vancouver Centre, Vancouver, BC, Canada; University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
28
|
Kumar A, Kennecke H, Lim H, Woods R, Renouf D, Speers C, Cheung W. Adjuvant Chemotherapy (AC) Use and Outcomes in Stage II Colon Cancer (CC) with vs. without Poor Prognostic Features. Ann Oncol 2012. [DOI: 10.1016/s0923-7534(20)33160-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
|
29
|
|
30
|
Woods R, Larkin JO, Muldoon C, Kennedy MJ, Mehigan B, McCormick P. Metastatic paediatric colorectal carcinoma. Ir Med J 2012; 105:88-89. [PMID: 22558819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
A 16-year-old girl presented to our unit with crampy abdominal pain, change in bowel habit, a subjective impression of weight loss and a single episode of haematochezia. She was found to have a rectosigmoid adenocarcinoma and proceeded to laparoscopic anterior resection, whereupon peritoneal metastases were discovered. She received chemotherapy and is alive and well ten month later with no radiological evidence of disease. Colorectal carcinoma is rare in the paediatric population but is increasing in incidence. Early diagnosis is critical to enable optimal outcomes.
Collapse
Affiliation(s)
- R Woods
- St. James's Hospital, James's St., Dublin 8
| | | | | | | | | | | |
Collapse
|
31
|
De Cruz P, Kamm M, Hamilton A, Ritchie K, Gorelik A, Liew D, Prideaux L, Lawrance I, Andrews J, Bampton P, Sparrow M, Jakobovits S, Florin T, Gibson P, Debinski H, Gearry R, Macrae F, Leong R, Kronborg I, Connor S, Pavli P, Smith GR, Selby W, Johnston M, Brouwer R, Keck J, Woods R, Connell W, Brown S, Bell S, Lust M, Elliott R, Desmond P. P342 Adalimumab prevents post-operative Crohn's disease recurrence and is superior to thiopurines: Early results from the prospective POCER study. J Crohns Colitis 2012. [DOI: 10.1016/s1873-9946(12)60361-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
|
32
|
Bradley KL, Nuk JE, Chia SK, Villa D, Speers CH, Woods R, Young S, Tyldesley S. P4-19-05: A Population-Based Study of Guideline-Based BRCA Screening in Male Breast Carcinoma. Cancer Res 2011. [DOI: 10.1158/0008-5472.sabcs11-p4-19-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Purpose: The British Columbia Cancer Agency (BCCA) Hereditary Cancer Program (HCP) is a publicly funded, centralized program that provides BRCA testing to patients with male breast cancer (MBC) who meet specified referral criteria (aimed at detecting a mutation in > 10% of those tested). Criteria include: MBC with Ashkenazi heritage, MBC with one other family member with breast or ovarian cancer, MBC diagnosed at < 35 years, Bilateral MBC with first diagnosed at < 50 year. In this context, the purpose was to study referral patterns for hereditary counselling and outcomes of BRCA testing within a population-based study of male breast carcinoma.
Patients and Methods
Records of consecutive cases of invasive MBC diagnosed from 2000 to 2010 were reviewed. We documented any recorded personal and family history of cancer. For those meeting the HCP referral criteria we recorded whether a referral was made and the outcome of any genetic testing.
Results: Of 158 cases of MBC, 23 (14.6%) patients (21 met referral criteria; 2 did not) were seen for genetic counselling, of whom 21 were offered BRCA1/2 testing, and 19 accepted testing. Of 19 patients with BRCA1/2 genetic test results, 3 (16%) had a pathogenic mutation identified; one in the BRCA1 gene (c.1387_1390delinsGAAAG) and two in the BRCA2 gene (***c.755_758delACAG; c.1813dupA). In a further 4 cases (21%) an unclassified variant in BRCA1 was identified. In the remaining 12 cases (63%), testing was uninformative.
Conclusions: The BRCA1/2 mutation detection rate of 16% is in line with the expected rate of >10% using established selection criteria. Expanding the criteria at this time to include all male breast cancers would be expected to decrease the detection rate below 10% with the potential to negatively impact on the publicly-funded and finite resources of the Hereditary Cancer Program and Cancer Genetics Laboratory.
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P4-19-05.
