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Wu CHD, Wierzbicki M, Parpia S, Kundapur V, Bujold A, Filion EJ, Lau H, Faria S, Ahmed N, Leong N, Okawara G, Hirmiz KJ, Owen TE, Louie AV, Wright J, Whelan TJ, Swaminath A. Long-Term Toxicity in Patients Receiving Radiotherapy for Ultracentral Stage I Non-Small Cell Lung Cancer - A Secondary Analysis of the LUSTRE Randomized Trial. Int J Radiat Oncol Biol Phys 2023; 117:S171. [PMID: 37784427 DOI: 10.1016/j.ijrobp.2023.06.636] [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) Hypofractionated and stereotactic body radiotherapy (SBRT) are increasingly used in the treatment of centrally located, early-stage non-small cell lung cancer (NSCLC), though there are concerns of increased morbidity and mortality in patients with ultracentral tumors (UC). We report on the long-term toxicity of patients with UC lung cancer treated on a prospective randomized clinical trial of SBRT versus conventionally hypofractionated radiotherapy (CRT) for stage I NSCLC (NCT01968941). MATERIALS/METHODS Patients with UC tumors, defined as those where the planning target volume directly overlaps with the proximal bronchial tree (PBT), were identified from the larger cohort of patients treated on the trial. These patients received either SBRT with 60 Gy in 8 fractions or CRT with 60 Gy in 15 fractions. The primary endpoint of this secondary analysis was development of any grade 3 or higher toxicity defined using CTCAE version 3.0. Secondary endpoints included local control, as well as dosimetric analysis of the PBT, using EQD2 with α/β ratio of 3 to assess the relationship between dose to the PBT and toxicity. RESULTS Twenty-nine patients were identified with UC tumors; 21 received SBRT and 8 received CRT. Median age was 72 years (range 55-88 years) and 59% were female. Median FEV1 was 1.46L (range 0.64-2.37L). Patients had either T1 (59%) or T2 (41%) lesions, with median tumor size 2.5cm (range 1.1-4.9cm). Most patients had histologically confirmed disease (squamous cell, n = 10; adenocarcinoma, n = 8; radiographically suspicious, n = 11). The median follow-up was 2.9 years (range 0.7-5.2 years). The 3-year local control rate of all patients was 88.3% (95% confidence interval: 75.7-100%). There were 3 patients with late (>3 months) grade 3 toxicity (bronchial stricture, chest pain, and atelectasis) and 1 patient with late grade 5 toxicity (bleeding/hemorrhage), all treated in the SBRT arm. Median EQD2 dose to PBT in patients with grade ≥3 late toxicity compared to the rest of the cohort was: Dmax, 132 vs 129 Gy; D0.1cc, 129 vs 119 Gy; D1cc, 124 vs 80 Gy; and D5cc, 83 vs 41 Gy. Median EQD2 volumetric doses in grade ≥3 patients (compared to the rest) to PBT were: V65 Gy, 9.7 vs 2.2cc; V80 Gy, 7.9 vs 1.1cc; V90 Gy, 6.2 vs 0.4cc; and V100 Gy, 4.8 vs 0.3cc. The single patient with grade 5 toxicity had the highest D5cc (116 Gy) and V100 Gy (7cc) among all patients. CONCLUSION Stereotactic radiation with 60 Gy in 8 fractions for UC lung cancer provides good local control but carries an approximately 15-20% rate of late grade ≥3 toxicity. There appears to be a dosimetric association between toxicity and dose to the PBT. It may be more important to minimize volumetric PBT dose rather than maximum point dose to reduce risk of severe late toxicity.
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Affiliation(s)
- C H D Wu
- BC Cancer Agency, Victoria, BC, Canada
| | - M Wierzbicki
- Juravinski Cancer Centre, McMaster University, Hamilton, ON, Canada
| | - S Parpia
- Juravinski Cancer Centre, McMaster University, Hamilton, ON, Canada
| | - V Kundapur
- Saskatoon Cancer Centre, Saskatoon, SK, Canada
| | - A Bujold
- Hopital Maisonneuve-Rosemont, Universite de Montreal, Montreal, QC, Canada
| | - E J Filion
- Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada
| | - H Lau
- University of Calgary, Calgary, AB, Canada
| | - S Faria
- McGill University Health Center, Montreal, QC, Canada
| | - N Ahmed
- Department of Radiation Oncology, Cancer Care Manitoba, Winnipeg, MB, Canada
| | - N Leong
- Allan Blair Cancer Centre, Regina, SK, Canada
| | - G Okawara
- Juravinski Cancer Centre, McMaster University, Hamilton, ON, Canada
| | - K J Hirmiz
- Windsor Regional Hospital Cancer Program, Windsor, ON, Canada
| | - T E Owen
- Cancer Centre of Southeastern Ontario, Kingston, ON, Canada
| | - A V Louie
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - J Wright
- Juravinski Cancer Centre, McMaster University, Hamilton, ON, Canada
| | - T J Whelan
- Juravinski Cancer Centre, McMaster University, Hamilton, ON, Canada
| | - A Swaminath
- Juravinski Cancer Centre, McMaster University, Hamilton, ON, Canada
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Wagner LI, Gray RJ, Garcia S, Whelan TJ, Tevarweerk A, Yanez B, Carlos R, Gareen I, McCaskill-Stevens W, Cella D, Sparano JA, Sledge GW. Abstract GS6-03: Symptoms and health-related quality of life on endocrine therapy alone (E) versus chemoendocrine therapy (C+E): TAILORx patient-reported outcomes results. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-gs6-03] [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: TAILORx patient-reported outcomes (PRO) quantify symptoms and health-related quality of life (HRQL) from C+E beyond E alone from the patient's perspective, thus can inform decision-making for women in the intermediate risk group for whom chemotherapy may still be considered.
Methods: TAILORx participants with OncoType DX Recurrence Scores 11-25 were randomly assigned to E or C+E. All TAILORx participants enrolled 1/2010-10/2010 (N=612) completed PROs measuring fatigue, endocrine symptoms, cognitive impairments (PCI), and fear of recurrence at baseline, 3, 6, 12, 24 and 36 months. HRQL was assessed at baseline, 12, and 36 months. Linear regression (LR) examined PRO scores among the per-protocol sample.
Results: Overall, participants reported significantly more fatigue, endocrine symptoms and PCI at 3, 6, 12, 24 and 36 months compared to baseline and those randomized to C+E reported a greater magnitude of change baseline-3 months compared to those randomized to E alone (Table 1). Overall, by 12 months symptoms were comparable between groups. Pre-menopausal women had comparable symptoms at 24 and 36 months. Post-menopausal women randomized to C+E had greater endocrine symptoms at 24 and 36 months and greater fatigue at 6 and 24 months. Fear of recurrence was comparable between arms during treatment and follow-up. Multiple linear regression identified increased fatigue (LR slope β=0.67), endocrine symptoms (β =0.14), and PCI (β=0.11) as significant predictors of decreased HRQL across arms (p< 0.001). HRQL was comparable between E and C+E at 12- and 36-months.
Mean PRO change scores from baseline by treatment arm and menopausal status in per protocol population Months 36122436N=Overall454469458384343n=Pre-menopausal153151150118103n=Post-menopausal301318308266240FACIT-Fatigue Overall sample C+E-8.77-4.37-4.01-4.27-3.67E-2.48-1.97-2.14-1.49-1.83LMED-5.32***-1.55-1.01-1.76-0.90Pre-M C+E-8.01-3.26-2.99-2.45-1.60E-3.87-1.66-1.32-2.52-2.11LMED-3.11-0.82-1.121.021.46Post-M C+E-9.22-4.97-4.55-5.14-4.67E-1.87-2.10-2.52-1.09-1.71LMED-6.42***-1.99*-1.16-3.02*-2.01FACT-Endocrine Symptoms Overall sample C+E-5.56-5.63-6.96-6.81-7.14E-3.61-4.24-5.62-5.31-5.17LMED-1.62*-0.97-1.08-1.05-1.69Pre-M C+E-7.62-8.34-7.94-8.29-8.96E-5.96-6.19-8.95-10.39-10.84LMED-1.44-1.631.062.272.18Post-M C+E-4.39-4.19-6.45-6.10-6.28E-2.55-3.41-4.10-3.23-2.87LMED-1.49-0.45-2.04-2.39*-3.17**Significance between mean change scores *p<0.05;**p<0.01;***p<0.001. LMED=estimated tx difference using linear model regressing score on baseline value and tx
Conclusions: TAILORx is the first trial to examine patient-reported fatigue, endocrine symptoms, PCI and HRQL among breast cancer patients randomized to endocrine therapy alone vs chemoendocrine therapy, thus allowing us to quantify acute and long-term symptoms uniquely attributable to chemotherapy. As expected, chemotherapy is associated with greater fatigue, endocrine symptoms and PCI acutely during treatment, and for post-menopausal women with greater long-term endocrine symptoms. Increased symptoms were associated with poorer HRQL. Long-term HRQL was comparable between groups.
Citation Format: Wagner LI, Gray RJ, Garcia S, Whelan TJ, Tevarweerk A, Yanez B, Carlos R, Gareen I, McCaskill-Stevens W, Cella D, Sparano JA, Sledge, Jr. GW, On behalf of the TAILORx Study Team. Symptoms and health-related quality of life on endocrine therapy alone (E) versus chemoendocrine therapy (C+E): TAILORx patient-reported outcomes results [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr GS6-03.
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Affiliation(s)
- LI Wagner
- Wake Forest School of Medicine, Winston Salem, NC; Dana-Farber Cancer Institute, Boston, MA; Northwestern University School of Medicine, Chicago, IL; McMaster University, Hamilton, ON, Canada; University of Wisconsin, Madison, WI; University of Michigan, Ann Arbor, MI; Brown University, Providence, RI; National Institutes of Health, National Cancer Institute, Bethesda, MD; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Stanford University Medical Center, Stanford, CA
| | - RJ Gray
- Wake Forest School of Medicine, Winston Salem, NC; Dana-Farber Cancer Institute, Boston, MA; Northwestern University School of Medicine, Chicago, IL; McMaster University, Hamilton, ON, Canada; University of Wisconsin, Madison, WI; University of Michigan, Ann Arbor, MI; Brown University, Providence, RI; National Institutes of Health, National Cancer Institute, Bethesda, MD; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Stanford University Medical Center, Stanford, CA
| | - S Garcia
- Wake Forest School of Medicine, Winston Salem, NC; Dana-Farber Cancer Institute, Boston, MA; Northwestern University School of Medicine, Chicago, IL; McMaster University, Hamilton, ON, Canada; University of Wisconsin, Madison, WI; University of Michigan, Ann Arbor, MI; Brown University, Providence, RI; National Institutes of Health, National Cancer Institute, Bethesda, MD; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Stanford University Medical Center, Stanford, CA
| | - TJ Whelan
- Wake Forest School of Medicine, Winston Salem, NC; Dana-Farber Cancer Institute, Boston, MA; Northwestern University School of Medicine, Chicago, IL; McMaster University, Hamilton, ON, Canada; University of Wisconsin, Madison, WI; University of Michigan, Ann Arbor, MI; Brown University, Providence, RI; National Institutes of Health, National Cancer Institute, Bethesda, MD; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Stanford University Medical Center, Stanford, CA
| | - A Tevarweerk
- Wake Forest School of Medicine, Winston Salem, NC; Dana-Farber Cancer Institute, Boston, MA; Northwestern University School of Medicine, Chicago, IL; McMaster University, Hamilton, ON, Canada; University of Wisconsin, Madison, WI; University of Michigan, Ann Arbor, MI; Brown University, Providence, RI; National Institutes of Health, National Cancer Institute, Bethesda, MD; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Stanford University Medical Center, Stanford, CA
| | - B Yanez
- Wake Forest School of Medicine, Winston Salem, NC; Dana-Farber Cancer Institute, Boston, MA; Northwestern University School of Medicine, Chicago, IL; McMaster University, Hamilton, ON, Canada; University of Wisconsin, Madison, WI; University of Michigan, Ann Arbor, MI; Brown University, Providence, RI; National Institutes of Health, National Cancer Institute, Bethesda, MD; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Stanford University Medical Center, Stanford, CA
| | - R Carlos
- Wake Forest School of Medicine, Winston Salem, NC; Dana-Farber Cancer Institute, Boston, MA; Northwestern University School of Medicine, Chicago, IL; McMaster University, Hamilton, ON, Canada; University of Wisconsin, Madison, WI; University of Michigan, Ann Arbor, MI; Brown University, Providence, RI; National Institutes of Health, National Cancer Institute, Bethesda, MD; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Stanford University Medical Center, Stanford, CA
| | - I Gareen
- Wake Forest School of Medicine, Winston Salem, NC; Dana-Farber Cancer Institute, Boston, MA; Northwestern University School of Medicine, Chicago, IL; McMaster University, Hamilton, ON, Canada; University of Wisconsin, Madison, WI; University of Michigan, Ann Arbor, MI; Brown University, Providence, RI; National Institutes of Health, National Cancer Institute, Bethesda, MD; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Stanford University Medical Center, Stanford, CA
| | - W McCaskill-Stevens
- Wake Forest School of Medicine, Winston Salem, NC; Dana-Farber Cancer Institute, Boston, MA; Northwestern University School of Medicine, Chicago, IL; McMaster University, Hamilton, ON, Canada; University of Wisconsin, Madison, WI; University of Michigan, Ann Arbor, MI; Brown University, Providence, RI; National Institutes of Health, National Cancer Institute, Bethesda, MD; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Stanford University Medical Center, Stanford, CA
| | - D Cella
- Wake Forest School of Medicine, Winston Salem, NC; Dana-Farber Cancer Institute, Boston, MA; Northwestern University School of Medicine, Chicago, IL; McMaster University, Hamilton, ON, Canada; University of Wisconsin, Madison, WI; University of Michigan, Ann Arbor, MI; Brown University, Providence, RI; National Institutes of Health, National Cancer Institute, Bethesda, MD; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Stanford University Medical Center, Stanford, CA
| | - JA Sparano
- Wake Forest School of Medicine, Winston Salem, NC; Dana-Farber Cancer Institute, Boston, MA; Northwestern University School of Medicine, Chicago, IL; McMaster University, Hamilton, ON, Canada; University of Wisconsin, Madison, WI; University of Michigan, Ann Arbor, MI; Brown University, Providence, RI; National Institutes of Health, National Cancer Institute, Bethesda, MD; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Stanford University Medical Center, Stanford, CA
| | - GW Sledge
- Wake Forest School of Medicine, Winston Salem, NC; Dana-Farber Cancer Institute, Boston, MA; Northwestern University School of Medicine, Chicago, IL; McMaster University, Hamilton, ON, Canada; University of Wisconsin, Madison, WI; University of Michigan, Ann Arbor, MI; Brown University, Providence, RI; National Institutes of Health, National Cancer Institute, Bethesda, MD; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Stanford University Medical Center, Stanford, CA
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Albain K, Gray RJ, Sparano JA, Makower DF, Pritchard KI, Hayes DF, Geyer CE, Dees EC, Goetz MP, Olson JA, Lively T, Badve SS, Saphner TJ, Wagner LI, Whelan TJ, Ellis MJ, Paik S, Wood WC, Ravdin PM, Keane MM, Gomez HL, Reddy PS, Goggins TF, Mayer IA, Brufsky AM, Toppmeyer DL, Kaklamani VG, Berenberg JL, Abrams J, Sledge GW. Abstract GS4-07: Race, ethnicity and clinical outcomes in hormone receptor-positive, HER2-negative, node-negative breast cancer: results from the TAILORx trial. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-gs4-07] [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] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Black race is associated with worse outcomes in localized hormone receptor (HR)-positive breast cancer in population-based and in clinical trial cohorts, whether using self-identified race (Albain et al. JNCI 2009 [PMID: 19584328; Sparano et al. JNCI 2012 [PMID: 22250182) or genetically-identified race (Schneider et al. J Precision Oncol 2017 [PMID: 29333527]). This disparity persists after adjustment for treatment delivery parameters (Hershman et al. JCO 2009 [PMID:19307504]). We evaluated clinicopathologic characteristics, treatment delivered and clinical outcomes in the Trial Assigning Individualized Options for Treatment (TAILORx) by race and ethnicity (Sparano et al. NEJM 2018 [PMID: 29860917]).
Methods: The analysis included 9719 evaluable TAILORx participants. The association between clinical outcomes and race (white, black, Asian, other/unknown) and ethnicity (Hispanic vs. non-Hispanic) was examined, including invasive disease-free survival (iDFS), distant relapse-free interval (DRFI), relapse-free interval (RFI), and overall survival (OS). Proportional hazards models were fit including age (5 categories), tumor size (>2 cm vs. <=2 cm), histologic grade (high vs. medium vs. low vs. unknown), continuous recurrence score (RS), race, and ethnicity in the overall population and randomized treatment arms in the RS 11-25 cohort.
Results: The study population included 8189 (84%) whites, 693 (7%) blacks, 405 (4%) Asians, and 432 (4%) with other/unknown race. Regarding ethnicity, 7635 (79%) were non-Hispanic, 889 (9%) Hispanic, and 1195 (12%) unknown. There was no significant difference in RS distribution (p=0.22) in blacks compared with whites, or in median (17 vs. 17) or mean RS (19.1 vs. 18.2). There was likewise no difference in Hispanic vs. non-Hispanic ethnicity for RS distribution (p=0.72) or median (17 vs. 17) or mean RS (18.5 vs. 18.0). Black race (39% vs. 30%) and Hispanic ethnicity (39% vs. 30%) were both associated with younger age (</=50 years) at diagnosis. The use and type of adjuvant chemotherapy and endocrine therapy, and duration of endocrine therapy, were similar in black (vs. white) and Hispanic (vs. non-Hispanic) populations. In proportional hazards models, black race (compared with white race) was associated with worse clinical outcomes in the entire population and in those with a RS 11-25 (see table). Hispanic ethnicity was generally associated with better outcomes (compared with non-Hispanic ethnicity). For the cohort with a RS of 11-25, there was no evidence for chemotherapy benefit for any racial or ethnic group.