Collapse
Affiliation(s)
- KL Bradley
- 1British Columbia Cancer Agency, Vancouver, BC, Canada
| | - JE Nuk
- 1British Columbia Cancer Agency, Vancouver, BC, Canada
| | - SK Chia
- 1British Columbia Cancer Agency, Vancouver, BC, Canada
| | - D Villa
- 1British Columbia Cancer Agency, Vancouver, BC, Canada
| | - CH Speers
- 1British Columbia Cancer Agency, Vancouver, BC, Canada
| | - R Woods
- 1British Columbia Cancer Agency, Vancouver, BC, Canada
| | - S Young
- 1British Columbia Cancer Agency, Vancouver, BC, Canada
| | - S Tyldesley
- 1British Columbia Cancer Agency, Vancouver, BC, Canada
| |
Collapse
|
33
|
Woods R, Yerushalmi R, Speers C, Tydesley S, Gelmon K. P5-14-17: Stage IV at Presentation – Are HER2 Positive Tumors Overrepresented? Cancer Res 2011. [DOI: 10.1158/0008-5472.sabcs11-p5-14-17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: A minority of patients are diagnosed with Stage IV breast cancer at presentation. Recent studies (Dawood 2010) have suggested a better outcome for de novo vs. recurrent Stage IV but they did not account for the variation of molecular subtype. We questioned whether HER2 overexpressing tumors were over-represented in de novo Stage IV disease, and whether this impacted on survival compared to other subtypes. Further, if different subtypes are more likely to present with metastatic disease, then this factor may need to be considered when developing guidelines for staging. With such considerations in mind, the purpose of this study was to determine the breast cancer subtypes according to stage. The main hypothesis was that HER2 positive tumors would be more prevalent in stage IV presentations. Methods: Using the Breast Cancer Outcomes Unit database from the BC Cancer Agency (BCCA), patients referred to the BCCA with a new diagnosis of breast cancer between 2005 and 2010 were selected. Patients with a previous or synchronous contralateral breast cancer, male cases, and patients with referrals for reasons other than new disease were excluded. Four subtypes according to available markers were defined: ER+/HER2−, ER+/HER2+, ER-/HER2+, and ER-/HER2−.
Results: Using these criteria, 485 cases of de novo stage IV disease and 10,723 stages I — III cases were extracted. After excluding cases with missing data, our final cohort consisted of 10,186 stage I-III cases and 425 stage IV cases. Distribution by subtype is presented in the Table below.
Assessment of other patient characteristics for the group of Stage IV de novo patients revealed that age (younger for HER+ subgroups), site of metastases (more visceral vs. non- visceral for ER-/HER2+ and ER-/HER2−) and type of systemic therapy (chemotherapy (CT), hormone therapy (HT), trastuzumab (T) or not) were significant. Surgery rates for both mastectomy and breast-conserving surgery were similar for all subtypes. The ER-/HER2− subtype had the worst overall survival (p < 0.001).
Conclusion: Young age and HER2 overexpression is more common in stage IV de novo presentations (26.6% of stage IV tumors were HER2+ vs. only 16% of stage I-III tumors). This data may be important in considering routine staging guidelines at diagnosis to ensure correct diagnosis and treatment recommendations.
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P5-14-17.
Collapse
Affiliation(s)
- R Woods
- 1BC Cancer Agency, Vancouver, BC, Canada
| | | | - C Speers
- 1BC Cancer Agency, Vancouver, BC, Canada
| | - S Tydesley
- 1BC Cancer Agency, Vancouver, BC, Canada
| | - K Gelmon
- 1BC Cancer Agency, Vancouver, BC, Canada
| |
Collapse
|
34
|
Olson RA, Woods R, Lau J, Speers C, Lo A, Tyldesley S, Weir L. Impact of internal mammary node inclusion in the radiation treatment volume on the outcomes of patients with breast cancer treated with locoregional radiation after six years of follow-up. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.27_suppl.81] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
81 Background: There is ongoing controversy about radiotherapy (RT) to internal mammary nodes (IMNs). Proponents of IMN RT cite the survival benefit seen in postmastectomy RT trials that included IMNs. However, others point out that benefit cannot be definitively attributed to IMN inclusion, as other lymph node regions were included in the RT arms. The issue is important, as IMN RT potentially increases cardiac and respiratory morbidity. Methods: 2,413 women referred to a provincial RT program with newly diagnosed node positive, or T3/4N0 non-M1 invasive breast cancer, treated with a complete course of locoregional RT from 2001 to 2006, were retrospectively identified in a provincial database. IMN RT inclusion versus exclusion was determined through review of patient charts and RT treatment plans. Breast cancer-specific survival (BCSS), relapse-free survival (RFS), and overall survival (OS) were compared between the two groups using univariate and multivariable analyses. Results: Analyses were performed at a median follow-up of 6.2 years. 41.4% of the subjects received IMN RT. The 5-year BCSS for the IMN inclusion and exclusion group was 84.8% versus 82.9%, respectively (HR 0.93 [95% CI 0.76, 1.14]; p=.51); the 5-year RFS was 87.4% versus 86.9% (HR 0.993 [0.83, 1.19]; p=0.94); and the 5-year OS was 84.8% versus 82.9% (HR 0.84 [0.70, 1.01]; p=0.06). After controlling for potentially confounding variables, there was no significant difference in BCSS (HR 0.96 [0.78, 1.18], p=0.88), RFS (HR 1.02 [0.84, 1.22], p=0.87), or OS (HR 0.91 [0.76, 1.10]; p=0.35). Conclusions: After a median follow-up of 6.2 years, this population-based study shows no benefit from including IMNs in the locoregional RT volume after adjusting for other prognostic and treatment variables.