Race (black vs.white) and clinical outcomes in proportional hazards modelsClinical endpointEntire Population (N=693 black) Hazard ratio for eventRS 11-25 (N=471 black) Hazard ratio for eveniDFS1.33 (p=0.005)1.49 (p=0.001)DRFI1.21 (p=0.28)1.60 (p=0.02)RFI1.39 (p=0.02)1.80 (p<0.001)OS1.52 (p=0.005)1.67 (p=0.003
Conclusions: In patients eligible and selected for participation in TAILORx, black women had worse clinical outcomes despite similar 21-gene assay RS results and comparable systemic therapy. This adds to an emerging body of evidence suggesting a biologic basis or other factors contributing to racial disparities in HR-positive breast cancer that requires further evaluation.
Citation Format: Albain K, Gray RJ, Sparano JA, Makower DF, Pritchard KI, Hayes DF, Geyer, Jr. CE, Dees EC, Goetz MP, Olson, Jr. JA, Lively T, Badve SS, Saphner TJ, Wagner LI, Whelan TJ, Ellis MJ, Paik S, Wood WC, Ravdin PM, Keane MM, Gomez HL, Reddy PS, Goggins TF, Mayer IA, Brufsky AM, Toppmeyer DL, Kaklamani VG, Berenberg JL, Abrams J, Sledge, Jr. GW. Race, ethnicity and clinical outcomes in hormone receptor-positive, HER2-negative, node-negative breast cancer: results from the TAILORx trial [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr GS4-07.
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Affiliation(s)
- K Albain
- Loyola University Chicago Stritch School of Medicine, Maywood, IL; Dana Farber Cancer Institute, Boston, MA; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Sunnybrook Research Institute, Toronto, Canada; University of Michigan, Ann Arbor, MI; Virginia Commonwealth University School of Medicine and the Massey Cancer Center, Richmond, VA; University of North Carolina, Chapel Hill, NC; Mayo Clinic, Rochester, MN; University of Maryland School of Medicine, Baltimore, MD; National Institutes of Health, National Cancer Institute, Bethesda, MD; Indiana University School of Medicine, Indianapolis, IN; Vince Lombardi Cancer Clinic, Two Rivers, WI; Wake Forest University Health Service, Winston Salem, NC; McMaster University, Hamilton, Canada; Baylor College of Medicine, Houston, TX; Yonsei University College of Medicine, Seoul, South Korea; Emory University, Atlanta, GA; , San Antonio, TX; Cancer Trials Ireland, Dublin, Ireland; Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; C
| | - RJ Gray
- Loyola University Chicago Stritch School of Medicine, Maywood, IL; Dana Farber Cancer Institute, Boston, MA; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Sunnybrook Research Institute, Toronto, Canada; University of Michigan, Ann Arbor, MI; Virginia Commonwealth University School of Medicine and the Massey Cancer Center, Richmond, VA; University of North Carolina, Chapel Hill, NC; Mayo Clinic, Rochester, MN; University of Maryland School of Medicine, Baltimore, MD; National Institutes of Health, National Cancer Institute, Bethesda, MD; Indiana University School of Medicine, Indianapolis, IN; Vince Lombardi Cancer Clinic, Two Rivers, WI; Wake Forest University Health Service, Winston Salem, NC; McMaster University, Hamilton, Canada; Baylor College of Medicine, Houston, TX; Yonsei University College of Medicine, Seoul, South Korea; Emory University, Atlanta, GA; , San Antonio, TX; Cancer Trials Ireland, Dublin, Ireland; Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; C
| | - JA Sparano
- Loyola University Chicago Stritch School of Medicine, Maywood, IL; Dana Farber Cancer Institute, Boston, MA; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Sunnybrook Research Institute, Toronto, Canada; University of Michigan, Ann Arbor, MI; Virginia Commonwealth University School of Medicine and the Massey Cancer Center, Richmond, VA; University of North Carolina, Chapel Hill, NC; Mayo Clinic, Rochester, MN; University of Maryland School of Medicine, Baltimore, MD; National Institutes of Health, National Cancer Institute, Bethesda, MD; Indiana University School of Medicine, Indianapolis, IN; Vince Lombardi Cancer Clinic, Two Rivers, WI; Wake Forest University Health Service, Winston Salem, NC; McMaster University, Hamilton, Canada; Baylor College of Medicine, Houston, TX; Yonsei University College of Medicine, Seoul, South Korea; Emory University, Atlanta, GA; , San Antonio, TX; Cancer Trials Ireland, Dublin, Ireland; Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; C
| | - DF Makower
- Loyola University Chicago Stritch School of Medicine, Maywood, IL; Dana Farber Cancer Institute, Boston, MA; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Sunnybrook Research Institute, Toronto, Canada; University of Michigan, Ann Arbor, MI; Virginia Commonwealth University School of Medicine and the Massey Cancer Center, Richmond, VA; University of North Carolina, Chapel Hill, NC; Mayo Clinic, Rochester, MN; University of Maryland School of Medicine, Baltimore, MD; National Institutes of Health, National Cancer Institute, Bethesda, MD; Indiana University School of Medicine, Indianapolis, IN; Vince Lombardi Cancer Clinic, Two Rivers, WI; Wake Forest University Health Service, Winston Salem, NC; McMaster University, Hamilton, Canada; Baylor College of Medicine, Houston, TX; Yonsei University College of Medicine, Seoul, South Korea; Emory University, Atlanta, GA; , San Antonio, TX; Cancer Trials Ireland, Dublin, Ireland; Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; C
| | - KI Pritchard
- Loyola University Chicago Stritch School of Medicine, Maywood, IL; Dana Farber Cancer Institute, Boston, MA; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Sunnybrook Research Institute, Toronto, Canada; University of Michigan, Ann Arbor, MI; Virginia Commonwealth University School of Medicine and the Massey Cancer Center, Richmond, VA; University of North Carolina, Chapel Hill, NC; Mayo Clinic, Rochester, MN; University of Maryland School of Medicine, Baltimore, MD; National Institutes of Health, National Cancer Institute, Bethesda, MD; Indiana University School of Medicine, Indianapolis, IN; Vince Lombardi Cancer Clinic, Two Rivers, WI; Wake Forest University Health Service, Winston Salem, NC; McMaster University, Hamilton, Canada; Baylor College of Medicine, Houston, TX; Yonsei University College of Medicine, Seoul, South Korea; Emory University, Atlanta, GA; , San Antonio, TX; Cancer Trials Ireland, Dublin, Ireland; Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; C
| | - DF Hayes
- Loyola University Chicago Stritch School of Medicine, Maywood, IL; Dana Farber Cancer Institute, Boston, MA; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Sunnybrook Research Institute, Toronto, Canada; University of Michigan, Ann Arbor, MI; Virginia Commonwealth University School of Medicine and the Massey Cancer Center, Richmond, VA; University of North Carolina, Chapel Hill, NC; Mayo Clinic, Rochester, MN; University of Maryland School of Medicine, Baltimore, MD; National Institutes of Health, National Cancer Institute, Bethesda, MD; Indiana University School of Medicine, Indianapolis, IN; Vince Lombardi Cancer Clinic, Two Rivers, WI; Wake Forest University Health Service, Winston Salem, NC; McMaster University, Hamilton, Canada; Baylor College of Medicine, Houston, TX; Yonsei University College of Medicine, Seoul, South Korea; Emory University, Atlanta, GA; , San Antonio, TX; Cancer Trials Ireland, Dublin, Ireland; Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; C
| | - CE Geyer
- Loyola University Chicago Stritch School of Medicine, Maywood, IL; Dana Farber Cancer Institute, Boston, MA; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Sunnybrook Research Institute, Toronto, Canada; University of Michigan, Ann Arbor, MI; Virginia Commonwealth University School of Medicine and the Massey Cancer Center, Richmond, VA; University of North Carolina, Chapel Hill, NC; Mayo Clinic, Rochester, MN; University of Maryland School of Medicine, Baltimore, MD; National Institutes of Health, National Cancer Institute, Bethesda, MD; Indiana University School of Medicine, Indianapolis, IN; Vince Lombardi Cancer Clinic, Two Rivers, WI; Wake Forest University Health Service, Winston Salem, NC; McMaster University, Hamilton, Canada; Baylor College of Medicine, Houston, TX; Yonsei University College of Medicine, Seoul, South Korea; Emory University, Atlanta, GA; , San Antonio, TX; Cancer Trials Ireland, Dublin, Ireland; Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; C
| | - EC Dees
- Loyola University Chicago Stritch School of Medicine, Maywood, IL; Dana Farber Cancer Institute, Boston, MA; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Sunnybrook Research Institute, Toronto, Canada; University of Michigan, Ann Arbor, MI; Virginia Commonwealth University School of Medicine and the Massey Cancer Center, Richmond, VA; University of North Carolina, Chapel Hill, NC; Mayo Clinic, Rochester, MN; University of Maryland School of Medicine, Baltimore, MD; National Institutes of Health, National Cancer Institute, Bethesda, MD; Indiana University School of Medicine, Indianapolis, IN; Vince Lombardi Cancer Clinic, Two Rivers, WI; Wake Forest University Health Service, Winston Salem, NC; McMaster University, Hamilton, Canada; Baylor College of Medicine, Houston, TX; Yonsei University College of Medicine, Seoul, South Korea; Emory University, Atlanta, GA; , San Antonio, TX; Cancer Trials Ireland, Dublin, Ireland; Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; C
| | - MP Goetz
- Loyola University Chicago Stritch School of Medicine, Maywood, IL; Dana Farber Cancer Institute, Boston, MA; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Sunnybrook Research Institute, Toronto, Canada; University of Michigan, Ann Arbor, MI; Virginia Commonwealth University School of Medicine and the Massey Cancer Center, Richmond, VA; University of North Carolina, Chapel Hill, NC; Mayo Clinic, Rochester, MN; University of Maryland School of Medicine, Baltimore, MD; National Institutes of Health, National Cancer Institute, Bethesda, MD; Indiana University School of Medicine, Indianapolis, IN; Vince Lombardi Cancer Clinic, Two Rivers, WI; Wake Forest University Health Service, Winston Salem, NC; McMaster University, Hamilton, Canada; Baylor College of Medicine, Houston, TX; Yonsei University College of Medicine, Seoul, South Korea; Emory University, Atlanta, GA; , San Antonio, TX; Cancer Trials Ireland, Dublin, Ireland; Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; C
| | - JA Olson
- Loyola University Chicago Stritch School of Medicine, Maywood, IL; Dana Farber Cancer Institute, Boston, MA; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Sunnybrook Research Institute, Toronto, Canada; University of Michigan, Ann Arbor, MI; Virginia Commonwealth University School of Medicine and the Massey Cancer Center, Richmond, VA; University of North Carolina, Chapel Hill, NC; Mayo Clinic, Rochester, MN; University of Maryland School of Medicine, Baltimore, MD; National Institutes of Health, National Cancer Institute, Bethesda, MD; Indiana University School of Medicine, Indianapolis, IN; Vince Lombardi Cancer Clinic, Two Rivers, WI; Wake Forest University Health Service, Winston Salem, NC; McMaster University, Hamilton, Canada; Baylor College of Medicine, Houston, TX; Yonsei University College of Medicine, Seoul, South Korea; Emory University, Atlanta, GA; , San Antonio, TX; Cancer Trials Ireland, Dublin, Ireland; Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; C
| | - T Lively
- Loyola University Chicago Stritch School of Medicine, Maywood, IL; Dana Farber Cancer Institute, Boston, MA; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Sunnybrook Research Institute, Toronto, Canada; University of Michigan, Ann Arbor, MI; Virginia Commonwealth University School of Medicine and the Massey Cancer Center, Richmond, VA; University of North Carolina, Chapel Hill, NC; Mayo Clinic, Rochester, MN; University of Maryland School of Medicine, Baltimore, MD; National Institutes of Health, National Cancer Institute, Bethesda, MD; Indiana University School of Medicine, Indianapolis, IN; Vince Lombardi Cancer Clinic, Two Rivers, WI; Wake Forest University Health Service, Winston Salem, NC; McMaster University, Hamilton, Canada; Baylor College of Medicine, Houston, TX; Yonsei University College of Medicine, Seoul, South Korea; Emory University, Atlanta, GA; , San Antonio, TX; Cancer Trials Ireland, Dublin, Ireland; Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; C
| | - SS Badve
- Loyola University Chicago Stritch School of Medicine, Maywood, IL; Dana Farber Cancer Institute, Boston, MA; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Sunnybrook Research Institute, Toronto, Canada; University of Michigan, Ann Arbor, MI; Virginia Commonwealth University School of Medicine and the Massey Cancer Center, Richmond, VA; University of North Carolina, Chapel Hill, NC; Mayo Clinic, Rochester, MN; University of Maryland School of Medicine, Baltimore, MD; National Institutes of Health, National Cancer Institute, Bethesda, MD; Indiana University School of Medicine, Indianapolis, IN; Vince Lombardi Cancer Clinic, Two Rivers, WI; Wake Forest University Health Service, Winston Salem, NC; McMaster University, Hamilton, Canada; Baylor College of Medicine, Houston, TX; Yonsei University College of Medicine, Seoul, South Korea; Emory University, Atlanta, GA; , San Antonio, TX; Cancer Trials Ireland, Dublin, Ireland; Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; C
| | - TJ Saphner
- Loyola University Chicago Stritch School of Medicine, Maywood, IL; Dana Farber Cancer Institute, Boston, MA; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Sunnybrook Research Institute, Toronto, Canada; University of Michigan, Ann Arbor, MI; Virginia Commonwealth University School of Medicine and the Massey Cancer Center, Richmond, VA; University of North Carolina, Chapel Hill, NC; Mayo Clinic, Rochester, MN; University of Maryland School of Medicine, Baltimore, MD; National Institutes of Health, National Cancer Institute, Bethesda, MD; Indiana University School of Medicine, Indianapolis, IN; Vince Lombardi Cancer Clinic, Two Rivers, WI; Wake Forest University Health Service, Winston Salem, NC; McMaster University, Hamilton, Canada; Baylor College of Medicine, Houston, TX; Yonsei University College of Medicine, Seoul, South Korea; Emory University, Atlanta, GA; , San Antonio, TX; Cancer Trials Ireland, Dublin, Ireland; Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; C
| | - LI Wagner
- Loyola University Chicago Stritch School of Medicine, Maywood, IL; Dana Farber Cancer Institute, Boston, MA; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Sunnybrook Research Institute, Toronto, Canada; University of Michigan, Ann Arbor, MI; Virginia Commonwealth University School of Medicine and the Massey Cancer Center, Richmond, VA; University of North Carolina, Chapel Hill, NC; Mayo Clinic, Rochester, MN; University of Maryland School of Medicine, Baltimore, MD; National Institutes of Health, National Cancer Institute, Bethesda, MD; Indiana University School of Medicine, Indianapolis, IN; Vince Lombardi Cancer Clinic, Two Rivers, WI; Wake Forest University Health Service, Winston Salem, NC; McMaster University, Hamilton, Canada; Baylor College of Medicine, Houston, TX; Yonsei University College of Medicine, Seoul, South Korea; Emory University, Atlanta, GA; , San Antonio, TX; Cancer Trials Ireland, Dublin, Ireland; Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; C
| | - TJ Whelan
- Loyola University Chicago Stritch School of Medicine, Maywood, IL; Dana Farber Cancer Institute, Boston, MA; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Sunnybrook Research Institute, Toronto, Canada; University of Michigan, Ann Arbor, MI; Virginia Commonwealth University School of Medicine and the Massey Cancer Center, Richmond, VA; University of North Carolina, Chapel Hill, NC; Mayo Clinic, Rochester, MN; University of Maryland School of Medicine, Baltimore, MD; National Institutes of Health, National Cancer Institute, Bethesda, MD; Indiana University School of Medicine, Indianapolis, IN; Vince Lombardi Cancer Clinic, Two Rivers, WI; Wake Forest University Health Service, Winston Salem, NC; McMaster University, Hamilton, Canada; Baylor College of Medicine, Houston, TX; Yonsei University College of Medicine, Seoul, South Korea; Emory University, Atlanta, GA; , San Antonio, TX; Cancer Trials Ireland, Dublin, Ireland; Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; C
| | - MJ Ellis
- Loyola University Chicago Stritch School of Medicine, Maywood, IL; Dana Farber Cancer Institute, Boston, MA; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Sunnybrook Research Institute, Toronto, Canada; University of Michigan, Ann Arbor, MI; Virginia Commonwealth University School of Medicine and the Massey Cancer Center, Richmond, VA; University of North Carolina, Chapel Hill, NC; Mayo Clinic, Rochester, MN; University of Maryland School of Medicine, Baltimore, MD; National Institutes of Health, National Cancer Institute, Bethesda, MD; Indiana University School of Medicine, Indianapolis, IN; Vince Lombardi Cancer Clinic, Two Rivers, WI; Wake Forest University Health Service, Winston Salem, NC; McMaster University, Hamilton, Canada; Baylor College of Medicine, Houston, TX; Yonsei University College of Medicine, Seoul, South Korea; Emory University, Atlanta, GA; , San Antonio, TX; Cancer Trials Ireland, Dublin, Ireland; Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; C
| | - S Paik
- Loyola University Chicago Stritch School of Medicine, Maywood, IL; Dana Farber Cancer Institute, Boston, MA; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Sunnybrook Research Institute, Toronto, Canada; University of Michigan, Ann Arbor, MI; Virginia Commonwealth University School of Medicine and the Massey Cancer Center, Richmond, VA; University of North Carolina, Chapel Hill, NC; Mayo Clinic, Rochester, MN; University of Maryland School of Medicine, Baltimore, MD; National Institutes of Health, National Cancer Institute, Bethesda, MD; Indiana University School of Medicine, Indianapolis, IN; Vince Lombardi Cancer Clinic, Two Rivers, WI; Wake Forest University Health Service, Winston Salem, NC; McMaster University, Hamilton, Canada; Baylor College of Medicine, Houston, TX; Yonsei University College of Medicine, Seoul, South Korea; Emory University, Atlanta, GA; , San Antonio, TX; Cancer Trials Ireland, Dublin, Ireland; Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; C
| | - WC Wood
- Loyola University Chicago Stritch School of Medicine, Maywood, IL; Dana Farber Cancer Institute, Boston, MA; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Sunnybrook Research Institute, Toronto, Canada; University of Michigan, Ann Arbor, MI; Virginia Commonwealth University School of Medicine and the Massey Cancer Center, Richmond, VA; University of North Carolina, Chapel Hill, NC; Mayo Clinic, Rochester, MN; University of Maryland School of Medicine, Baltimore, MD; National Institutes of Health, National Cancer Institute, Bethesda, MD; Indiana University School of Medicine, Indianapolis, IN; Vince Lombardi Cancer Clinic, Two Rivers, WI; Wake Forest University Health Service, Winston Salem, NC; McMaster University, Hamilton, Canada; Baylor College of Medicine, Houston, TX; Yonsei University College of Medicine, Seoul, South Korea; Emory University, Atlanta, GA; , San Antonio, TX; Cancer Trials Ireland, Dublin, Ireland; Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; C
| | - PM Ravdin