Collapse
Affiliation(s)
- R. A. Olson
- British Columbia Cancer Agency, Vancouver, BC, Canada; University of British Columbia, Vancouver, BC, Canada
| | - R. Woods
- British Columbia Cancer Agency, Vancouver, BC, Canada; University of British Columbia, Vancouver, BC, Canada
| | - J. Lau
- British Columbia Cancer Agency, Vancouver, BC, Canada; University of British Columbia, Vancouver, BC, Canada
| | - C. Speers
- British Columbia Cancer Agency, Vancouver, BC, Canada; University of British Columbia, Vancouver, BC, Canada
| | - A. Lo
- British Columbia Cancer Agency, Vancouver, BC, Canada; University of British Columbia, Vancouver, BC, Canada
| | - S. Tyldesley
- British Columbia Cancer Agency, Vancouver, BC, Canada; University of British Columbia, Vancouver, BC, Canada
| | - L. Weir
- British Columbia Cancer Agency, Vancouver, BC, Canada; University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
35
|
Yerushalmi R, Tyldesley S, Woods R, Kennecke HF, Speers C, Gelmon KA. Is breast-conserving therapy a safe option for patients with tumor multicentricity and multifocality? Ann Oncol 2011; 23:876-81. [PMID: 21810730 DOI: 10.1093/annonc/mdr326] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND We compared outcomes after breast-conserving therapy (BCT) and mastectomy in multicentric (MC)/multifocal (MF) versus unifocal breast cancer. PATIENTS AND METHODS Women with stage I-II disease were classified as having unifocal or MC/MF disease. MC/MF and other prognostic factors were compared using binary logistic regression analysis. Univariate and multivariate analyses (MVAs) for relapse were carried out using cumulative incidence curves and Fine and Gray regression models. For the BCT group, matched analysis was added. RESULTS Median follow-up was 7.9 years, 11 983 having BCT (unifocal: 11 683, MC/MF: 300) and 7771 having mastectomy (unifocal: 6884, MC/MF: 887). MC/MF patients treated with BCT were 50-69 years old, free of extensive ductal carcinoma in situ (DCIS), and had smaller tumors. The cumulative 10-year local recurrence rates among unifocal and MC/MF disease were 4.6% [95% confidence interval (CI) 4.1% to 5.0%] versus 5.5% (95% CI 2.6% to 9.9%) for the BCT group, P = 0.76 and 5.8% (95% CI 5.2% to 6.5%) versus 6.5% (95% CI 4.7% to 8.7%) for the mastectomy group, P = 0.77. MC/MF was not a significant factor for relapse or survival on MVA. In the matched analysis, relapse rates were similar in the unifocal and MC/MF groups, P = 0.60. CONCLUSION BCT is a reasonable option in selected MC/MF cases, particularly those women aged 50-69 years old with small (<1 cm) MF tumors and without an extensive DCIS component.
Collapse
Affiliation(s)
- R Yerushalmi
- Department of Medical Oncology, BC Cancer Agency, Vancouver, Canada.