- Loyola University Chicago Stritch School of Medicine, Maywood, IL; Dana Farber Cancer Institute, Boston, MA; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Sunnybrook Research Institute, Toronto, Canada; University of Michigan, Ann Arbor, MI; Virginia Commonwealth University School of Medicine and the Massey Cancer Center, Richmond, VA; University of North Carolina, Chapel Hill, NC; Mayo Clinic, Rochester, MN; University of Maryland School of Medicine, Baltimore, MD; National Institutes of Health, National Cancer Institute, Bethesda, MD; Indiana University School of Medicine, Indianapolis, IN; Vince Lombardi Cancer Clinic, Two Rivers, WI; Wake Forest University Health Service, Winston Salem, NC; McMaster University, Hamilton, Canada; Baylor College of Medicine, Houston, TX; Yonsei University College of Medicine, Seoul, South Korea; Emory University, Atlanta, GA; , San Antonio, TX; Cancer Trials Ireland, Dublin, Ireland; Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; C
| | - MM Keane
- Loyola University Chicago Stritch School of Medicine, Maywood, IL; Dana Farber Cancer Institute, Boston, MA; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Sunnybrook Research Institute, Toronto, Canada; University of Michigan, Ann Arbor, MI; Virginia Commonwealth University School of Medicine and the Massey Cancer Center, Richmond, VA; University of North Carolina, Chapel Hill, NC; Mayo Clinic, Rochester, MN; University of Maryland School of Medicine, Baltimore, MD; National Institutes of Health, National Cancer Institute, Bethesda, MD; Indiana University School of Medicine, Indianapolis, IN; Vince Lombardi Cancer Clinic, Two Rivers, WI; Wake Forest University Health Service, Winston Salem, NC; McMaster University, Hamilton, Canada; Baylor College of Medicine, Houston, TX; Yonsei University College of Medicine, Seoul, South Korea; Emory University, Atlanta, GA; , San Antonio, TX; Cancer Trials Ireland, Dublin, Ireland; Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; C
| | - HL Gomez
- Loyola University Chicago Stritch School of Medicine, Maywood, IL; Dana Farber Cancer Institute, Boston, MA; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Sunnybrook Research Institute, Toronto, Canada; University of Michigan, Ann Arbor, MI; Virginia Commonwealth University School of Medicine and the Massey Cancer Center, Richmond, VA; University of North Carolina, Chapel Hill, NC; Mayo Clinic, Rochester, MN; University of Maryland School of Medicine, Baltimore, MD; National Institutes of Health, National Cancer Institute, Bethesda, MD; Indiana University School of Medicine, Indianapolis, IN; Vince Lombardi Cancer Clinic, Two Rivers, WI; Wake Forest University Health Service, Winston Salem, NC; McMaster University, Hamilton, Canada; Baylor College of Medicine, Houston, TX; Yonsei University College of Medicine, Seoul, South Korea; Emory University, Atlanta, GA; , San Antonio, TX; Cancer Trials Ireland, Dublin, Ireland; Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; C
| | - PS Reddy
- Loyola University Chicago Stritch School of Medicine, Maywood, IL; Dana Farber Cancer Institute, Boston, MA; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Sunnybrook Research Institute, Toronto, Canada; University of Michigan, Ann Arbor, MI; Virginia Commonwealth University School of Medicine and the Massey Cancer Center, Richmond, VA; University of North Carolina, Chapel Hill, NC; Mayo Clinic, Rochester, MN; University of Maryland School of Medicine, Baltimore, MD; National Institutes of Health, National Cancer Institute, Bethesda, MD; Indiana University School of Medicine, Indianapolis, IN; Vince Lombardi Cancer Clinic, Two Rivers, WI; Wake Forest University Health Service, Winston Salem, NC; McMaster University, Hamilton, Canada; Baylor College of Medicine, Houston, TX; Yonsei University College of Medicine, Seoul, South Korea; Emory University, Atlanta, GA; , San Antonio, TX; Cancer Trials Ireland, Dublin, Ireland; Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; C
| | - TF Goggins
- Loyola University Chicago Stritch School of Medicine, Maywood, IL; Dana Farber Cancer Institute, Boston, MA; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Sunnybrook Research Institute, Toronto, Canada; University of Michigan, Ann Arbor, MI; Virginia Commonwealth University School of Medicine and the Massey Cancer Center, Richmond, VA; University of North Carolina, Chapel Hill, NC; Mayo Clinic, Rochester, MN; University of Maryland School of Medicine, Baltimore, MD; National Institutes of Health, National Cancer Institute, Bethesda, MD; Indiana University School of Medicine, Indianapolis, IN; Vince Lombardi Cancer Clinic, Two Rivers, WI; Wake Forest University Health Service, Winston Salem, NC; McMaster University, Hamilton, Canada; Baylor College of Medicine, Houston, TX; Yonsei University College of Medicine, Seoul, South Korea; Emory University, Atlanta, GA; , San Antonio, TX; Cancer Trials Ireland, Dublin, Ireland; Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; C
| | - IA Mayer
- Loyola University Chicago Stritch School of Medicine, Maywood, IL; Dana Farber Cancer Institute, Boston, MA; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Sunnybrook Research Institute, Toronto, Canada; University of Michigan, Ann Arbor, MI; Virginia Commonwealth University School of Medicine and the Massey Cancer Center, Richmond, VA; University of North Carolina, Chapel Hill, NC; Mayo Clinic, Rochester, MN; University of Maryland School of Medicine, Baltimore, MD; National Institutes of Health, National Cancer Institute, Bethesda, MD; Indiana University School of Medicine, Indianapolis, IN; Vince Lombardi Cancer Clinic, Two Rivers, WI; Wake Forest University Health Service, Winston Salem, NC; McMaster University, Hamilton, Canada; Baylor College of Medicine, Houston, TX; Yonsei University College of Medicine, Seoul, South Korea; Emory University, Atlanta, GA; , San Antonio, TX; Cancer Trials Ireland, Dublin, Ireland; Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; C
| | - AM Brufsky
- Loyola University Chicago Stritch School of Medicine, Maywood, IL; Dana Farber Cancer Institute, Boston, MA; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Sunnybrook Research Institute, Toronto, Canada; University of Michigan, Ann Arbor, MI; Virginia Commonwealth University School of Medicine and the Massey Cancer Center, Richmond, VA; University of North Carolina, Chapel Hill, NC; Mayo Clinic, Rochester, MN; University of Maryland School of Medicine, Baltimore, MD; National Institutes of Health, National Cancer Institute, Bethesda, MD; Indiana University School of Medicine, Indianapolis, IN; Vince Lombardi Cancer Clinic, Two Rivers, WI; Wake Forest University Health Service, Winston Salem, NC; McMaster University, Hamilton, Canada; Baylor College of Medicine, Houston, TX; Yonsei University College of Medicine, Seoul, South Korea; Emory University, Atlanta, GA; , San Antonio, TX; Cancer Trials Ireland, Dublin, Ireland; Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; C
| | - DL Toppmeyer
- Loyola University Chicago Stritch School of Medicine, Maywood, IL; Dana Farber Cancer Institute, Boston, MA; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Sunnybrook Research Institute, Toronto, Canada; University of Michigan, Ann Arbor, MI; Virginia Commonwealth University School of Medicine and the Massey Cancer Center, Richmond, VA; University of North Carolina, Chapel Hill, NC; Mayo Clinic, Rochester, MN; University of Maryland School of Medicine, Baltimore, MD; National Institutes of Health, National Cancer Institute, Bethesda, MD; Indiana University School of Medicine, Indianapolis, IN; Vince Lombardi Cancer Clinic, Two Rivers, WI; Wake Forest University Health Service, Winston Salem, NC; McMaster University, Hamilton, Canada; Baylor College of Medicine, Houston, TX; Yonsei University College of Medicine, Seoul, South Korea; Emory University, Atlanta, GA; , San Antonio, TX; Cancer Trials Ireland, Dublin, Ireland; Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; C
| | - VG Kaklamani
- Loyola University Chicago Stritch School of Medicine, Maywood, IL; Dana Farber Cancer Institute, Boston, MA; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Sunnybrook Research Institute, Toronto, Canada; University of Michigan, Ann Arbor, MI; Virginia Commonwealth University School of Medicine and the Massey Cancer Center, Richmond, VA; University of North Carolina, Chapel Hill, NC; Mayo Clinic, Rochester, MN; University of Maryland School of Medicine, Baltimore, MD; National Institutes of Health, National Cancer Institute, Bethesda, MD; Indiana University School of Medicine, Indianapolis, IN; Vince Lombardi Cancer Clinic, Two Rivers, WI; Wake Forest University Health Service, Winston Salem, NC; McMaster University, Hamilton, Canada; Baylor College of Medicine, Houston, TX; Yonsei University College of Medicine, Seoul, South Korea; Emory University, Atlanta, GA; , San Antonio, TX; Cancer Trials Ireland, Dublin, Ireland; Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; C
| | - JL Berenberg
- Loyola University Chicago Stritch School of Medicine, Maywood, IL; Dana Farber Cancer Institute, Boston, MA; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Sunnybrook Research Institute, Toronto, Canada; University of Michigan, Ann Arbor, MI; Virginia Commonwealth University School of Medicine and the Massey Cancer Center, Richmond, VA; University of North Carolina, Chapel Hill, NC; Mayo Clinic, Rochester, MN; University of Maryland School of Medicine, Baltimore, MD; National Institutes of Health, National Cancer Institute, Bethesda, MD; Indiana University School of Medicine, Indianapolis, IN; Vince Lombardi Cancer Clinic, Two Rivers, WI; Wake Forest University Health Service, Winston Salem, NC; McMaster University, Hamilton, Canada; Baylor College of Medicine, Houston, TX; Yonsei University College of Medicine, Seoul, South Korea; Emory University, Atlanta, GA; , San Antonio, TX; Cancer Trials Ireland, Dublin, Ireland; Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; C
| | - J Abrams
- Loyola University Chicago Stritch School of Medicine, Maywood, IL; Dana Farber Cancer Institute, Boston, MA; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Sunnybrook Research Institute, Toronto, Canada; University of Michigan, Ann Arbor, MI; Virginia Commonwealth University School of Medicine and the Massey Cancer Center, Richmond, VA; University of North Carolina, Chapel Hill, NC; Mayo Clinic, Rochester, MN; University of Maryland School of Medicine, Baltimore, MD; National Institutes of Health, National Cancer Institute, Bethesda, MD; Indiana University School of Medicine, Indianapolis, IN; Vince Lombardi Cancer Clinic, Two Rivers, WI; Wake Forest University Health Service, Winston Salem, NC; McMaster University, Hamilton, Canada; Baylor College of Medicine, Houston, TX; Yonsei University College of Medicine, Seoul, South Korea; Emory University, Atlanta, GA; , San Antonio, TX; Cancer Trials Ireland, Dublin, Ireland; Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; C
| | - GW Sledge
- Loyola University Chicago Stritch School of Medicine, Maywood, IL; Dana Farber Cancer Institute, Boston, MA; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Sunnybrook Research Institute, Toronto, Canada; University of Michigan, Ann Arbor, MI; Virginia Commonwealth University School of Medicine and the Massey Cancer Center, Richmond, VA; University of North Carolina, Chapel Hill, NC; Mayo Clinic, Rochester, MN; University of Maryland School of Medicine, Baltimore, MD; National Institutes of Health, National Cancer Institute, Bethesda, MD; Indiana University School of Medicine, Indianapolis, IN; Vince Lombardi Cancer Clinic, Two Rivers, WI; Wake Forest University Health Service, Winston Salem, NC; McMaster University, Hamilton, Canada; Baylor College of Medicine, Houston, TX; Yonsei University College of Medicine, Seoul, South Korea; Emory University, Atlanta, GA; , San Antonio, TX; Cancer Trials Ireland, Dublin, Ireland; Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; C
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Dubsky P, Curigliano G, Burstein HJ, Winer EP, Gnant M, Loibl S, Colleoni M, Regan MM, Piccart-Gebhart M, Senn HJ, Thürlimann B, André F, Baselga J, Bergh J, Bonnefoi H, Brucker SY, Cardoso F, Carey L, Ciruelos E, Cuzick J, Denkert C, Di Leo A, Ejlertsen B, Francis P, Galimberti V, Garber J, Gulluoglu B, Goodwin P, Harbeck N, Hayes DF, Huang CS, Huober J, Khaled H, Jassem J, Jiang Z, Karlsson P, Morrow M, Orecchia R, Osborne KC, Pagani O, Partridge AH, Pritchard K, Ro J, Rutgers EJT, Sedlmayer F, Semiglazov V, Shao Z, Smith I, Toi M, Tutt A, Viale G, Watanabe T, Whelan TJ, Xu B. Reply to 'The St Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2017: the point of view of an International Panel of Experts in Radiation Oncology' by Kirova et al. Ann Oncol 2018; 29:281-282. [PMID: 29045519 DOI: 10.1093/annonc/mdx543] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Affiliation(s)
- P Dubsky
- Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria.,Klinik St. Anna, Luzern, Switzerland
| | - G Curigliano
- Breast Cancer Program, Istituto Europeo di Oncologia, Milan, Italy
| | - H J Burstein
- Breast Oncology Center, Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA
| | - E P Winer
- Breast Oncology Center, Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA
| | - M Gnant
- Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria
| | - S Loibl
- German Breast Group, Neu-Isenburg, Germany
| | - M Colleoni
- Breast Cancer Program, Istituto Europeo di Oncologia, Milan, Italy
| | - M M Regan
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA
| | | | - H-J Senn
- Tumor and Breast Center ZeTuP, St Gallen, Switzerland
| | - B Thürlimann
- Breast Center, Kantonsspital St. Gallen, St Gallen, Switzerland
| | | | - F André
- Institut de Cancérologie Gustave Roussy, Villejuif, France
| | - J Baselga
- Memorial Sloan Kettering Cancer Center, New York, USA
| | - J Bergh
- Karolinska Institute and University Hospital, Stockholm, Sweden
| | - H Bonnefoi
- University of Bordeaux, Bordeaux, France
| | - S Y Brucker
- Universitäts-Frauenklinik Tübingen, Tübingen, Germany
| | - F Cardoso
- Champalimaud Cancer Centre, Lisbon, Portugal
| | - L Carey
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, USA
| | - E Ciruelos
- Hospital Universitario 12 de Octubre, Madrid, Spain
| | - J Cuzick
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - C Denkert
- Institut für Pathologie, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - A Di Leo
- Azienda Usl Toscana Centro, Prato, Italy
| | | | - P Francis
- Peter McCallum Cancer Centre, Melbourne, Australia
| | - V Galimberti
- Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria
| | - J Garber
- Klinik St. Anna, Luzern, Switzerland
| | - B Gulluoglu
- Marmara University School of Medicine, Istanbul, Turkey
| | - P Goodwin
- University of Toronto, Mount Sinai Hospital, Toronto, Canada
| | - N Harbeck
- University of Munich, München, Germany
| | - D F Hayes
- Comprehensive Cancer Center, University of Michigan, Ann-Arbor, USA
| | - C-S Huang
- National Taiwan University Hospital, Taipei, Taiwan
| | | | - H Khaled
- The National Cancer Institute, Cairo University, Cairo, Egypt
| | - J Jassem
- Medical University of Gdansk, Gdansk, Poland
| | - Z Jiang
- Hospital Affiliated to Military Medical Science, Beijing, China
| | - P Karlsson
- Institute of Clinical Sciences, Sahlgrenska Academy, Sahlgrensky University Hospital, Gothenburg, Sweden
| | - M Morrow
- Memorial Sloan Kettering Cancer Center, New York, USA
| | - R Orecchia
- Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria
| | | | - O Pagani
- Institute of Oncology Southern Switzerland, Ospedale San Giovanni, Bellinzona, Switzerland
| | | | - K Pritchard
- University of Toronto, Sunnybrook Odette Cancer Center, Toronto, Canada
| | - J Ro
- National Cancer Center, Ilsandong-gu, Goyang-si, Gyeonggi-do, Korea
| | - E J T Rutgers
- Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - F Sedlmayer
- LKH Salzburg, Paracelsus Medical University Clinics, Salzburg, Austria
| | - V Semiglazov
- N.N.Petrov Research Institute of Oncology, St. Petersburg, Russian Federation
| | - Z Shao
- Fudan University Cancer Hospital, Shanghai, China
| | - I Smith
- The Royal Marsden, Sutton, Surrey, UK
| | - M Toi
- Graduate School of Medicine Kyoto University, Sakyo-ku Kyoto City, Japan
| | - A Tutt
- Breast Cancer Now Research Centre, The Institute of Cancer Research, London, UK
| | - G Viale
- University of Milan, Milan, Italy.,Istituto Europeo di Oncologia, Milan, Italy
| | - T Watanabe
- Hamamatsu Oncology Center, Hamamatsu, Japan
| | | | - B Xu
- National Cancer Center, Chaoyang District, Beijing, China
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Curigliano G, Burstein HJ, Winer EP, Gnant M, Dubsky P, Loibl S, Colleoni M, Regan MM, Piccart-Gebhart M, Senn HJ, Thürlimann B, André F, Baselga J, Bergh J, Bonnefoi H, Brucker SY, Cardoso F, Carey L, Ciruelos E, Cuzick J, Denkert C, Di Leo A, Ejlertsen B, Francis P, Galimberti V, Garber J, Gulluoglu B, Goodwin P, Harbeck N, Hayes DF, Huang CS, Huober J, Khaled H, Jassem J, Jiang Z, Karlsson P, Morrow M, Orecchia R, Osborne KC, Pagani O, Partridge AH, Pritchard K, Ro J, Rutgers EJT, Sedlmayer F, Semiglazov V, Shao Z, Smith I, Toi M, Tutt A, Viale G, Watanabe T, Whelan TJ, Xu B. De-escalating and escalating treatments for early-stage breast cancer: the St. Gallen International Expert Consensus Conference on the Primary Therapy of Early Breast Cancer 2017. Ann Oncol 2018; 29:2153. [PMID: 29733336 DOI: 10.1093/annonc/mdx806] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Yerushalmi R, Dong B, Chapman JW, Goss PE, Pollak MN, Burnell MJ, Levine MN, Bramwell VHC, Pritchard KI, Whelan TJ, Ingle JN, Shepherd LE, Parulekar WR, Han L, Ding K, Gelmon KA. Impact of baseline BMI and weight change in CCTG adjuvant breast cancer trials. Ann Oncol 2018; 28:1560-1568. [PMID: 28379421 DOI: 10.1093/annonc/mdx152] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Indexed: 12/12/2022] Open
Abstract
Background We hypothesized that increased baseline BMI and BMI change would negatively impact clinical outcomes with adjuvant breast cancer systemic therapy. Methods Data from chemotherapy trials MA.5 and MA.21; endocrine therapy MA.12, MA.14 and MA.27; and trastuzumab HERA/MA.24 were analyzed. The primary objective was to examine the effect of BMI change on breast cancer-free interval (BCFI) landmarked at 5 years; secondary objectives included BMI changes at 1 and 3 years; BMI changes on disease-specific survival (DSS) and overall survival (OS); and effects of baseline BMI. Stratified analyses included trial therapy and composite trial stratification factors. Results In pre-/peri-/early post-menopausal chemotherapy trials (N = 2793), baseline BMI did not impact any endpoint and increased BMI from baseline did not significantly affect BCFI (P = 0.85) after 5 years although it was associated with worse BCFI (P = 0.03) and DSS (P = 0.07) after 1 year. BMI increase by 3 and 5 years was associated with better DSS (P = 0.01; 0.01) and OS (P = 0.003; 0.05). In pre-menopausal endocrine therapy trial MA.12 (N = 672), patients with higher baseline BMI had worse BCFI (P = 0.02) after 1 year, worse DSS (P = 0.05; 0.004) after 1 and 5 years and worse OS (P = 0.01) after 5 years. Increased BMI did not impact BCFI (P = 0.90) after 5 years, although it was associated with worse BCFI (P = 0.01) after 1 year. In post-menopausal endocrine therapy trials MA.14 and MA.27 (N = 8236), baseline BMI did not significantly impact outcome for any endpoint. BMI change did not impact BCFI or DSS after 1 or 3 years, although a mean increased BMI of 0.3 was associated with better OS (P = 0.02) after 1 year. With the administration of trastuzumab (N = 1395) baseline BMI and BMI change did not significantly impact outcomes. Conclusions Higher baseline BMI and BMI increases negatively affected outcomes only in pre-/peri-/early post-menopausal trial patients. Otherwise, BMI increases similar to those expected in healthy women either did not impact outcome or were associated with better outcomes. Clinical Trials numbers CAN-NCIC-MA5; National Cancer Institute (NCI)-V90-0027; MA.12-NCT00002542; MA.14-NCT00002864; MA.21-NCT00014222; HERA, NCT00045032;CAN-NCIC-MA24; MA-27-NCT00066573.
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Affiliation(s)
- R Yerushalmi
- Department of Medical Oncology, Davidoff Cancer Center, Rabin Medical Center, Petah Tikva and Tel-Aviv University, Tel Aviv, Israel
| | - B Dong
- Canadian Cancer Trials Group (CCTG; Formerly, NCIC Clinical Trials Group), Queen's University, Kingston, Canada
| | - J W Chapman
- Canadian Cancer Trials Group (CCTG; Formerly, NCIC Clinical Trials Group), Queen's University, Kingston, Canada
| | - P E Goss
- Massachusetts General Hospital Cancer Center, Boston, USA
| | - M N Pollak
- Department of Medical Oncology, Jewish General Hospital, McGill University, Montreal
| | - M J Burnell
- Department of Medical Oncology, Saint John Regional Hospital, Saint John
| | - M N Levine
- Department of Oncology, McMaster University, Juravinski Cancer Center, Hamilton, Ontario
| | - V H C Bramwell
- Department of Medical Oncology, Tom Baker Cancer Centre, Alberta Health Services and University of Calgary, Calgary
| | - K I Pritchard
- Department of Medical Oncology, Sunnybrook Odette Cancer Centre and the University of Toronto, Toronto, Canada
| | - T J Whelan
- Department of Oncology, Juravinski Cancer Center, McMaster University, Hamilton, Ontario
| | - J N Ingle
- Department of Oncology, Mayo Clinic, Rochester, USA
| | - L E Shepherd
- Canadian Cancer Trials Group (CCTG; Formerly, NCIC Clinical Trials Group), Queen's University, Kingston, Canada
| | - W R Parulekar
- Canadian Cancer Trials Group (CCTG; Formerly, NCIC Clinical Trials Group), Queen's University, Kingston, Canada
| | - L Han
- Canadian Cancer Trials Group (CCTG; Formerly, NCIC Clinical Trials Group), Queen's University, Kingston, Canada
| | - K Ding
- Canadian Cancer Trials Group (CCTG; Formerly, NCIC Clinical Trials Group), Queen's University, Kingston, Canada
| | - K A Gelmon
- Department of Medical Oncology, British Columbia Cancer Agency, Vancouver, Canada
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7
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Curigliano G, Burstein HJ, Winer EP, Gnant M, Dubsky P, Loibl S, Colleoni M, Regan MM, Piccart-Gebhart M, Senn HJ, Thürlimann B, André F, Baselga J, Bergh J, Bonnefoi H, Brucker SY, Cardoso F, Carey L, Ciruelos E, Cuzick J, Denkert C, Di Leo A, Ejlertsen B, Francis P, Galimberti V, Garber J, Gulluoglu B, Goodwin P, Harbeck N, Hayes DF, Huang CS, Huober J, Khaled H, Jassem J, Jiang Z, Karlsson P, Morrow M, Orecchia R, Osborne KC, Pagani O, Partridge AH, Pritchard K, Ro J, Rutgers EJT, Sedlmayer F, Semiglazov V, Shao Z, Smith I, Toi M, Tutt A, Viale G, Watanabe T, Whelan TJ, Xu B. De-escalating and escalating treatments for early-stage breast cancer: the St. Gallen International Expert Consensus Conference on the Primary Therapy of Early Breast Cancer 2017. Ann Oncol 2017; 28:1700-1712. [PMID: 28838210 PMCID: PMC6246241 DOI: 10.1093/annonc/mdx308] [Citation(s) in RCA: 704] [Impact Index Per Article: 100.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
The 15th St. Gallen International Breast Cancer Conference 2017 in Vienna, Austria reviewed substantial new evidence on loco-regional and systemic therapies for early breast cancer. Treatments were assessed in light of their intensity, duration and side-effects, seeking where appropriate to escalate or de-escalate therapies based on likely benefits as predicted by tumor stage and tumor biology. The Panel favored several interventions that may reduce surgical morbidity, including acceptance of 2 mm margins for DCIS, the resection of residual cancer (but not baseline extent of cancer) in women undergoing neoadjuvant therapy, acceptance of sentinel node biopsy following neoadjuvant treatment of many patients, and the preference for neoadjuvant therapy in HER2 positive and triple-negative, stage II and III breast cancer. The Panel favored escalating radiation therapy with regional nodal irradiation in high-risk patients, while encouraging omission of boost in low-risk patients. The Panel endorsed gene expression signatures that permit avoidance of chemotherapy in many patients with ER positive breast cancer. For women with higher risk tumors, the Panel escalated recommendations for adjuvant endocrine treatment to include ovarian suppression in premenopausal women, and extended therapy for postmenopausal women. However, low-risk patients can avoid these treatments. Finally, the Panel recommended bisphosphonate use in postmenopausal women to prevent breast cancer recurrence. The Panel recognized that recommendations are not intended for all patients, but rather to address the clinical needs of the majority of common presentations. Individualization of adjuvant therapy means adjusting to the tumor characteristics, patient comorbidities and preferences, and managing constraints of treatment cost and access that may affect care in both the developed and developing world.
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Affiliation(s)
- G Curigliano
- Breast Cancer Program, Istituto Europeo di Oncologia, Milano, Italy
| | - H J Burstein
- Breast Oncology Center, Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA
| | - E P Winer
- Breast Oncology Center, Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA
| | - M Gnant
- Department of Surgery, Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria
| | - P Dubsky
- Department of Surgery, Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria
- Klinik St. Anna, Luzern, Switzerland
| | - S Loibl
- German Breast Group, Neu-Isenburg, Germany
| | - M Colleoni
- Breast Cancer Program, Istituto Europeo di Oncologia, Milano, Italy
| | - M M Regan
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA
| | - M Piccart-Gebhart
- Department of Medical Oncology, Institut Jules Bordet, UniversitÕ Libre de Bruxelles, Brussels, Belgium
| | - H-J Senn
- Tumor and Breast Center ZeTuP, St. Gallen
| | - B Thürlimann
- Breast Center, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - F André
- Institut de Cancérologie Gustave Roussy, Villejuif, France
| | - J Baselga
- Memorial Sloan Kettering Cancer Center, New York, USA
| | - J Bergh
- Karolinska Institute and University Hospital, Stockholm, Sweden
| | - H Bonnefoi
- University of Bordeaux, Bordeaux, France
| | - S Y Brucker
- Universitäts-Frauenklinik Tübingen, Tübingen, Germany
| | - F Cardoso
- Champalimaud Cancer Centre, Lisbon, Portugal
| | - L Carey
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, USA
| | - E Ciruelos
- Hospital Universitario 12 de Octubre, Madrid, Spain
| | - J Cuzick
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - C Denkert
- Institut für Pathologie, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - A Di Leo
- Azienda Usl Toscana Centro, Prato, Italy
| | | | - P Francis
- Peter McCallum Cancer Centre, Melbourne, Australia
| | - V Galimberti
- Breast Cancer Program, Istituto Europeo di Oncologia, Milano, Italy
| | - J Garber
- Breast Oncology Center, Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA
| | - B Gulluoglu
- Marmara University School of Medicine, Istanbul, Turkey
| | - P Goodwin
- University of Toronto, Mount Sinai Hospital, Toronto, Canada
| | - N Harbeck
- University of Munich, München, Germany
| | - D F Hayes
- Comprehensive Cancer Center, University of Michigan, Ann-Arbor, USA
| | - C-S Huang
- National Taiwan University Hospital, Taipei, Taiwan
| | | | - H Khaled
- The National Cancer Institute, Cairo University, Cairo, Egypt
| | - J Jassem
- Medical University of Gdansk, Gdansk, Poland
| | - Z Jiang
- Hospital Affiliated to Military Medical Science, Beijing, China
| | - P Karlsson
- Institute of Clinical Sciences, Sahlgrenska Academy, Sahlgrensky University Hospital, Gothenburg, Sweden
| | - M Morrow
- Memorial Sloan Kettering Cancer Center, New York, USA
| | - R Orecchia
- Breast Cancer Program, Istituto Europeo di Oncologia, Milano, Italy
| | | | - O Pagani
- Institute of Oncology Southern Switzerland, Ospedale San Giovanni, Bellinzona, Switzerland
| | - A H Partridge
- Breast Oncology Center, Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA
| | - K Pritchard
- Sunnybrook Odette Cancer Center, University of Toronto, Toronto, Canada
| | - J Ro
- National Cancer Center, Ilsandong-gu, Goyang-si, Gyeonggi-do, Korea
| | - E J T Rutgers
- Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - F Sedlmayer
- LKH Salzburg, Paracelsus Medical University Clinics, Salzburg, Austria
| | - V Semiglazov
- N.N. Petrov Research Institute of Oncology, St. Petersburg, Russian Federation
| | - Z Shao
- Fudan University Cancer Hospital, Shanghai, China
| | - I Smith
- The Royal Marsden, Sutton, Surrey, UK
| | - M Toi
- Graduate School of Medicine Kyoto University, Sakyo-ku, Kyoto City, Japan
| | - A Tutt
- Breast Cancer Now Research Centre, The Institute of Cancer Research, London, UK
| | - G Viale
- University of Milan, Milan, Italy
- Istituto Europeo di Oncologia, Milan, Italy
| | - T Watanabe
- Hamamatsu Oncology Center, Hamamatsu, Japan
| | | | - B Xu
- National Cancer Center, Chaoyang District, Beijing, China
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8
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Gillgrass AE, Pond GR, Levine MN, Whelan TJ, Hassell JA, Bane AL. Abstract P4-12-09: The immune response in triple negative breast cancer. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p4-12-09] [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: Triple Negative Breast Cancer (TNBC) is often associated with a poor prognosis. However TNBC is a heterogeneous group of tumors and while some patients have a poor prognosis others appear to do well long-term. There are currently no clinical or pathologic tumor features that distinguish poor from good outcome. Some TNBCs have infiltration with immune cells and the degree of this infiltration correlates with prognosis.
Objectives: 1) To comprehensively examine immune factors associated with outcome in a cohort of TNBC patients, and 2) to develop an immune gene signature that can stratify patients into low and high risk groups.
Methods: We profiled RNA from 22 TNBCs (10 who had experienced a recurrence) from our institutional cohort using the PanCancer Immune Profiling Panel from NanoString. This panel consists of an extensive list of 770 genes designed to evaluate the immune microenvironment of tumors. The genes fall into a number of functional categories including; 1. Genes that identify specific immune cells, 2. Cytokines that promote an effective immune response and others that are associated with immunosuppression, 3. Chemokines, which attract immune cells into the tumor, 4. Genes that assess both the activation and inhibition of immune cell function, 5. Genes that identify tumor specific antigens. Analysis was performed in the nSolver Advanced Analysis Program.
Results: Using unsupervised hierarchical clustering of genes that were highly differentially expressed, the tumors were classified into 3 immune groups with distinct clinical outcomes. Group 1 ('Immune Excluded'), consisted of tumors with the lowest levels of expression of the immune markers assessed, suggesting that these tumors have a low or absent immune infiltrate; 7 of 7 patients in this group recurred. Group 2 ('Immune Activated') contains tumors that had the highest levels of anti-tumoral immune cell genes and their activation markers. This we interpret to represent a tumor group with a robust anti-tumor immune response; 0 of the 6 patients in this group recurred. In comparison Group 3 ('Immune Low') had moderate to low levels of expression of the majority of immune genes assessed. This we interpret to represent a group of tumors with limited immune cells present; 3 of 9 patients in this group recurred. Lastly, when comparing scores for immune cells, patients that recurred had lower scores for cytotoxic cells, CD8 T cells, Th1 cells and B cells.
Conclusion: In this pilot study high expression of anti-tumoral immune genes correlated with good outcome, whereas lower/absent expression of these genes correlated with poor outcome. We are currently extending these findings to our entire cohort of 180 TNBC patients.
Citation Format: Gillgrass AE, Pond GR, Levine MN, Whelan TJ, Hassell JA, Bane AL. The immune response in triple negative breast cancer [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P4-12-09.
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Affiliation(s)
| | - GR Pond
- McMaster University, Hamilton, ON, Canada
| | - MN Levine
- McMaster University, Hamilton, ON, Canada
| | - TJ Whelan
- McMaster University, Hamilton, ON, Canada
| | - JA Hassell
- McMaster University, Hamilton, ON, Canada
| | - AL Bane
- McMaster University, Hamilton, ON, Canada
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9
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Bane AL, Whelan TJ, Pond GR, Parpia S, Gohla G, Fyles AW, Pignol JP, Pritchard KI, Chambers S, Levine MN. Tumor factors predictive of response to hypofractionated radiotherapy in a randomized trial following breast conserving therapy. Ann Oncol 2014; 25:992-8. [PMID: 24562444 DOI: 10.1093/annonc/mdu090] [Citation(s) in RCA: 81] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
PURPOSE To determine whether tumor grade, molecular subtype and hypoxia predict response to hypofractionated versus standard radiotherapy (RT) following breast-conserving surgery (BCS) for node-negative breast cancer in a randomized controlled trial (RCT). PATIENTS AND METHODS Formalin-fixed paraffin-embedded (FFPE) tumor blocks were available on 989 of 1234 patients enrolled in the Hypofractionation Whole Breast Irradiation (HWBI) Trial. A central pathology review and assessment of tumor grade using the Nottingham grading system was carried out. Tumors were classified by molecular subtype as luminal A, luminal B, HER2 enriched, basal-like or unclassified using a six-biomarker panel; ER, PR, HER-2, Ki67, CK5/6 and EGFR. Tumors were also classified as hypoxic based on the expression of HIF1α, CAIX or GLUT-1. The primary end point was local recurrence (LR). RESULTS Median follow-up was 12 years. In the multivariable Cox model, molecular subtype was the only factor predictive of LR, the 10-year cumulative incidence was 4.5% for luminal A and basal-like, 7.9% for luminal B and 16.9% for HER-2 enriched tumors (P < 0.01). Tumor grade, molecular subtype or hypoxia did not predict response to hypofractionation. CONCLUSIONS In women enrolled in the HWBI trial following BCS tumor molecular subtype predicted LR. However tumor grade, molecular subtype and hypoxia did not predict response to hypofractionation suggesting that patients with node-negative breast tumors of all grades and molecular subtypes may be safely treated with hypofractionated RT regimens.