| | | | | | | | | | | |
Collapse
|
36
|
Kennecke HF, Rahman M, Yip S, Woods R, Schaeffer D, Tai I. Effect of nab-rapamycin versus rapamycin in colorectal cancer cell lines and associations with KRAS and PI3K mutations. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e13532] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
37
|
Lim HJ, Aubin F, Zhou C, Kollmannsberger CK, Woods R, Carter B, Huntsman D, Gill S. Incidence and distribution of HER2-positive gastric and gastroesophageal junction (GEJ) adenocarinomas in British Columbia (BC). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e14559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
38
|
Yu JS, Woods R, Speers C, Gill S, Kennecke HF. Prognostic factors (PF) influencing overall survival (OS) in stage IV colorectal cancer (CRC). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e14021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
39
|
Chan A, Woods R, Gill S. Factors associated with delayed time to adjuvant chemotherapy (AC) in stage III colon cancer: British Columbia Cancer Agency (BCCA) cohort experience. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e16603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
40
|
Ho J, Woods R, Tai I, Kennecke HF, Lim HJ. Association of matrix metalloproteinase-1 (MMP-1) and matrix metalloproteinase-2 (MMP-2) expression with KRAS/BRAF mutational status and survival outcomes in metastatic colorectal cancer (CRC) patients. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e14088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
41
|
Alipour S, Woods R, Lim HJ, Gill S, Kennecke HF, Speers C, Brown CJ, Cheung WY. Effect of body mass index (BMI) and body surface area (BSA) on outcomes in early-stage colon cancer (CC). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.3615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
42
|
Yerushalmi R, Tyldesley S, Kennecke H, Speers C, Woods R, Knight B, Gelmon KA. Tumor markers in metastatic breast cancer subtypes: frequency of elevation and correlation with outcome. Ann Oncol 2011; 23:338-45. [PMID: 21543625 DOI: 10.1093/annonc/mdr154] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Little is known about the correlations between tumor markers (TMs), breast cancer subtypes, site(s) of metastasis and prognosis. METHODS Women diagnosed with metastatic breast cancer were included. Breast cancer subtypes were defined as LuminalA, LuminalB, LuminalHer2, Her2, Basal and non-Basal triple negative (TN). Levels of elevation of TM values [cancer antigen 15-3 (CA 15-3), carcinoembryonic antigen (CEA) and cancer antigen 125 (CA 125)] among the subtypes were analyzed. Site(s) of metastasis and outcomes were captured. RESULTS Eight hundred and ten patients were included. Luminal subtypes were associated with an elevation in at least one TM: 90.8% of LuminalHer2+, 90% of LuminalB and 88.6% of LuminalA. TMs were less frequently elevated in Basal (74.1%) and non-Basal TN (71.4%) cases (P < 0.001). CA 15-3 was the most frequently elevated TM. The incidence of TM elevation did not differ between patients with solitary versus multiple metastatic sites. Breast cancer-specific survival (BCSS) was significantly worse for patients with elevated TMs (P = 0.001). CONCLUSIONS TM elevation of CA 15-3, CEA and/or CA 125 was documented in the majority of patients with metastatic breast cancer with CA 15-3 occurring most commonly. Luminal subtypes expressed elevated TMs significantly more frequently compared with the non-Luminal groups. TM elevation was not different between the different sites of metastasis. Overall, elevated TMs predicted a worse BCSS.
Collapse
Affiliation(s)
- R Yerushalmi
- Department of Medical Oncology, British Columbia Cancer Agency, Vancouver Cancer Center, Vancouver, Canada.
| | | | | | | | | | | | | |
Collapse
|
43
|
|
44
|
Lim HJ, Woods R, Johal BS. Role of trimodality therapy versus dual-modality in T3N0 rectal cancer patients. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.4_suppl.597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
597 Background: Adjuvant radiation (R) and chemotherapy (C) is generally recommended for patients (pts) with pT3N0 rectal cancer, although there is no data to support the use of adjuvant chemotherapy. This study examines the whether there is benefit with trimodality therapy vs. dual modality in this population. Methods: The BCCA Colorectal Cancer Outcomes Unit database was used to identify referred pts with pT3N0 rectal carcinoma diagnosed between 2000-2004. The data from this cohort has been previously reported (Johal et al. ASCO Annual Meeting 2007) During this period, “short course” R (25Gy/5, surgery within 10 days) was recommended for resectable cT3 tumors followed by 6 months of C. If not treated pre-operatively (pre-op), guidelines specified post-op “long course” (45Gy/25) R and C. Three treatment groups were identified: Surgery alone (S), S and R (SR), and S, R and C (SRC). Eligible pts had complete surgical resection with or without total mesorectal Excision (TME). Pts treated with “downstaging” pre-op long course R, with S and C only (13 pts) or with R2 resection were excluded. Locoregional Recurrence (LR) and Distant Recurrence (DR) rates determined. Reasons for non-treatment were determined by chart review. Due to the heterogeneity between the groups, a univariate and multivariate analysis was performed. Results: The patient characteristics have been previously reported. 5-yr LR was similar between SR and SRC (3.84 %vs. 6.34% p=0.474). 5-yr DR were 24.81% (SR), and 17.56% (SRC) p=0.0354 and 5 yr OS 68.4% (SR), and 86% (SRC) p=.0002. On multivariate analysis, chemotherapy did impact on OS with a HR of 0.532, p=0.0462. Conclusions: Treatment of pT3N0 rectal cancer was variable in clinical practice despite established guidelines. There was significant heterogeneity with respect to comorbid medical conditions between groups receiving SR and SRC which limits comparability between groups. However, those patients who received tri-modality therapy experienced less distant relapse and an increase in overall survival. No significant financial relationships to disclose.
Collapse
Affiliation(s)
- H. J. Lim
- British Columbia Cancer Agency, Vancouver, BC, Canada; British Columbia Cancer Agency, Surrey, BC, Canada
| | - R. Woods
- British Columbia Cancer Agency, Vancouver, BC, Canada; British Columbia Cancer Agency, Surrey, BC, Canada
| | - B. S. Johal
- British Columbia Cancer Agency, Vancouver, BC, Canada; British Columbia Cancer Agency, Surrey, BC, Canada
| |
Collapse
|
45
|
Ho J, Woods R, Kennecke HF, Tai I, Lim HJ. Evaluation of the association of matrix metalloproteinase-1 (MMP-1) and matrix metalloproteinase-2 (MMP-2) expression with KRAS and BRAF mutational status or survival outcomes in colorectal cancer (CRC) patients. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.4_suppl.452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
452 Background: MMP-1 and MMP-2 proteins are felt to be involved in tumor growth, invasion and metastasis and may be regulated by the KRAS pathway. Methods: A tissue microarray was constructed from archival formalin-fixed paraffin-embedded primary tumor tissue samples of 96 patients with metastatic CRC. MMP-1 and MMP-2 expression was measured semiquantitatively by immunohistochemistry and graded 0 to 2. Mutation analysis was done for KRAS in codons 12 and 13, and patients without KRAS mutations were tested for BRAF V600E mutation. Chi-squared test, Fisher's exact test and Cox-proportionate hazard ratios were used for statistical analysis. Results: 96 patients had samples available for analysis (median age at diagnosis 60, 57% male, 46% stage IV at diagnosis, 33/93 (35%) KRAS mutated, 7/51 (14%) BRAF mutated, 22% received anti-EGFR therapy). No significant association was identified between MMP-1 and KRAS (p=0.88) or BRAF (p=0.54), or between MMP-2 and KRAS (p=0.08) or BRAF (p=0.41). Neither overall survival nor survival from diagnosis of metastatic disease were affected by MMP-1 or MMP-2 expression. Conclusions: MMP-1 and MMP-2 expression is not associated with KRAS or BRAF mutational status and is not a prognostic factor in our cohort of CRC patients. No significant financial relationships to disclose.
Collapse
Affiliation(s)
- J. Ho
- British Columbia Cancer Agency, Vancouver, BC, Canada; British Columbia Cancer Agency Research Center, Vancouver, BC, Canada
| | - R. Woods
- British Columbia Cancer Agency, Vancouver, BC, Canada; British Columbia Cancer Agency Research Center, Vancouver, BC, Canada
| | - H. F. Kennecke
- British Columbia Cancer Agency, Vancouver, BC, Canada; British Columbia Cancer Agency Research Center, Vancouver, BC, Canada
| | - I. Tai
- British Columbia Cancer Agency, Vancouver, BC, Canada; British Columbia Cancer Agency Research Center, Vancouver, BC, Canada
| | - H. J. Lim
- British Columbia Cancer Agency, Vancouver, BC, Canada; British Columbia Cancer Agency Research Center, Vancouver, BC, Canada
| |
Collapse
|
46
|
Lim HJ, Aubin F, Kollmannsberger CK, Huntsman D, Carter B, Zhou C, Woods R, Gill S. Incidence and distribution of HER2-positive gastric and gastroesophageal junction (GEJ) adenocarinomas in British Columbia (BC). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.4_suppl.91] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
91 Background: HER2-positive rates have been reported as 20% of GC and 34% in GEJ adenocarcinoma in a recent global phase III trial with trastuzumab and chemotherapy. This study examines the incidence and distribution HER2-positive GC and GEJ adenocarcinomas in the province of BC. Methods: Formalin fixed embedded tissue from patients (pts) with resected gastric or GEJ adenocarcinoma from 2004-2007 were identified retrospectively through the BC Cancer Agency registry and prospectively for pts with a new diagnosis of advanced disease. Biopsies and resection samples were analyzed via previously validated methods IHC (Ventana 4B5 antibody), FISH (Eurovision probes) and SISH (Ventana probes). IHC scores of 3 were considered positive, 2 were cequivocal and 0 or 1 were negative. A 10% cut-off was used to determine positive samples. Equivocal staining was considered positive via FISH or SISH. A ratio of > 2.0 was considered amplified for FISH and SISH. P values were calculated using a logistic regression model with HER2 positive as the endpoint. Results: Of the 87 samples, 64 (74%) were gastric and 23 (26%) GEJ. Overall, HER2 was positive 20% (IHC), 18% (FISH) and 18% (SISH). 13% of cases tested IHC 3+ while 24% tested IHC 2+. In equivocal IHC 2+ cases, 7% were considered positive by FISH. Positivity rates were higher for GEJ (26%, 22% and 17%) vs. gastric (8%, 11% and 9%) via IHC (p = 0.02), but did not significantly differ by FISH (p = 0.19), or SISH (p = 0.30) respectively. The majority of positive cases were intestinal type vs. other (diffuse type or mixed) 25% vs. 0% IHC p = 0.0002, 25% vs. 3% FISH p = 0.001, 20% vs. 3% SISH p = 0.006. The positivity rates were similar with biopsy vs resection specimens (12% vs. 16% IHC p = 0.64, 12% vs. 21% FISH p = 0.30, 12% vs. 10%, SISH p = 0.88). Conclusions: The rates of HER2-positive disease in a Western population based study were similar to the ToGA study. HER 2 positivity was associated with cancers arising in the GEJ and of intestinal type. The frequency of positivity was similar for testing by biopsy versus resection specimens. This study is ongoing and updated results will be reported. No significant financial relationships to disclose.