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Affiliation(s)
- A L Bane
- Department of Pathology and Molecular Medicine
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10
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Hilton JF, Bouganim N, Dong B, Chapman JW, Arnaout A, O'Malley F, Gelmon KA, Yerushalmi R, Levine MN, Bramwell VHC, Whelan TJ, Pritchard KI, Shepherd LE, Clemons M. Do alternative methods of measuring tumor size, including consideration of multicentric/multifocal disease, enhance prognostic information beyond TNM staging in women with early stage breast cancer: an analysis of the NCIC CTG MA.5 and MA.12 clinical trials. Breast Cancer Res Treat 2013; 142:143-51. [PMID: 24113743 DOI: 10.1007/s10549-013-2714-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Accepted: 09/26/2013] [Indexed: 12/11/2022]
Abstract
The AJCC staging criteria consider tumor size to be the largest dimension of largest tumor. Some case series suggest using summation of all tumor dimensions in patients with multicentric/multifocal (MC/MF) disease. We used data from NCIC CTG MA.5 and MA.12 clinical trials to examine alternative methods of assessing tumor size on breast-cancer-free-interval (BCFI). The 710 MA.5 pre-/peri-menopausal node positive and 672 MA.12 pre-menopausal node-negative/-positive patients have 10-year median follow-up. All patients received adjuvant chemotherapy. Tumors were centrally reviewed for grade, hormone receptor, and HER2 status. Continuous pathologic tumor size was: (1) largest dimension of largest tumor (cm); (2) tumor area (cm(2)); (3) volume of tumor (cm(3)); (4) with MC/MF disease, summation of (1)-(3) for up to 3 foci. We examined univariate and multivariate effects of tumor size on BCFI utilizing (un)stratified Cox regression and the Wald test statistic. In univariate analysis, larger tumor dimension was significantly associated with worse BFCI in node positive patients: p < 0.0001 for MA.5; p = 0.01 for MA.12. In MA.5 multivariate analysis, larger summation of largest tumor dimensions was associated with worse BCFI (p = 0.0003), while larger single dimension was associated with worse BCFI (p = 0.02) for MA.12. Presence of MC/MF and other tumor size measurements were not associated (p > 0.05) with BFCI. While physicians could consider the largest diameter of the largest focus of disease or the sum of the largest diameters of all foci in their T-stage determination, it appears that the current method of T-staging offers equivalent determinations of prognosis.
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Affiliation(s)
- J F Hilton
- NCIC Clinical Trials Group, Queens University, Kingston, ON, Canada
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11
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Dong B, Chapman JAW, Yerushalmi R, Goss PE, Pollak MN, Burnell MJ, Bramwell VH, Levine MN, Pritchard KI, Whelan TJ, Ingle JN, Parulekar W, Shepherd LE, Gelmon KA. P5-14-01: Differences in Efficacy by Assessment Method: NCIC CTG Adjuvant Breast Cancer Trials MA.5, MA.12, MA.14, MA.21, MA.27 Meta-Analysis. Cancer Res 2011. [DOI: 10.1158/0008-5472.sabcs11-p5-14-01] [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
Background: Based on recent breast cancer literature, we hypothesized that there could be substantive differences in apparent efficacy estimates using a log-normal (LN) survival model rather than with standard Kaplan-Meier (K-M) or Cox model methods. While both Cox and LN survival analyses offer greater specification by individual patient characteristics, the LN model may more robustly estimate survival under model misspecification. Methods: We recently pooled data for 5 NCIC CTG primary breast cancer trials: MA.5, MA.12, MA.14, MA.21, and MA.27. The total patient count for patients who received at least 1 dose of trial therapy is 11,253. Compilation included definition of STEEP endpoints (C Hudis, JCO, 2008) and standardized factor categorizations. The primary endpoint is Breast Cancer Free Interval (BCFI) defined as the time from randomization until recurrence: first local invasive or DCIS; regional, or distant; contralateral invasive or DCIS; or death from breast cancer. We found substantive evidence of non-proportionality for 7 factors compiled for the meta-analyses. In this work, we fit multivariate Cox and LN models with these 7 factors, lymph node status and pathologic T status. We then compare BCFI efficacy estimates for patient and tumour characteristics at 1-, 3-, and 5-years obtained with K-M, Cox, and LN models. Results: There was evidence that the Cox assumption of proportional hazards was violated for 7 factors: age, menopausal status, hormone receptor status, anthracycline use, chemotherapy use, race, and ECOG performance status. Differences between models were intrinsically affected by timing and extent of non-proportionality; there was no consistent pattern. In particular, investigations to date indicate efficacy estimates with absolute differences between K-M, Cox and LN estimates which varied by time of assessment: at 1-year 0.0 to 6.7%, at 3-years 0.4 to 18.6%, and at 5-years 0.2 to 17.0%. BCFI estimates with the K-M were inconsistently closer to those with the LN or Cox model: for K-M to Cox at 1-year 0.4 to 5.2%, at 3-years 0.4 to 15%, at 5-years 0.4 to 14.3%; for K-M to LN at 1-year 0.0 to 6.7%, at 3-years 0.5 to 18.6%, at 5-years 0.2 to 17.0%; for Cox to LN at 1-year 0.8 to 1.8%, at 3-years 1.9 to 6.0%, at 5-years 0.6 to 5.7%. K-M and Cox models have step-wise adjustments at events for K-M and Cox, rather than smooth modeling with the LN. Discussion: Even with reasonably large population subgroups, there were substantive differences in apparent survival (0.0 to 18.6%) between K-M, Cox and LN model types. The magnitude of differences in survival estimates was large enough to be clinically relevant and warrant further consideration as we evaluate new therapies and prognostic/predictive factors. We will be statistically investigating framework robustness under differing levels of model misspecification.
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P5-14-01.
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Affiliation(s)
- B Dong
- 1NCIC Clinical Trials Group, Queen's University, Kingston, ON, Canada; Vancouver Cancer Centre-BCCA, Vancouver, BC, Canada; Harvard Medical School, Boston, MA; McGill University, Montreal, QC, Canada; Atlantic Health Sciences Corporation, Saint John, NB, Canada; Alberta Cancer Board, Calgary, AB, Canada; McMaster University, Hamilton, ON, Canada; University of Toronto, Toronto, ON, Canada; Mayo Clinic, Rochester, MN
| | - J-AW Chapman
- 1NCIC Clinical Trials Group, Queen's University, Kingston, ON, Canada; Vancouver Cancer Centre-BCCA, Vancouver, BC, Canada; Harvard Medical School, Boston, MA; McGill University, Montreal, QC, Canada; Atlantic Health Sciences Corporation, Saint John, NB, Canada; Alberta Cancer Board, Calgary, AB, Canada; McMaster University, Hamilton, ON, Canada; University of Toronto, Toronto, ON, Canada; Mayo Clinic, Rochester, MN
| | - R Yerushalmi
- 1NCIC Clinical Trials Group, Queen's University, Kingston, ON, Canada; Vancouver Cancer Centre-BCCA, Vancouver, BC, Canada; Harvard Medical School, Boston, MA; McGill University, Montreal, QC, Canada; Atlantic Health Sciences Corporation, Saint John, NB, Canada; Alberta Cancer Board, Calgary, AB, Canada; McMaster University, Hamilton, ON, Canada; University of Toronto, Toronto, ON, Canada; Mayo Clinic, Rochester, MN
| | - PE Goss
- 1NCIC Clinical Trials Group, Queen's University, Kingston, ON, Canada; Vancouver Cancer Centre-BCCA, Vancouver, BC, Canada; Harvard Medical School, Boston, MA; McGill University, Montreal, QC, Canada; Atlantic Health Sciences Corporation, Saint John, NB, Canada; Alberta Cancer Board, Calgary, AB, Canada; McMaster University, Hamilton, ON, Canada; University of Toronto, Toronto, ON, Canada; Mayo Clinic, Rochester, MN
| | - MN Pollak
- 1NCIC Clinical Trials Group, Queen's University, Kingston, ON, Canada; Vancouver Cancer Centre-BCCA, Vancouver, BC, Canada; Harvard Medical School, Boston, MA; McGill University, Montreal, QC, Canada; Atlantic Health Sciences Corporation, Saint John, NB, Canada; Alberta Cancer Board, Calgary, AB, Canada; McMaster University, Hamilton, ON, Canada; University of Toronto, Toronto, ON, Canada; Mayo Clinic, Rochester, MN
| | - MJ Burnell
- 1NCIC Clinical Trials Group, Queen's University, Kingston, ON, Canada; Vancouver Cancer Centre-BCCA, Vancouver, BC, Canada; Harvard Medical School, Boston, MA; McGill University, Montreal, QC, Canada; Atlantic Health Sciences Corporation, Saint John, NB, Canada; Alberta Cancer Board, Calgary, AB, Canada; McMaster University, Hamilton, ON, Canada; University of Toronto, Toronto, ON, Canada; Mayo Clinic, Rochester, MN
| | - VH Bramwell
- 1NCIC Clinical Trials Group, Queen's University, Kingston, ON, Canada; Vancouver Cancer Centre-BCCA, Vancouver, BC, Canada; Harvard Medical School, Boston, MA; McGill University, Montreal, QC, Canada; Atlantic Health Sciences Corporation, Saint John, NB, Canada; Alberta Cancer Board, Calgary, AB, Canada; McMaster University, Hamilton, ON, Canada; University of Toronto, Toronto, ON, Canada; Mayo Clinic, Rochester, MN
| | - MN Levine
- 1NCIC Clinical Trials Group, Queen's University, Kingston, ON, Canada; Vancouver Cancer Centre-BCCA, Vancouver, BC, Canada; Harvard Medical School, Boston, MA; McGill University, Montreal, QC, Canada; Atlantic Health Sciences Corporation, Saint John, NB, Canada; Alberta Cancer Board, Calgary, AB, Canada; McMaster University, Hamilton, ON, Canada; University of Toronto, Toronto, ON, Canada; Mayo Clinic, Rochester, MN
| | - KI Pritchard
- 1NCIC Clinical Trials Group, Queen's University, Kingston, ON, Canada; Vancouver Cancer Centre-BCCA, Vancouver, BC, Canada; Harvard Medical School, Boston, MA; McGill University, Montreal, QC, Canada; Atlantic Health Sciences Corporation, Saint John, NB, Canada; Alberta Cancer Board, Calgary, AB, Canada; McMaster University, Hamilton, ON, Canada; University of Toronto, Toronto, ON, Canada; Mayo Clinic, Rochester, MN
| | - TJ Whelan
- 1NCIC Clinical Trials Group, Queen's University, Kingston, ON, Canada; Vancouver Cancer Centre-BCCA, Vancouver, BC, Canada; Harvard Medical School, Boston, MA; McGill University, Montreal, QC, Canada; Atlantic Health Sciences Corporation, Saint John, NB, Canada; Alberta Cancer Board, Calgary, AB, Canada; McMaster University, Hamilton, ON, Canada; University of Toronto, Toronto, ON, Canada; Mayo Clinic, Rochester, MN
| | - JN Ingle
- 1NCIC Clinical Trials Group, Queen's University, Kingston, ON, Canada; Vancouver Cancer Centre-BCCA, Vancouver, BC, Canada; Harvard Medical School, Boston, MA; McGill University, Montreal, QC, Canada; Atlantic Health Sciences Corporation, Saint John, NB, Canada; Alberta Cancer Board, Calgary, AB, Canada; McMaster University, Hamilton, ON, Canada; University of Toronto, Toronto, ON, Canada; Mayo Clinic, Rochester, MN
| | - W Parulekar
- 1NCIC Clinical Trials Group, Queen's University, Kingston, ON, Canada; Vancouver Cancer Centre-BCCA, Vancouver, BC, Canada; Harvard Medical School, Boston, MA; McGill University, Montreal, QC, Canada; Atlantic Health Sciences Corporation, Saint John, NB, Canada; Alberta Cancer Board, Calgary, AB, Canada; McMaster University, Hamilton, ON, Canada; University of Toronto, Toronto, ON, Canada; Mayo Clinic, Rochester, MN
| | - LE Shepherd
- 1NCIC Clinical Trials Group, Queen's University, Kingston, ON, Canada; Vancouver Cancer Centre-BCCA, Vancouver, BC, Canada; Harvard Medical School, Boston, MA; McGill University, Montreal, QC, Canada; Atlantic Health Sciences Corporation, Saint John, NB, Canada; Alberta Cancer Board, Calgary, AB, Canada; McMaster University, Hamilton, ON, Canada; University of Toronto, Toronto, ON, Canada; Mayo Clinic, Rochester, MN
| | - KA Gelmon
- 1NCIC Clinical Trials Group, Queen's University, Kingston, ON, Canada; Vancouver Cancer Centre-BCCA, Vancouver, BC, Canada; Harvard Medical School, Boston, MA; McGill University, Montreal, QC, Canada; Atlantic Health Sciences Corporation, Saint John, NB, Canada; Alberta Cancer Board, Calgary, AB, Canada; McMaster University, Hamilton, ON, Canada; University of Toronto, Toronto, ON, Canada; Mayo Clinic, Rochester, MN
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12
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Whelan TJ, Olivotto I, Ackerman I, Chapman JW, Chua B, Nabid A, Vallis KA, White JR, Rousseau P, Fortin A, Pierce LJ, Manchul L, Craighead P, Nolan MC, Bowen J, McCready DR, Pritchard KI, Levine MN, Parulekar W. NCIC-CTG MA.20: An intergroup trial of regional nodal irradiation in early breast cancer. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.18_suppl.lba1003] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [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
LBA1003 Background: Randomized trials have demonstrated that locoregional radiation after mastectomy reduces locoregional recurrence and improves overall survival (OS) in women with node positive breast cancer treated with adjuvant systemic therapy. MA.20 evaluated the addition of regional nodal irradiation (RNI) to whole breast irradiation (WBI) following breast conserving surgery (BCS). Methods: Women with high risk node-negative or node-positive breast cancer treated with BCS and adjuvant chemotherapy and/or endocrine therapy were stratified by positive nodes, axillary nodes removed, chemo- and endocrine therapy and randomized to WBI (50Gy in 25 fractions +/- boost irradiation) or WBI plus RNI (45Gy in 25 fractions) to the internal mammary, supraclavicular, and high axillary lymph nodes. The primary outcome was OS. The Data Safety Monitoring Committee approved the analysis plan for the protocol specified interim analysis of relapse patterns, survival and toxicity at 5 years. Upon review of the data, they recommended release of the results. Results: Between March 2000 to March 2007, 1,832 women were randomly assigned to WBI+RNI (916) or WBI (916). Median follow-up was 62 months. Characteristics of the study population were: mean age, 53.3 years; node negative, 10%; 1-3 positive nodes, 85%; > 4 positive nodes, 5%; adjuvant chemotherapy, 91%; and adjuvant endocrine therapy, 71%. WBI+RNI in comparison to WBI alone was associated with an improvement in isolated locoregional disease free survival (DFS; HR=.59, p=.02, 5 year risk: 96.8% and 94.5% respectively), distant DFS (HR=.64, p=.002, 5 year risk: 92.4% and 87.0% respectively), DFS (HR=.68, p=.003, 5 year risk: 89.7% and 84.0% respectively) and OS (HR=.76, p=.07, 5 year risk: 92.3% and 90.7% respectively). WBI+RNI in comparison to WBI was associated with an increase in grade 2 or greater pneumonitis (1.3% and 0.2% respectively, p=.01), and lymphedema (7.3% and 4.1% respectively, p=.004). Conclusions: The majority of women with node positive breast cancer are now managed by BCS followed by WBI and adjuvant systemic therapy. Results from MA.20 demonstrate that additional RNI reduces the risk of locoregional and distant recurrence, and improves DFS with a trend in improved OS.