Collapse
Affiliation(s)
- H. J. Lim
- British Columbia Cancer Agency, Vancouver, BC, Canada; Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada; Vancouver Cancer Center, British Columbia Cancer Agency, Vancouver, BC, Canada
| | - F. Aubin
- British Columbia Cancer Agency, Vancouver, BC, Canada; Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada; Vancouver Cancer Center, British Columbia Cancer Agency, Vancouver, BC, Canada
| | - C. K. Kollmannsberger
- British Columbia Cancer Agency, Vancouver, BC, Canada; Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada; Vancouver Cancer Center, British Columbia Cancer Agency, Vancouver, BC, Canada
| | - D. Huntsman
- British Columbia Cancer Agency, Vancouver, BC, Canada; Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada; Vancouver Cancer Center, British Columbia Cancer Agency, Vancouver, BC, Canada
| | - B. Carter
- British Columbia Cancer Agency, Vancouver, BC, Canada; Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada; Vancouver Cancer Center, British Columbia Cancer Agency, Vancouver, BC, Canada
| | - C. Zhou
- British Columbia Cancer Agency, Vancouver, BC, Canada; Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada; Vancouver Cancer Center, British Columbia Cancer Agency, Vancouver, BC, Canada
| | - R. Woods
- British Columbia Cancer Agency, Vancouver, BC, Canada; Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada; Vancouver Cancer Center, British Columbia Cancer Agency, Vancouver, BC, Canada
| | - S. Gill
- British Columbia Cancer Agency, Vancouver, BC, Canada; Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada; Vancouver Cancer Center, British Columbia Cancer Agency, Vancouver, BC, Canada
| |
Collapse
|
47
|
Tyldesley S, Woods R, Speers C, Nichol A, Weir L, Olivotto I. Abstract P4-11-03: The Impact of Fractionation on Local Relapse for Patients with Grade 3 Breast Cancer. Cancer Res 2010. [DOI: 10.1158/0008-5472.sabcs10-p4-11-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Several randomized trials have demonstrated that hypofractionated (HF) and conventionally fractionated (CF) radiotherapy (RT) provide equivalent local control following breast conserving surgery (BCS). However, an update of the Canadian trial suggested that patients with grade 3 disease had an increased risk of local relapse after HF. The risk of local relapse following HF or CF according to grade was investigated among a population-based cohort from British Columbia, Canada. Materials and methods: Female patients diagnosed between 1990 and 2000 with T1-T2N0M0 breast cancer treated with lumpectomy, axillary dissection and RT with at least 6 nodes removed and RT delivered to the breast were identified. Whole breast RT prescriptions were distributed in two groups : HF (typically 42.5 to 44 Gy in 16 fractions), and CF (45Gy to 50 Gy in 25 fractions). The 45 Gy prescription was followed by a boost to the biopsy cavity regardless of the margin status. Patients with close or positive margins received a boost (typically 7.5 to 10Gy in 3 to 4 fractions, or 10 to 20Gy in 5 to 10 fractions). Baseline demographic (age, year of diagnosis), tumour (grade, histology, size, lymphatic vascular space invasion (LVI), presence of extensive DCIS) and treatment factors (margin status, hormonal or chemotherapy use, RT fractionation group, and RT boost use) were abstracted. Cumulative rates of local relapse were estimated using a competing risk approach (distant relapses or death were competing risks) and compared across groups using Gray's test. Factors significant on univariate analysis were included with fractionation group in a multivariate (Fine and Gray) model among grade 3 patients. Results: The cohort consisted of 1,335 patients diagnosed with grade 3 breast cancers: 252 received CF and 1083 patients received HF. The fractionation groups were well balanced for most of the aforementioned factors except median age (56 years for CF vs 52 years for HF (P<0.01), and use of systemic therapy (hormones alone: 26% vs 19%; chemotherapy alone: 27%vs 33%; and chemo+hormone therapy: 8% vs 10% (p=0.04) for HF compared to CF). The 10-year cumulative incidence rate of local relapse in patients with grade 3 breast cancers was 6.9% for the HF group and 6.2 % for the CF group (p=0.99). A Fine and Gray multivariate competing risk model showed that age under 40 years (p=0.02), positive margins (p=0.05) and negative ER status (p=0.01) were associated with an increased risk of local relapse, but fractionation group was not (Hazard ratio=0.95, p=0.88).
Conclusions: There was no evidence that hypofractionation was inferior to conventional fractionation for breast conserving therapy in patients with T1-T2 N0, grade 3 breast cancer in a population-based series.
Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P4-11-03.
Collapse
Affiliation(s)
- S Tyldesley
- British Columbia Cancer Agency, Vancouver, BC, Canada
| | - R Woods
- British Columbia Cancer Agency, Vancouver, BC, Canada
| | - C Speers
- British Columbia Cancer Agency, Vancouver, BC, Canada
| | - A Nichol
- British Columbia Cancer Agency, Vancouver, BC, Canada
| | - L Weir
- British Columbia Cancer Agency, Vancouver, BC, Canada
| | - I. Olivotto
- British Columbia Cancer Agency, Vancouver, BC, Canada
| |
Collapse
|
48
|
Tyldesley S, Karam I, Nichol A, Woods R, Speers C, Kennecke H. Abstract P4-11-06: Population Based Outcomes after Whole Brain Radiotherapy in Patients with Metastatic Breast Cancer in the Pre and Post Trastuzumab Eras. Cancer Res 2010. [DOI: 10.1158/0008-5472.sabcs10-p4-11-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: In the Pre-trastuzumab (Pre-T) era, survival rates after brain radiotherapy (RT) for breast cancer patients were 4 to 8 months. Trastuzumab (T) was approved and funded in British Columbia in the metastatic setting in 1999. We examined the survival of Her2-positive and negative metastatic breast cancer at a provincial level in the Pre-T and T eras after brain RT.
Material and Methods: All women with a diagnosis of breast cancer between 2000 and 2007 (T era) who were treated with brain RT in British Columbia were identified. A series of cases with brain metastasis from breast cancer treated with brain irradiation diagnosed between 1986 and 1992 with banked tissue on which Her-2 testing had been performed were also identified (Pre-T era). Date of death was determined from the tumour registry. Baseline prognostic factors were compared using Chi Square for categorical data, and t-test for continuous data. Survival was estimated using the Kaplan-Meier method, and comparisons between eras and between her-2 groups were done with a log-rank test. Variables significant for survival on log-rank test were entered into a Cox regression for multivariate analysis for each era separately.
Results: A total of 455 women with brain metastases from breast cancer were identified from the T era, and 131 were identified from the Pre-T era. The median age at diagnosis was 53 years in both eras. The percentage of cases with ER-positive (43% and 41% p=0.2) and Grade 3 tumours (74% and 67%, p=0.2) were not statistically different. The percentage of cases with Her2-positive disease were statistically different the two eras (29% in Pre-T and 46% in the T eras, p=<0.001). Of the T era Her2-positive patients, 85% received T. The median time from diagnosis to brain RT was longer in the pre-T era (3.3 years versus 2.3 years, p< 0.001). The most common prescription used for whole brain RT was 20 Gy in 5 fractions in both eras, however it was more common in the pre-T era (87%) compared to the T era (68%) (p=<0.001). Although stereotactic radiotherapy, which first became available in our region in 1997, was occasionally used as a boost in BC, all but 15 (11%) of the pre-T era patients had died prior to its availability. Survival was longer after whole brain RT in the T era (1 year survival 27% versus 14%, log rank p=0.07). In the T era, one year survival was better for those with Her2 positive disease in the T era (39%) compared to those with Her2 negative disease (19%) in the T era (p-value < 0.0001), and to those with Her 2 positive disease in the pre-T era (3%, P<0.001). In the pre-T era, although 1 year survival was better (18%) for Her2 negative disease compared to Her2 positive disease (3%), the difference was not statistically significant (p=0.1). In a Cox model, RT dose and ER status were significant variables in both eras, but Her2 status and age were only significant variables in the T era (p all < 0.001).
Discussion: For patients with Her2 negative disease, there was no difference in survival after RT for brain metastases between the Pre-T and T eras. However, for patients with Her2 positive disease, survival after RT for brain metastases has increased significantly in the trastuzumab era.
Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P4-11-06.