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Affiliation(s)
- T. J. Whelan
- Juravinski Cancer Centre at Hamilton Health Sciences, Hamilton, ON, Canada; British Columbia Cancer Agency, Vancouver, BC, Canada; Toronto Sunnybrook Reg Cancer Center, Toronto, ON, Canada; NCIC Clinical Trials Group, Queen's University, Kingston, ON, Canada; Peter MacCallum Cancer Centre, Melbourne, Australia; Centre Hospitalier de Sherbrooke, Sherbrooke, QC, Canada; Oxford University, Oxford, England; Radiation Therapy Oncology Group and Medical College of Wisconsin, Milwaukee, WI; Centre Hopitalier
| | - I. Olivotto
- Juravinski Cancer Centre at Hamilton Health Sciences, Hamilton, ON, Canada; British Columbia Cancer Agency, Vancouver, BC, Canada; Toronto Sunnybrook Reg Cancer Center, Toronto, ON, Canada; NCIC Clinical Trials Group, Queen's University, Kingston, ON, Canada; Peter MacCallum Cancer Centre, Melbourne, Australia; Centre Hospitalier de Sherbrooke, Sherbrooke, QC, Canada; Oxford University, Oxford, England; Radiation Therapy Oncology Group and Medical College of Wisconsin, Milwaukee, WI; Centre Hopitalier
| | - I. Ackerman
- Juravinski Cancer Centre at Hamilton Health Sciences, Hamilton, ON, Canada; British Columbia Cancer Agency, Vancouver, BC, Canada; Toronto Sunnybrook Reg Cancer Center, Toronto, ON, Canada; NCIC Clinical Trials Group, Queen's University, Kingston, ON, Canada; Peter MacCallum Cancer Centre, Melbourne, Australia; Centre Hospitalier de Sherbrooke, Sherbrooke, QC, Canada; Oxford University, Oxford, England; Radiation Therapy Oncology Group and Medical College of Wisconsin, Milwaukee, WI; Centre Hopitalier
| | - J. W. Chapman
- Juravinski Cancer Centre at Hamilton Health Sciences, Hamilton, ON, Canada; British Columbia Cancer Agency, Vancouver, BC, Canada; Toronto Sunnybrook Reg Cancer Center, Toronto, ON, Canada; NCIC Clinical Trials Group, Queen's University, Kingston, ON, Canada; Peter MacCallum Cancer Centre, Melbourne, Australia; Centre Hospitalier de Sherbrooke, Sherbrooke, QC, Canada; Oxford University, Oxford, England; Radiation Therapy Oncology Group and Medical College of Wisconsin, Milwaukee, WI; Centre Hopitalier
| | - B. Chua
- Juravinski Cancer Centre at Hamilton Health Sciences, Hamilton, ON, Canada; British Columbia Cancer Agency, Vancouver, BC, Canada; Toronto Sunnybrook Reg Cancer Center, Toronto, ON, Canada; NCIC Clinical Trials Group, Queen's University, Kingston, ON, Canada; Peter MacCallum Cancer Centre, Melbourne, Australia; Centre Hospitalier de Sherbrooke, Sherbrooke, QC, Canada; Oxford University, Oxford, England; Radiation Therapy Oncology Group and Medical College of Wisconsin, Milwaukee, WI; Centre Hopitalier
| | - A. Nabid
- Juravinski Cancer Centre at Hamilton Health Sciences, Hamilton, ON, Canada; British Columbia Cancer Agency, Vancouver, BC, Canada; Toronto Sunnybrook Reg Cancer Center, Toronto, ON, Canada; NCIC Clinical Trials Group, Queen's University, Kingston, ON, Canada; Peter MacCallum Cancer Centre, Melbourne, Australia; Centre Hospitalier de Sherbrooke, Sherbrooke, QC, Canada; Oxford University, Oxford, England; Radiation Therapy Oncology Group and Medical College of Wisconsin, Milwaukee, WI; Centre Hopitalier
| | - K. A. Vallis
- Juravinski Cancer Centre at Hamilton Health Sciences, Hamilton, ON, Canada; British Columbia Cancer Agency, Vancouver, BC, Canada; Toronto Sunnybrook Reg Cancer Center, Toronto, ON, Canada; NCIC Clinical Trials Group, Queen's University, Kingston, ON, Canada; Peter MacCallum Cancer Centre, Melbourne, Australia; Centre Hospitalier de Sherbrooke, Sherbrooke, QC, Canada; Oxford University, Oxford, England; Radiation Therapy Oncology Group and Medical College of Wisconsin, Milwaukee, WI; Centre Hopitalier
| | - J. R. White
- Juravinski Cancer Centre at Hamilton Health Sciences, Hamilton, ON, Canada; British Columbia Cancer Agency, Vancouver, BC, Canada; Toronto Sunnybrook Reg Cancer Center, Toronto, ON, Canada; NCIC Clinical Trials Group, Queen's University, Kingston, ON, Canada; Peter MacCallum Cancer Centre, Melbourne, Australia; Centre Hospitalier de Sherbrooke, Sherbrooke, QC, Canada; Oxford University, Oxford, England; Radiation Therapy Oncology Group and Medical College of Wisconsin, Milwaukee, WI; Centre Hopitalier
| | - P. Rousseau
- Juravinski Cancer Centre at Hamilton Health Sciences, Hamilton, ON, Canada; British Columbia Cancer Agency, Vancouver, BC, Canada; Toronto Sunnybrook Reg Cancer Center, Toronto, ON, Canada; NCIC Clinical Trials Group, Queen's University, Kingston, ON, Canada; Peter MacCallum Cancer Centre, Melbourne, Australia; Centre Hospitalier de Sherbrooke, Sherbrooke, QC, Canada; Oxford University, Oxford, England; Radiation Therapy Oncology Group and Medical College of Wisconsin, Milwaukee, WI; Centre Hopitalier
| | - A. Fortin
- Juravinski Cancer Centre at Hamilton Health Sciences, Hamilton, ON, Canada; British Columbia Cancer Agency, Vancouver, BC, Canada; Toronto Sunnybrook Reg Cancer Center, Toronto, ON, Canada; NCIC Clinical Trials Group, Queen's University, Kingston, ON, Canada; Peter MacCallum Cancer Centre, Melbourne, Australia; Centre Hospitalier de Sherbrooke, Sherbrooke, QC, Canada; Oxford University, Oxford, England; Radiation Therapy Oncology Group and Medical College of Wisconsin, Milwaukee, WI; Centre Hopitalier
| | - L. J. Pierce
- Juravinski Cancer Centre at Hamilton Health Sciences, Hamilton, ON, Canada; British Columbia Cancer Agency, Vancouver, BC, Canada; Toronto Sunnybrook Reg Cancer Center, Toronto, ON, Canada; NCIC Clinical Trials Group, Queen's University, Kingston, ON, Canada; Peter MacCallum Cancer Centre, Melbourne, Australia; Centre Hospitalier de Sherbrooke, Sherbrooke, QC, Canada; Oxford University, Oxford, England; Radiation Therapy Oncology Group and Medical College of Wisconsin, Milwaukee, WI; Centre Hopitalier
| | - L. Manchul
- Juravinski Cancer Centre at Hamilton Health Sciences, Hamilton, ON, Canada; British Columbia Cancer Agency, Vancouver, BC, Canada; Toronto Sunnybrook Reg Cancer Center, Toronto, ON, Canada; NCIC Clinical Trials Group, Queen's University, Kingston, ON, Canada; Peter MacCallum Cancer Centre, Melbourne, Australia; Centre Hospitalier de Sherbrooke, Sherbrooke, QC, Canada; Oxford University, Oxford, England; Radiation Therapy Oncology Group and Medical College of Wisconsin, Milwaukee, WI; Centre Hopitalier
| | - P. Craighead
- Juravinski Cancer Centre at Hamilton Health Sciences, Hamilton, ON, Canada; British Columbia Cancer Agency, Vancouver, BC, Canada; Toronto Sunnybrook Reg Cancer Center, Toronto, ON, Canada; NCIC Clinical Trials Group, Queen's University, Kingston, ON, Canada; Peter MacCallum Cancer Centre, Melbourne, Australia; Centre Hospitalier de Sherbrooke, Sherbrooke, QC, Canada; Oxford University, Oxford, England; Radiation Therapy Oncology Group and Medical College of Wisconsin, Milwaukee, WI; Centre Hopitalier
| | - M. C. Nolan
- Juravinski Cancer Centre at Hamilton Health Sciences, Hamilton, ON, Canada; British Columbia Cancer Agency, Vancouver, BC, Canada; Toronto Sunnybrook Reg Cancer Center, Toronto, ON, Canada; NCIC Clinical Trials Group, Queen's University, Kingston, ON, Canada; Peter MacCallum Cancer Centre, Melbourne, Australia; Centre Hospitalier de Sherbrooke, Sherbrooke, QC, Canada; Oxford University, Oxford, England; Radiation Therapy Oncology Group and Medical College of Wisconsin, Milwaukee, WI; Centre Hopitalier
| | - J. Bowen
- Juravinski Cancer Centre at Hamilton Health Sciences, Hamilton, ON, Canada; British Columbia Cancer Agency, Vancouver, BC, Canada; Toronto Sunnybrook Reg Cancer Center, Toronto, ON, Canada; NCIC Clinical Trials Group, Queen's University, Kingston, ON, Canada; Peter MacCallum Cancer Centre, Melbourne, Australia; Centre Hospitalier de Sherbrooke, Sherbrooke, QC, Canada; Oxford University, Oxford, England; Radiation Therapy Oncology Group and Medical College of Wisconsin, Milwaukee, WI; Centre Hopitalier
| | - D. R. McCready
- Juravinski Cancer Centre at Hamilton Health Sciences, Hamilton, ON, Canada; British Columbia Cancer Agency, Vancouver, BC, Canada; Toronto Sunnybrook Reg Cancer Center, Toronto, ON, Canada; NCIC Clinical Trials Group, Queen's University, Kingston, ON, Canada; Peter MacCallum Cancer Centre, Melbourne, Australia; Centre Hospitalier de Sherbrooke, Sherbrooke, QC, Canada; Oxford University, Oxford, England; Radiation Therapy Oncology Group and Medical College of Wisconsin, Milwaukee, WI; Centre Hopitalier
| | - K. I. Pritchard
- Juravinski Cancer Centre at Hamilton Health Sciences, Hamilton, ON, Canada; British Columbia Cancer Agency, Vancouver, BC, Canada; Toronto Sunnybrook Reg Cancer Center, Toronto, ON, Canada; NCIC Clinical Trials Group, Queen's University, Kingston, ON, Canada; Peter MacCallum Cancer Centre, Melbourne, Australia; Centre Hospitalier de Sherbrooke, Sherbrooke, QC, Canada; Oxford University, Oxford, England; Radiation Therapy Oncology Group and Medical College of Wisconsin, Milwaukee, WI; Centre Hopitalier
| | - M. N. Levine
- Juravinski Cancer Centre at Hamilton Health Sciences, Hamilton, ON, Canada; British Columbia Cancer Agency, Vancouver, BC, Canada; Toronto Sunnybrook Reg Cancer Center, Toronto, ON, Canada; NCIC Clinical Trials Group, Queen's University, Kingston, ON, Canada; Peter MacCallum Cancer Centre, Melbourne, Australia; Centre Hospitalier de Sherbrooke, Sherbrooke, QC, Canada; Oxford University, Oxford, England; Radiation Therapy Oncology Group and Medical College of Wisconsin, Milwaukee, WI; Centre Hopitalier
| | - W. Parulekar
- Juravinski Cancer Centre at Hamilton Health Sciences, Hamilton, ON, Canada; British Columbia Cancer Agency, Vancouver, BC, Canada; Toronto Sunnybrook Reg Cancer Center, Toronto, ON, Canada; NCIC Clinical Trials Group, Queen's University, Kingston, ON, Canada; Peter MacCallum Cancer Centre, Melbourne, Australia; Centre Hospitalier de Sherbrooke, Sherbrooke, QC, Canada; Oxford University, Oxford, England; Radiation Therapy Oncology Group and Medical College of Wisconsin, Milwaukee, WI; Centre Hopitalier
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Parulekar W, Chapman JW, Aparicio S, Murray Y, Boyle FM, Di Leo A, Kaufman B, Levy C, Manikhas A, Martin M, Pritchard KI, Schwartzberg LS, Burnell MJ, Dent S, Ellard S, Tonkin KS, Whelan TJ, Lemieux J, Bordeleau L, Gelmon KA. Phase III study of taxane chemotherapy with lapatinib or trastuzumab as first-line therapy for women with HER2/neu-positive metastatic breast cancer (BC) (NCIC Clinical Trials Group (NCICCTG)MA.31/GSK EGF 108919). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.tps108] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Parulekar W, Chen BE, Elliott C, Shepherd LE, Gelmon KA, Pritchard KI, Whelan TJ, Ligibel JA, Hershman DL, Mayer IA, Hobday TJ, Rastogi P, Lemieux J, Ganz PA, Stambolic V, Goodwin PJ. A phase III randomized trial of metformin versus placebo on recurrence and survival in early-stage breast cancer (BC) (NCIC Clinical Trials Group MA.32). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.tps103] [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] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Yerushalmi R, Dong B, Chapman JW, Goss PE, Pollak MN, Burnell MJ, Bramwell VH, Levine MN, Pritchard KI, Whelan TJ, Ingle JN, Parulekar W, Shepherd LE, Gelmon KA. Impact of a change of body mass index (BMI) on outcome following adjuvant endocrine therapy, chemotherapy, or trastuzumab for breast cancer. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.513] [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
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Whelan TJ, Olivotto I, Ackerman I, Chapman JW, Chua B, Nabid A, Vallis KA, White JR, Rousseau P, Fortin A, Pierce LJ, Manchul L, Craighead P, Nolan MC, Bowen J, McCready DR, Pritchard KI, Levine MN, Parulekar W. NCIC CTG MA.20: An intergroup trial of regional nodal irradiation in early breast cancer. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.lba1003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Pollak MN, Chapman JW, Pritchard KI, Krook JE, Dhaliwal HS, Vandenberg TA, Whelan TJ, O'Reilly SE, Wilson CF, Shepherd LE. Tamoxifen versus tamoxifen plus octreotide LAR as adjuvant therapy for early-stage breast cancer in postmenopausal women: Update of NCIC CTG MA14 trial. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.542] [Citation(s) in RCA: 2] [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
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Nenshi R, Kennedy E, Baxter NN, Saskin R, Sutradhar R, Urbach DR, Sroka G, Feldman LS, Vassiliou MC, Kaneva PA, Fayez R, Fried GM, Krajewski SA, Brown CJ, Hur C, McCrea PH, Mitchell A, Porter G, Grushka J, Razek T, Khwaja K, Fata P, Martel G, Moloo H, Picciano G, Boushey RP, Poulin EC, Mamazza J, Haas B, Xiong W, Brennan-Barnes M, Gomez D, Nathens AB, Yang I, Forbes SS, Stephen WJ, Loeb M, Smith R, Christoffersen EP, McLean RF, Westerholm J, Garcia-Osogobio S, Farrokhyar F, Cadeddu M, Anvari M, Ponton-Carss A, Hutchison C, Violato C, Segedi M, Mittleman M, Fisman D, Kinlin L, Rousseau M, Saleh W, Ferri LE, Feldman LS, Stanbridge DD, Mayrand S, Fried GM, Pandya A, Gagliardi A, Nathens A, Ahmed N, Tran T, Demyttenaere SV, Polyhronopoulos G, Seguin C, Artho GP, Kaneva P, Fried GM, Feldman LS, Demyttenaere SV, Bergman S, Anderson J, Mikami DJ, Melvin WS, Racz JM, Dubois L, Katchky A, Wall WJ, Faryniuk A, Hochman D, Clarkson CA, Rubiano AM, Clarkson CA, Boone D, Ball CG, Dixon E, Kirkpatrick AW, Sutherland FR, Feliciano DV, Wyrzykowski AD, Nicholas JM, Dente CJ, Ball CG, Feliciano DV, Ullah SM, McAlister VC, Malik S, Ramsey D, Pooler S, Teague B, Misra M, Cadeddu M, Anvari M, Kaminsky M, Vergis A, Gillman LM, Gillman LM, Vergis A, Altaf A, Ellsmere J, Bonjer HJ, Klassen D, Orzech N, Palter V, Aggarwal R, Okrainec A, Grantcharov TP, Ghaderi I, Feldman LS, Sroka G, Kaneva PA, Fried GM, Shlomovitz E, Reznick RK, Kucharczyk W, Lee L, Iqbal S, Barayan H, Lu Y, Fata P, Razek T, Khwaja K, Boora PS, White JS, Vogt KN, Charyk-Stewart T, Minuk L, Eckert K, Chin-Yee I, Gray D, Parry N, Humphrey RJ, Bütter A, Schmidt J, Grieci T, Gagnon R, Han V, Duhaime S, Pitt DF, Palter V, Orzech N, Aggarwal R, Okrainec A, Grantcharov TP, Dubois L, Vogt KN, Davies W, Schlachta CM, Shi X, Birch DW, Gu Y, Moser MA, Swanson TW, Schaeffer DF, Tang BQ, Rusnak CH, Amson BJ, Vogt KN, Dubois L, Hobbs A, Etemad-Rezai R, Schlachta CM, Claydon E, McAlister V, Grushka J, Sur W, Laberge JM, Tchervenkov J, Bell L, Flageole H, Labidi S, Gagné JP, Gowing R, Kahnamoui K, McAlister CC, Marble A, Coughlin S, Karanicolas P, Emmerton-Coughlin H, Kanbur B, Kanbur S, Colquhoun P, Trottier DC, Doucette S, Huynh H, Soto CM, Poulin EC, Mamazza J, Boushey RP, Jamal MH, Rousseau M, Meterissian S, Snell L, Racz JM, Davies E, Aminazadeh N, Farrokhyar F, Reid S, Naeeni A, Naeeni M, Kashfi A, Kahnamoui K, Martin K, Weir M, Taylor B, Martin KM, Girotti MJ, Parry NG, Hanna WC, Fraser S, Weissglas I, Ghitulescu G, Bilek A, Marek J, Galatas C, Bergman S, Chiu CG, Nguyen NH, Bloom SW, Wiebe S, Klassen D, Bonjer J, Lawlor D, Plowman J, Ransom T, Vallis M, Ellsmere J, Menezes AC, Karmali S, Birch DW, Forbes SS, Eskicioglu C, Brenneman FD, McLeod RS, Fraser SA, Bergman S, Garzon J, Gomez D, Lawless B, Haas B, Nathens AB, Lumb KJ, Harkness L, Williamson J, Charyk-Stewart T, Gray D, Malthaner RA, Van Koughnett JA, Vogt KN, Gray DK, Parry NG, Teague B, Cadeddu M, Anvari M, Misra M, Pooler S, Malik S, Swain P, Chackungal S, Vogt KN, Yoshy C, Etemad-Rezai R, Cunningham I, Dubois L, Schlachta CM, Scott L, Vinden C, Okrainec A, Henao O, Azzie G, Deen S, Hameed M, Ramirez V, Veillette C, Bray P, Jewett M, Okrainec A, Pagliarello G, Brenneman F, Buczkowski A, Nathens A, Razek T, Widder S, Anderson I, Klassen D, Saadia R, Johner A, Hameed SM, Qureshi AP, Vergis A, Jimenez CM, Green J, Pryor AD, Schlachta CM, Okrainec A, Perri MT, Trejos AL, Naish MD, Patel RV, Malthaner RA, Stanger J, Stewart K, Yasui Y, Cass C, Damaraju S, Graham K, Bharadwaj S, Srinathan S, Tan L, Unruh H, Finley C, Miller L, Ferri LE, Urbach DR, Darling G, Spicer J, Ergun S, McDonald B, Rousseau M, Kaneva P, Ferri LE, Spicer J, Andalib A, Benay C, Rousseau M, Kushner Y, Marcus V, Ferri LE, Hunt I, Gazala S, Razzak R, Chuck A, Valji A, Stewart K, Tsuyuki R, Bédard ELR, Bottoni DA, Campbell G, Malthaner RA, Rousseau M, Guevremont P, Chasen M, Spicer J, Eckert E, Alcindor T, Ades S, Ferri LE, McGory R, Nagpal D, Fortin D, Inculet RI, Malthaner RA, Ko M, Shargall Y, Compeau C, Razzak R, Gazala S, Hunt I, Veenstra J, Valji A, Stewart K, Bédard ELR, Davis PJ, Mancuso M, Mujoomdar AA, Gazala S, Bédard ELR, Lee L, Spicer J, Robineau C, Sirois C, Mulder D, Ferri LE, Cools-Lartigue J, Chang SY, Mayrand S, Marcus V, Fried GM, Ferri LE, Perry T, Hunt I, Allegretto M, Maguire C, Abele J, Williams D, Stewart K, Bédard ELR, Grover HS, Basi S, Chiasson P, Basi S, Gregory W, Irshad K, Schieman C, MacGregor JH, Kelly E, Gelfand G, Graham AJ, McFadden SP, Grondin SC, Croome KP, Chudzinski R, Hanto DW, Jamal MH, Doi SA, Barkun JS, Wong SL, Kwan AHL, Yang S, Law C, Luo Y, Spiers J, Forse A, Taylor W, Apriasz I, Mysliwiec B, Sarin N, Gregor J, Moulton CE, McLeod RS, Barnett H, Nhan C, Gallinger S, Demyttenaere SV, Nau P, Muscarella P, Melvin WS, Ellison EC, Wiseman SM, Melck AL, Davidge KM, Eskicioglu C, Lipa J, Ferguson P, Swallow CJ, Wright FC, Edwards JP, Kelly EJ, Lin Y, Lenders T, Ghali WA, Graham A, Francescutti V, Farrokhyar F, Tozer R, Heller B, Lovrics P, Jansz G, Kahnamoui K, Spiegle G, Schmocker S, Huang H, Victor C, Law C, Kennedy ED, McCart JA, Aslani N, Swanson T, Kennecke H, Woods R, Davis N, Klevan AE, Ramsay JA, Stephen WJ, Smith M, Plourde M, Johnson PM, Yaffe P, Walsh M, Hoskin D, Huynh HP, Trottier DC, Soto C, Auer R, Poulin EC, Mamazza J, Boushey RP, Moloo H, Huynh HP, Trottier DC, Soto C, Moloo H, Poulin EC, Mamazza J, Boushey RP, Nhan C, Driman DK, Smith AJ, Hunter A, McLeod RS, Eskicioglu C, Fenech DS, Victor C, McLeod RS, Trottier DC, Huynh H, Sabri E, Soto C, Scheer A, Zolfaghari S, Moloo H, Mamazza J, Poulin EC, Boushey RP, Hallet J, Guénette-Lemieux M, Bouchard A, Grégoire RC, Thibault C, Dionne G, Côté F, Langis P, Gagné JP, Raval MJ, Phang PT, Brown CJ, Kuzmanovic A, Planting A, Raval MJ, Phang PT, Brown CJ, Huynh HP, Trottier DC, Moloo H, Poulin EC, Mamazza J, Friedlich M, Stern HS, Boushey RP, Tang BQ, Moloo H, Bleier J, Goldberg SM, Alsharif J, Martel G, Bouchard A, Sabri E, Ramsay CR, Mamazza J, Poulin EC, Boushey RP, Richardson D, Porter G, Johnson P, Al-Sukhni E, Ridgway PF, O'Connor B, McLeod RS, Swallow CJ, Forbes SS, Urbach DR, Sutradhar R, Paszat L, Rabeneck L, Baxter NN, Chung W, Ko D, Sun C, Brown CJ, Raval M, Phang PT, Pao JS, Woods R, Raval MJ, Phang PT, Brown CJ, Power A, Francescutti V, Ramsey D, Kelly S, Stephen W, Simunovic M, Coates A, Goldsmith CH, Thabane L, Reeson D, Smith AJ, McLeod RS, DeNardi F, Whelan TJ, Levine MN, Al-Khayal KA, Buie WD, Wallace L, Sigalet D, Eskicioglu C, Gagliardi A, Fenech DS, Victor C, McLeod RS. Abstracts of presentations to the Annual Meetings of the Canadian Association of General Surgeons Canadian Association of Thoracic Surgeons Canadian Hepato-Pancreato-Biliary Society Canadian Society of Surgical Oncology Canadian Society of Colon and Rectal Surgeons: Victoria, BC Sept. 10-13, 2009. Can J Surg 2009; 52:S1-S48. [PMID: 35488397 PMCID: PMC2726442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023] Open
Affiliation(s)
- R Nenshi
- From the Institute for Clinical and Evaluative Sciences, Toronto, Ont
| | - E Kennedy
- From the Institute for Clinical and Evaluative Sciences, Toronto, Ont
| | - N N Baxter
- From the Institute for Clinical and Evaluative Sciences, Toronto, Ont
| | - R Saskin
- From the Institute for Clinical and Evaluative Sciences, Toronto, Ont
| | - R Sutradhar
- From the Institute for Clinical and Evaluative Sciences, Toronto, Ont
| | - D R Urbach
- From the Institute for Clinical and Evaluative Sciences, Toronto, Ont
| | - G Sroka
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University, Montréal, Que
| | - L S Feldman
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University, Montréal, Que
| | - M C Vassiliou
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University, Montréal, Que
| | - P A Kaneva
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University, Montréal, Que
| | - R Fayez
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University, Montréal, Que
| | - G M Fried
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University, Montréal, Que
| | - S A Krajewski
- From the Department of Surgery, University of British Columbia, Vancouver, BC, and the Institute for Technology Assessment, Massachusetts General Hospital, Boston, Mass
| | - C J Brown
- From the Department of Surgery, University of British Columbia, Vancouver, BC, and the Institute for Technology Assessment, Massachusetts General Hospital, Boston, Mass
| | - C Hur
- From the Department of Surgery, University of British Columbia, Vancouver, BC, and the Institute for Technology Assessment, Massachusetts General Hospital, Boston, Mass
| | - P H McCrea
- From the Department of Surgery, Dalhousie University, Queen Elizabeth II Health Sciences Centre, Halifax, NS
| | - A Mitchell
- From the Department of Surgery, Dalhousie University, Queen Elizabeth II Health Sciences Centre, Halifax, NS
| | - G Porter
- From the Department of Surgery, Dalhousie University, Queen Elizabeth II Health Sciences Centre, Halifax, NS
| | - J Grushka
- From the Division of General Surgery, Montréal General Hospital, McGill University, Montréal, Que
| | - T Razek
- From the Division of General Surgery, Montréal General Hospital, McGill University, Montréal, Que
| | - K Khwaja
- From the Division of General Surgery, Montréal General Hospital, McGill University, Montréal, Que
| | - P Fata
- From the Division of General Surgery, Montréal General Hospital, McGill University, Montréal, Que
| | - G Martel
- From The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - H Moloo
- From The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - G Picciano
- From The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - R P Boushey
- From The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - E C Poulin
- From The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - J Mamazza
- From The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - B Haas
- From the Division of General Surgery, St. Michael's Hospital, University of Toronto, Toronto, and the Children's Hospital of Eastern Ontario, Ottawa, Ont
| | - W Xiong
- From the Division of General Surgery, St. Michael's Hospital, University of Toronto, Toronto, and the Children's Hospital of Eastern Ontario, Ottawa, Ont
| | - M Brennan-Barnes
- From the Division of General Surgery, St. Michael's Hospital, University of Toronto, Toronto, and the Children's Hospital of Eastern Ontario, Ottawa, Ont
| | - D Gomez
- From the Division of General Surgery, St. Michael's Hospital, University of Toronto, Toronto, and the Children's Hospital of Eastern Ontario, Ottawa, Ont
| | - A B Nathens
- From the Division of General Surgery, St. Michael's Hospital, University of Toronto, Toronto, and the Children's Hospital of Eastern Ontario, Ottawa, Ont
| | - I Yang
- From the Departments of Surgery and Anesthesiology, McMaster University, Hamilton Health Sciences, Hamilton, Ont
| | - S S Forbes
- From the Departments of Surgery and Anesthesiology, McMaster University, Hamilton Health Sciences, Hamilton, Ont
| | - W J Stephen
- From the Departments of Surgery and Anesthesiology, McMaster University, Hamilton Health Sciences, Hamilton, Ont
| | - M Loeb
- From the Departments of Surgery and Anesthesiology, McMaster University, Hamilton Health Sciences, Hamilton, Ont
| | - R Smith
- From the Departments of Surgery and Anesthesiology, McMaster University, Hamilton Health Sciences, Hamilton, Ont
| | - E P Christoffersen
- From the Departments of Surgery and Anesthesiology, McMaster University, Hamilton Health Sciences, Hamilton, Ont
| | - R F McLean
- From the Departments of Surgery and Anesthesiology, McMaster University, Hamilton Health Sciences, Hamilton, Ont
| | - J Westerholm
- From the Centre for Minimal Access Surgery, McMaster University, Hamilton, Ont
| | - S Garcia-Osogobio
- From the Centre for Minimal Access Surgery, McMaster University, Hamilton, Ont
| | - F Farrokhyar
- From the Centre for Minimal Access Surgery, McMaster University, Hamilton, Ont
| | - M Cadeddu
- From the Centre for Minimal Access Surgery, McMaster University, Hamilton, Ont
| | - M Anvari
- From the Centre for Minimal Access Surgery, McMaster University, Hamilton, Ont
| | - A Ponton-Carss
- From the Department of Surgery, University of Calgary, Calgary, Alta
| | - C Hutchison
- From the Department of Surgery, University of Calgary, Calgary, Alta
| | - C Violato
- From the Department of Surgery, University of Calgary, Calgary, Alta
| | - M Segedi
- From the Harvard School of Public Health, Beth Israel Deaconess Medical Center, Boston, Mass., the University of British Columbia, Vancouver, BC, and The Hospital for Sick Children, University of Toronto, Toronto, Ont
| | - M Mittleman
- From the Harvard School of Public Health, Beth Israel Deaconess Medical Center, Boston, Mass., the University of British Columbia, Vancouver, BC, and The Hospital for Sick Children, University of Toronto, Toronto, Ont
| | - D Fisman
- From the Harvard School of Public Health, Beth Israel Deaconess Medical Center, Boston, Mass., the University of British Columbia, Vancouver, BC, and The Hospital for Sick Children, University of Toronto, Toronto, Ont
| | - L Kinlin
- From the Harvard School of Public Health, Beth Israel Deaconess Medical Center, Boston, Mass., the University of British Columbia, Vancouver, BC, and The Hospital for Sick Children, University of Toronto, Toronto, Ont
| | - M Rousseau
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University Health Centre, Montréal, Que
| | - W Saleh
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University Health Centre, Montréal, Que
| | - L E Ferri
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University Health Centre, Montréal, Que
| | - L S Feldman
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University Health Centre, Montréal, Que
| | - D D Stanbridge
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University Health Centre, Montréal, Que
| | - S Mayrand
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University Health Centre, Montréal, Que
| | - G M Fried
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University Health Centre, Montréal, Que
| | - A Pandya
- From the Division of General Surgery, University of Toronto, Toronto, Ont
| | - A Gagliardi
- From the Division of General Surgery, University of Toronto, Toronto, Ont
| | - A Nathens
- From the Division of General Surgery, University of Toronto, Toronto, Ont
| | - N Ahmed
- From the Division of General Surgery, University of Toronto, Toronto, Ont
| | - T Tran
- From the Department of Surgery, McGill University, Montréal, Que
| | - S V Demyttenaere
- From the Department of Surgery, McGill University, Montréal, Que
| | | | - C Seguin
- From the Department of Surgery, McGill University, Montréal, Que
| | - G P Artho
- From the Department of Surgery, McGill University, Montréal, Que
| | - P Kaneva
- From the Department of Surgery, McGill University, Montréal, Que
| | - G M Fried
- From the Department of Surgery, McGill University, Montréal, Que
| | - L S Feldman
- From the Department of Surgery, McGill University, Montréal, Que
| | - S V Demyttenaere
- From the Department of Surgery, Ohio State University, Columbus, Ohio, and the Department of Surgery, Jewish General Hospital, McGill University, Montréal, Que
| | - S Bergman
- From the Department of Surgery, Ohio State University, Columbus, Ohio, and the Department of Surgery, Jewish General Hospital, McGill University, Montréal, Que
| | - J Anderson
- From the Department of Surgery, Ohio State University, Columbus, Ohio, and the Department of Surgery, Jewish General Hospital, McGill University, Montréal, Que
| | - D J Mikami
- From the Department of Surgery, Ohio State University, Columbus, Ohio, and the Department of Surgery, Jewish General Hospital, McGill University, Montréal, Que
| | - W S Melvin
- From the Department of Surgery, Ohio State University, Columbus, Ohio, and the Department of Surgery, Jewish General Hospital, McGill University, Montréal, Que
| | - J M Racz
- From the Department of Surgery, University of Western Ontario, London, Ont
| | - L Dubois
- From the Department of Surgery, University of Western Ontario, London, Ont
| | - A Katchky
- From the Department of Surgery, University of Western Ontario, London, Ont
| | - W J Wall
- From the Department of Surgery, University of Western Ontario, London, Ont
| | - A Faryniuk
- From the Department of Surgery, University of Manitoba, Winnipeg, Man
| | - D Hochman
- From the Department of Surgery, University of Manitoba, Winnipeg, Man
| | - C A Clarkson
- From the Neiva City University Hospital, Neiva, Huila, Colombia
| | - A M Rubiano
- From the Neiva City University Hospital, Neiva, Huila, Colombia
| | - C A Clarkson
- From the Department of Surgery, Memorial University of Newfoundland, St. John's, NL
| | - D Boone
- From the Department of Surgery, Memorial University of Newfoundland, St. John's, NL
| | - C G Ball
- From the Departments of Surgery, Emory University, Atlanta, Ga., and the University of Calgary, Calgary, Alta
| | - E Dixon
- From the Departments of Surgery, Emory University, Atlanta, Ga., and the University of Calgary, Calgary, Alta
| | - A W Kirkpatrick
- From the Departments of Surgery, Emory University, Atlanta, Ga., and the University of Calgary, Calgary, Alta
| | - F R Sutherland
- From the Departments of Surgery, Emory University, Atlanta, Ga., and the University of Calgary, Calgary, Alta
| | - D V Feliciano
- From the Departments of Surgery, Emory University, Atlanta, Ga., and the University of Calgary, Calgary, Alta
| | - A D Wyrzykowski
- From the Department of Surgery, Emory University, Atlanta, Ga
| | - J M Nicholas
- From the Department of Surgery, Emory University, Atlanta, Ga
| | - C J Dente
- From the Department of Surgery, Emory University, Atlanta, Ga
| | - C G Ball
- From the Department of Surgery, Emory University, Atlanta, Ga
| | - D V Feliciano
- From the Department of Surgery, Emory University, Atlanta, Ga
| | - S M Ullah
- From the Division of Clinical Anatomy, Department of Anatomy and Cell Biology, Department of Surgery, University Hospital, University of Western Ontario, London, Ont
| | - V C McAlister
- From the Division of Clinical Anatomy, Department of Anatomy and Cell Biology, Department of Surgery, University Hospital, University of Western Ontario, London, Ont
| | - S Malik
- From the Centre for Minimal Access Surgery, St. Joseph's Hospital, McMaster University, Hamilton, Ont
| | - D Ramsey
- From the Centre for Minimal Access Surgery, St. Joseph's Hospital, McMaster University, Hamilton, Ont
| | - S Pooler
- From the Centre for Minimal Access Surgery, St. Joseph's Hospital, McMaster University, Hamilton, Ont
| | - B Teague
- From the Centre for Minimal Access Surgery, St. Joseph's Hospital, McMaster University, Hamilton, Ont
| | - M Misra
- From the Centre for Minimal Access Surgery, St. Joseph's Hospital, McMaster University, Hamilton, Ont
| | - M Cadeddu
- From the Centre for Minimal Access Surgery, St. Joseph's Hospital, McMaster University, Hamilton, Ont
| | - M Anvari
- From the Centre for Minimal Access Surgery, St. Joseph's Hospital, McMaster University, Hamilton, Ont
| | - M Kaminsky
- From the Department of Surgery, University of Manitoba, Winnipeg, Man., the Department of Critical Care Medicine and Regional Trauma Services, University of Calgary, Calgary, Alta., and the Division of General Surgery, University of Toronto, Toronto, Ont
| | - A Vergis
- From the Department of Surgery, University of Manitoba, Winnipeg, Man., the Department of Critical Care Medicine and Regional Trauma Services, University of Calgary, Calgary, Alta., and the Division of General Surgery, University of Toronto, Toronto, Ont
| | - L M Gillman
- From the Department of Surgery, University of Manitoba, Winnipeg, Man., the Department of Critical Care Medicine and Regional Trauma Services, University of Calgary, Calgary, Alta., and the Division of General Surgery, University of Toronto, Toronto, Ont
| | - L M Gillman
- From the Department of Surgery, University of Manitoba, Winnipeg, Man., the Department of Critical Care Medicine, Regional Trauma Services, University of Calgary, Calgary, Alta., and the Division of General Surgery, University of Toronto, Toronto, Ont
| | - A Vergis
- From the Department of Surgery, University of Manitoba, Winnipeg, Man., the Department of Critical Care Medicine, Regional Trauma Services, University of Calgary, Calgary, Alta., and the Division of General Surgery, University of Toronto, Toronto, Ont
| | - A Altaf
- From the Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, NS
| | - J Ellsmere
- From the Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, NS
| | - H J Bonjer
- From the Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, NS
| | - D Klassen
- From the Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, NS
| | - N Orzech
- From the Departments of Surgery, St. Michael's Hospital, Toronto Western Hospital, University of Toronto, Toronto, and the Department of Biosurgery and Surgical Technology, Imperial College, London, Ont
| | - V Palter
- From the Departments of Surgery, St. Michael's Hospital, Toronto Western Hospital, University of Toronto, Toronto, and the Department of Biosurgery and Surgical Technology, Imperial College, London, Ont
| | - R Aggarwal
- From the Departments of Surgery, St. Michael's Hospital, Toronto Western Hospital, University of Toronto, Toronto, and the Department of Biosurgery and Surgical Technology, Imperial College, London, Ont
| | - A Okrainec
- From the Departments of Surgery, St. Michael's Hospital, Toronto Western Hospital, University of Toronto, Toronto, and the Department of Biosurgery and Surgical Technology, Imperial College, London, Ont
| | - T P Grantcharov
- From the Departments of Surgery, St. Michael's Hospital, Toronto Western Hospital, University of Toronto, Toronto, and the Department of Biosurgery and Surgical Technology, Imperial College, London, Ont
| | - I Ghaderi
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University, Montréal, Que., and the University of Western Ontario, London, Ont
| | - L S Feldman
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University, Montréal, Que., and the University of Western Ontario, London, Ont
| | - G Sroka
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University, Montréal, Que., and the University of Western Ontario, London, Ont
| | - P A Kaneva
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University, Montréal, Que., and the University of Western Ontario, London, Ont
| | - G M Fried
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University, Montréal, Que., and the University of Western Ontario, London, Ont
| | - E Shlomovitz
- From the Departments of Surgery and Diagnostic Imaging, University Health Network, University of Toronto, Toronto, Ont
| | - R K Reznick
- From the Departments of Surgery and Diagnostic Imaging, University Health Network, University of Toronto, Toronto, Ont
| | - W Kucharczyk
- From the Departments of Surgery and Diagnostic Imaging, University Health Network, University of Toronto, Toronto, Ont
| | - L Lee
- From the Departments of Surgery and Medicine, McGill University Health Centre, Montréal, Que
| | - S Iqbal
- From the Departments of Surgery and Medicine, McGill University Health Centre, Montréal, Que
| | - H Barayan
- From the Departments of Surgery and Medicine, McGill University Health Centre, Montréal, Que
| | - Y Lu
- From the Departments of Surgery and Medicine, McGill University Health Centre, Montréal, Que
| | - P Fata
- From the Departments of Surgery and Medicine, McGill University Health Centre, Montréal, Que
| | - T Razek
- From the Departments of Surgery and Medicine, McGill University Health Centre, Montréal, Que
| | - K Khwaja
- From the Departments of Surgery and Medicine, McGill University Health Centre, Montréal, Que
| | - P S Boora
- From the Department of Surgery, University of Alberta, Edmonton, Alta
| | - J S White
- From the Department of Surgery, University of Alberta, Edmonton, Alta
| | - K N Vogt