Collapse
Affiliation(s)
- S Tyldesley
- British Columbia Cancer Agency, Vancouver, BC, Canada
| | - I Karam
- British Columbia Cancer Agency, Vancouver, BC, Canada
| | - A Nichol
- British Columbia Cancer Agency, Vancouver, BC, Canada
| | - R Woods
- British Columbia Cancer Agency, Vancouver, BC, Canada
| | - C Speers
- British Columbia Cancer Agency, Vancouver, BC, Canada
| | - H. Kennecke
- British Columbia Cancer Agency, Vancouver, BC, Canada
| |
Collapse
|
49
|
Davidson JA, Tyldesley S, Speers C, Woods R, Chia S. Abstract P5-15-02: Characteristics and Prognosis of Patients Presenting with Isolated Axillary Nodal Metastases from Occult Breast Primary Carcinoma. Cancer Res 2010. [DOI: 10.1158/0008-5472.sabcs10-p5-15-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Patients presenting with isolated axillary metastatic carcinoma represent a potentially curable subset of patients. As there are no published randomized trials, literature concerning this uncommon clinical entity is limited to small retrospective reports. These vary widely with respect to the information collected, span a large time period during which diagnostic and therapeutic options have advanced considerably, and are largely without a contemporary control group.
Methods: The British Columbia Breast Cancer Outcomes Unit (BCOU) database was searched to identify patients referred to the British Columbia Cancer Agency with a new diagnosis of isolated axillary metastatic cancer diagnosed between 2000 and 2005. Eligible patients were female, had pathological evidence of lymph node (LN) involvement but no evidence of a primary tumor or distant metastases on clinical workup. A series of control patients, with pathological T1 tumors and N1 involvement at presentation were selected from the BCOU database matched 3:1 for age, diagnosis year, tumor characteristics (histology, estrogen receptor status, HER2 status, and number of affected lymph nodes), and systemic treatment characteristics (adjuvant chemotherapy and/or endocrine therapy).
Results: 36 patients were identified to form the primary axillary cohort. The controls consisted of 1,406 patients, of whom 106 were matched for the above characteristics. Patients in the primary axillary cohort were fairly well-distributed among all diagnosis years, and all tumors exhibited ductal histology. 26 (72%) were estrogen receptor-positive and 8 (22%) were known to be HER2-positive. 9 (25%) patients underwent mastectomy. 33 (92%) patients received radiation therapy and 19 (53%) did not undergo any breast surgery. With a median follow-up of 5.2 and 5.4 years for the primary axillary cohort and the matched controls, the BCSS was 93% and 88% respectively. There were no locoregional recurrences documented in the primary axillary cohort.
Conclusions: This study represents one of the larger contemporary case control series of isolated axillary nodal presentations, demonstrating a good prognosis for this cohort of patients despite approximately half of the patients not having primary breast surgery.
Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P5-15-02.
Collapse
Affiliation(s)
- JA Davidson
- British Columbia Cancer Agency-Vancouver Centre, Vancouver, BC, Canada
| | - S Tyldesley
- British Columbia Cancer Agency-Vancouver Centre, Vancouver, BC, Canada
| | - C Speers
- British Columbia Cancer Agency-Vancouver Centre, Vancouver, BC, Canada
| | - R Woods
- British Columbia Cancer Agency-Vancouver Centre, Vancouver, BC, Canada
| | - S. Chia
- British Columbia Cancer Agency-Vancouver Centre, Vancouver, BC, Canada
| |
Collapse
|
50
|
Dhalla S, Woods R, Strathdee SA, Patrick DM, Hogg RS. HIV vaccine preparedness studies in the organization for economic co-operation and development (OECD) countries. AIDS Care 2010; 19:1118-27. [PMID: 17851989 DOI: 10.1080/09540120701352258] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
HIV vaccine development remains an urgent priority. This article is a systematic review of HIV vaccine preparedness studies in the high-income 30 Organization for Economic Co-operation and Development countries, to identify factors important for HIV vaccine trial development in injection drug users (IDU), men who have sex with men (MSM), and women at heterosexual risk (WAHR) across these countries. Of 27 articles we identified, willingness to participate (WTP) was assessed in eight studies involving IDU, 11 involving MSM, and one involving WAHR. WTP ranged in IDU at 41-86%, MSM at 23-94%, and in WAHR, it was at 81%. Studies reported recruitment of high-risk individuals. Retention was assessed in eight studies involving IDU, five involving MSM, and three involving WAHR. IDU were retained at a range of 3-98%, MSM at 70-95% and WAHR at 67-92%. This review provides an in-depth summary of HIV vaccine preparedness studies that were conducted in the Organization for Economic Co-operation and Development countries.
Collapse
Affiliation(s)
- S Dhalla
- Department of Health Care and Epidemiology, University of British Columbia, Vancouver, Canada.
| | | | | | | | | |
Collapse
|