- From the Divisions of General Surgery and Hematology, Trauma Program, London Health Sciences Centre, London, Ont
| | - T Charyk-Stewart
- From the Divisions of General Surgery and Hematology, Trauma Program, London Health Sciences Centre, London, Ont
| | - L Minuk
- From the Divisions of General Surgery and Hematology, Trauma Program, London Health Sciences Centre, London, Ont
| | - K Eckert
- From the Divisions of General Surgery and Hematology, Trauma Program, London Health Sciences Centre, London, Ont
| | - I Chin-Yee
- From the Divisions of General Surgery and Hematology, Trauma Program, London Health Sciences Centre, London, Ont
| | - D Gray
- From the Divisions of General Surgery and Hematology, Trauma Program, London Health Sciences Centre, London, Ont
| | - N Parry
- From the Divisions of General Surgery and Hematology, Trauma Program, London Health Sciences Centre, London, Ont
| | - R J Humphrey
- From the Departments of Surgery and Pediatrics, London Health Sciences Centre, University of Western Ontario, London, Ont
| | - A Bütter
- From the Departments of Surgery and Pediatrics, London Health Sciences Centre, University of Western Ontario, London, Ont
| | - J Schmidt
- From the Departments of Surgery and Pediatrics, London Health Sciences Centre, University of Western Ontario, London, Ont
| | - T Grieci
- From the Departments of Surgery and Pediatrics, London Health Sciences Centre, University of Western Ontario, London, Ont
| | - R Gagnon
- From the Departments of Surgery and Pediatrics, London Health Sciences Centre, University of Western Ontario, London, Ont
| | - V Han
- From the Departments of Surgery and Pediatrics, London Health Sciences Centre, University of Western Ontario, London, Ont
| | - S Duhaime
- From the University of Ottawa, Ottawa, Ont
| | - D F Pitt
- From the University of Ottawa, Ottawa, Ont
| | - V Palter
- From the Departments of Surgery, St. Michael's Hospital, Toronto Western Hospital, Toronto, and Imperial College, London, Ont
| | - N Orzech
- From the Departments of Surgery, St. Michael's Hospital, Toronto Western Hospital, Toronto, and Imperial College, London, Ont
| | - R Aggarwal
- From the Departments of Surgery, St. Michael's Hospital, Toronto Western Hospital, Toronto, and Imperial College, London, Ont
| | - A Okrainec
- From the Departments of Surgery, St. Michael's Hospital, Toronto Western Hospital, Toronto, and Imperial College, London, Ont
| | - T P Grantcharov
- From the Departments of Surgery, St. Michael's Hospital, Toronto Western Hospital, Toronto, and Imperial College, London, Ont
| | - L Dubois
- From the Department of Surgery, University of Western Ontario, London, Ont
| | - K N Vogt
- From the Department of Surgery, University of Western Ontario, London, Ont
| | - W Davies
- From the Department of Surgery, University of Western Ontario, London, Ont
| | - C M Schlachta
- From the Department of Surgery, University of Western Ontario, London, Ont
| | - X Shi
- From the Centre for the Advancement of Minimally Invasive Surgery, Edmonton, Alta
| | - D W Birch
- From the Centre for the Advancement of Minimally Invasive Surgery, Edmonton, Alta
| | - Y Gu
- From the Department of Surgery, University of Saskatchewan, Saskatoon, Sask
| | - M A Moser
- From the Department of Surgery, University of Saskatchewan, Saskatoon, Sask
| | - T W Swanson
- From the Department of Surgery, Royal Jubilee Hospital, Victoria, BC, University of British Columbia, Vancouver, BC
| | - D F Schaeffer
- From the Department of Surgery, Royal Jubilee Hospital, Victoria, BC, University of British Columbia, Vancouver, BC
| | - B Q Tang
- From the Department of Surgery, Royal Jubilee Hospital, Victoria, BC, University of British Columbia, Vancouver, BC
| | - C H Rusnak
- From the Department of Surgery, Royal Jubilee Hospital, Victoria, BC, University of British Columbia, Vancouver, BC
| | - B J Amson
- From the Department of Surgery, Royal Jubilee Hospital, Victoria, BC, University of British Columbia, Vancouver, BC
| | - K N Vogt
- From the Divisions of General Surgery and Radiology, London Health Sciences Centre, London, Ont
| | - L Dubois
- From the Divisions of General Surgery and Radiology, London Health Sciences Centre, London, Ont
| | - A Hobbs
- From the Divisions of General Surgery and Radiology, London Health Sciences Centre, London, Ont
| | - R Etemad-Rezai
- From the Divisions of General Surgery and Radiology, London Health Sciences Centre, London, Ont
| | - C M Schlachta
- From the Divisions of General Surgery and Radiology, London Health Sciences Centre, London, Ont
| | - E Claydon
- From the Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ont
| | - V McAlister
- From the Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ont
| | - J Grushka
- From the Divisions of Pediatric Surgery and Nephrology, Department of Pediatrics, Montréal Children's Hospital, and the Department of Surgery, McGill University, Montréal, Que
| | - W Sur
- From the Divisions of Pediatric Surgery and Nephrology, Department of Pediatrics, Montréal Children's Hospital, and the Department of Surgery, McGill University, Montréal, Que
| | - J-M Laberge
- From the Divisions of Pediatric Surgery and Nephrology, Department of Pediatrics, Montréal Children's Hospital, and the Department of Surgery, McGill University, Montréal, Que
| | - J Tchervenkov
- From the Divisions of Pediatric Surgery and Nephrology, Department of Pediatrics, Montréal Children's Hospital, and the Department of Surgery, McGill University, Montréal, Que
| | - L Bell
- From the Divisions of Pediatric Surgery and Nephrology, Department of Pediatrics, Montréal Children's Hospital, and the Department of Surgery, McGill University, Montréal, Que
| | - H Flageole
- From the Divisions of Pediatric Surgery and Nephrology, Department of Pediatrics, Montréal Children's Hospital, and the Department of Surgery, McGill University, Montréal, Que
| | - S Labidi
- From the Québec Centre for Minimally Invasive Surgery, Centre hospitalier universitaire de Québec, Québec, Que
| | - J P Gagné
- From the Québec Centre for Minimally Invasive Surgery, Centre hospitalier universitaire de Québec, Québec, Que
| | - R Gowing
- From the Department of Surgery, McMaster University, Hamilton, Ont
| | - K Kahnamoui
- From the Department of Surgery, McMaster University, Hamilton, Ont
| | - C C McAlister
- From the University of Toronto, Toronto, Ont., Dalhousie University, Halifax, NS
| | - A Marble
- From the University of Toronto, Toronto, Ont., Dalhousie University, Halifax, NS
| | - S Coughlin
- From the University of Western Ontario, London, Ont
| | | | | | - B Kanbur
- From the University of Western Ontario, London, Ont
| | - S Kanbur
- From the University of Western Ontario, London, Ont
| | - P Colquhoun
- From the University of Western Ontario, London, Ont
| | - D C Trottier
- From the Department of Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ont
| | - S Doucette
- From the Department of Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ont
| | - H Huynh
- From the Department of Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ont
| | - C M Soto
- From the Department of Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ont
| | - E C Poulin
- From the Department of Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ont
| | - J Mamazza
- From the Department of Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ont
| | - R P Boushey
- From the Department of Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ont
| | - M H Jamal
- From the Centre for Medical Education, Division of General Surgery, McGill University, Montréal, Que
| | - M Rousseau
- From the Centre for Medical Education, Division of General Surgery, McGill University, Montréal, Que
| | - S Meterissian
- From the Centre for Medical Education, Division of General Surgery, McGill University, Montréal, Que
| | - L Snell
- From the Centre for Medical Education, Division of General Surgery, McGill University, Montréal, Que
| | - J M Racz
- From the Department of Surgery, University of Western Ontario, London, Ont
| | - E Davies
- From the Department of Surgery, University of Western Ontario, London, Ont
| | - N Aminazadeh
- From the Department of Surgery, McMaster University, Hamilton, Ont
| | - F Farrokhyar
- From the Department of Surgery, McMaster University, Hamilton, Ont
| | - S Reid
- From the Department of Surgery, McMaster University, Hamilton, Ont
| | - A Naeeni
- From the Department of Surgery, McMaster University, Hamilton, Ont
| | - M Naeeni
- From the Department of Surgery, McMaster University, Hamilton, Ont
| | - A Kashfi
- From the Department of Surgery, McMaster University, Hamilton, Ont
| | - K Kahnamoui
- From the Department of Surgery, McMaster University, Hamilton, Ont
| | - K Martin
- From the London Health Sciences Centre, London, Ont
| | - M Weir
- From the London Health Sciences Centre, London, Ont
| | - B Taylor
- From the London Health Sciences Centre, London, Ont
| | - K M Martin
- From the London Health Sciences Centre, Children's Hospital of Western Ontario, London, Ont
| | - M J Girotti
- From the London Health Sciences Centre, Children's Hospital of Western Ontario, London, Ont
| | - N G Parry
- From the London Health Sciences Centre, Children's Hospital of Western Ontario, London, Ont
| | - W C Hanna
- From the Department of Surgery, Jewish General Hospital, McGill University, Montréal, Que
| | - S Fraser
- From the Department of Surgery, Jewish General Hospital, McGill University, Montréal, Que
| | - I Weissglas
- From the Department of Surgery, Jewish General Hospital, McGill University, Montréal, Que
| | - G Ghitulescu
- From the Department of Surgery, Jewish General Hospital, McGill University, Montréal, Que
| | - A Bilek
- From the Department of Surgery, Jewish General Hospital, McGill University, Montréal, Que
| | - J Marek
- From the Department of Surgery, Jewish General Hospital, McGill University, Montréal, Que
| | - C Galatas
- From the Department of Surgery, Jewish General Hospital, McGill University, Montréal, Que
| | - S Bergman
- From the Department of Surgery, Jewish General Hospital, McGill University, Montréal, Que
| | - C G Chiu
- From the Richmond Hospital, Richmond, BC
| | - N H Nguyen
- From the Richmond Hospital, Richmond, BC
| | - S W Bloom
- From the Richmond Hospital, Richmond, BC
| | - S Wiebe
- From the Queen Elizabeth II Health Sciences Centre (QEIIHSC), Halifax, NS
| | - D Klassen
- From the Queen Elizabeth II Health Sciences Centre (QEIIHSC), Halifax, NS
| | - J Bonjer
- From the Queen Elizabeth II Health Sciences Centre (QEIIHSC), Halifax, NS
| | - D Lawlor
- From the Queen Elizabeth II Health Sciences Centre (QEIIHSC), Halifax, NS
| | - J Plowman
- From the Queen Elizabeth II Health Sciences Centre (QEIIHSC), Halifax, NS
| | - T Ransom
- From the Queen Elizabeth II Health Sciences Centre (QEIIHSC), Halifax, NS
| | - M Vallis
- From the Queen Elizabeth II Health Sciences Centre (QEIIHSC), Halifax, NS
| | - J Ellsmere
- From the Queen Elizabeth II Health Sciences Centre (QEIIHSC), Halifax, NS
| | - A C Menezes
- From the Centre for the Advancement of Minimally Invasive Surgery (CAMIS), Alberta Health Services, Department of Surgery, University of Alberta, Edmonton, Alta
| | - S Karmali
- From the Centre for the Advancement of Minimally Invasive Surgery (CAMIS), Alberta Health Services, Department of Surgery, University of Alberta, Edmonton, Alta
| | - D W Birch
- From the Centre for the Advancement of Minimally Invasive Surgery (CAMIS), Alberta Health Services, Department of Surgery, University of Alberta, Edmonton, Alta
| | - S S Forbes
- From the Department of Surgery, University of Toronto, Toronto, Ont
| | - C Eskicioglu
- From the Department of Surgery, University of Toronto, Toronto, Ont
| | - F D Brenneman
- From the Department of Surgery, University of Toronto, Toronto, Ont
| | - R S McLeod
- From the Department of Surgery, University of Toronto, Toronto, Ont
| | - S A Fraser
- From the Department of General Surgery, Sir Mortimer B. Davis Jewish General Hospital, McGill University, Montréal, Que
| | - S Bergman
- From the Department of General Surgery, Sir Mortimer B. Davis Jewish General Hospital, McGill University, Montréal, Que
| | - J Garzon
- From the Department of General Surgery, Sir Mortimer B. Davis Jewish General Hospital, McGill University, Montréal, Que
| | - D Gomez
- From the Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ont
| | - B Lawless
- From the Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ont
| | - B Haas
- From the Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ont
| | - A B Nathens
- From the Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ont
| | - K J Lumb
- From the Department of Surgery, Trauma Program, London Health Sciences Centre, London, Ont
| | - L Harkness
- From the Department of Surgery, Trauma Program, London Health Sciences Centre, London, Ont
| | - J Williamson
- From the Department of Surgery, Trauma Program, London Health Sciences Centre, London, Ont
| | - T Charyk-Stewart
- From the Department of Surgery, Trauma Program, London Health Sciences Centre, London, Ont
| | - D Gray
- From the Department of Surgery, Trauma Program, London Health Sciences Centre, London, Ont
| | - R A Malthaner
- From the Department of Surgery, Trauma Program, London Health Sciences Centre, London, Ont
| | - J A Van Koughnett
- From the Division of General Surgery, University of Western Ontario, London, Ont
| | - K N Vogt
- From the Division of General Surgery, University of Western Ontario, London, Ont
| | - D K Gray
- From the Division of General Surgery, University of Western Ontario, London, Ont
| | - N G Parry
- From the Division of General Surgery, University of Western Ontario, London, Ont
| | - B Teague
- From the Centre for Minimal Access Surgery, St. Joseph's Healthcare, McMaster University, Hamilton, Ont
| | - M Cadeddu
- From the Centre for Minimal Access Surgery, St. Joseph's Healthcare, McMaster University, Hamilton, Ont
| | - M Anvari
- From the Centre for Minimal Access Surgery, St. Joseph's Healthcare, McMaster University, Hamilton, Ont
| | - M Misra
- From the Centre for Minimal Access Surgery, St. Joseph's Healthcare, McMaster University, Hamilton, Ont
| | - S Pooler
- From the Centre for Minimal Access Surgery, St. Joseph's Healthcare, McMaster University, Hamilton, Ont
| | - S Malik
- From the Centre for Minimal Access Surgery, St. Joseph's Healthcare, McMaster University, Hamilton, Ont
| | - P Swain
- From the Centre for Minimal Access Surgery, St. Joseph's Healthcare, McMaster University, Hamilton, Ont
| | - S Chackungal
- From the Division of General Surgery, Department of Radiology, Lawson Health Research Institute, London Health Sciences Centre, University of Western Ontario, London, Ont
| | - K N Vogt
- From the Division of General Surgery, Department of Radiology, Lawson Health Research Institute, London Health Sciences Centre, University of Western Ontario, London, Ont
| | - C Yoshy
- From the Division of General Surgery, Department of Radiology, Lawson Health Research Institute, London Health Sciences Centre, University of Western Ontario, London, Ont
| | - R Etemad-Rezai
- From the Division of General Surgery, Department of Radiology, Lawson Health Research Institute, London Health Sciences Centre, University of Western Ontario, London, Ont
| | - I Cunningham
- From the Division of General Surgery, Department of Radiology, Lawson Health Research Institute, London Health Sciences Centre, University of Western Ontario, London, Ont
| | - L Dubois
- From the Division of General Surgery, Department of Radiology, Lawson Health Research Institute, London Health Sciences Centre, University of Western Ontario, London, Ont
| | - C M Schlachta
- From the Division of General Surgery, Department of Radiology, Lawson Health Research Institute, London Health Sciences Centre, University of Western Ontario, London, Ont
| | - L Scott
- From the Division of General Surgery, Department of Radiology, Lawson Health Research Institute, London Health Sciences Centre, University of Western Ontario, London, Ont
| | - C Vinden
- From the Division of General Surgery, Department of Radiology, Lawson Health Research Institute, London Health Sciences Centre, University of Western Ontario, London, Ont
| | - A Okrainec
- From the Toronto Western Hospital, University Health Network, Hospital for Sick Children, University of Toronto, Toronto, Ont
| | - O Henao
- From the Toronto Western Hospital, University Health Network, Hospital for Sick Children, University of Toronto, Toronto, Ont
| | - G Azzie
- From the Toronto Western Hospital, University Health Network, Hospital for Sick Children, University of Toronto, Toronto, Ont
| | - S Deen
- From the Department of Surgery, Vancouver General Hospital, University of British Columbia, Vancouver, BC
| | - M Hameed
- From the Department of Surgery, Vancouver General Hospital, University of British Columbia, Vancouver, BC
| | - V Ramirez
- From the University Health Network, University of Toronto, Toronto, Ont
| | - C Veillette
- From the University Health Network, University of Toronto, Toronto, Ont
| | - P Bray
- From the University Health Network, University of Toronto, Toronto, Ont
| | - M Jewett
- From the University Health Network, University of Toronto, Toronto, Ont
| | - A Okrainec
- From the University Health Network, University of Toronto, Toronto, Ont
| | - G Pagliarello
- From the Departments of Surgery, University of British Columbia, Vancouver, BC, University of Alberta, Edmonton, University of Calgary, Calgary, Alta, University of Toronto, Toronto, Ont., McGill University, Montréal, Que, Dalhousie University, CAGS Committee on Acute Surgery and Critical Care, Halifax, NS
| | - F Brenneman
- From the Departments of Surgery, University of British Columbia, Vancouver, BC, University of Alberta, Edmonton, University of Calgary, Calgary, Alta, University of Toronto, Toronto, Ont., McGill University, Montréal, Que, Dalhousie University, CAGS Committee on Acute Surgery and Critical Care, Halifax, NS
| | - A Buczkowski
- From the Departments of Surgery, University of British Columbia, Vancouver, BC, University of Alberta, Edmonton, University of Calgary, Calgary, Alta, University of Toronto, Toronto, Ont., McGill University, Montréal, Que, Dalhousie University, CAGS Committee on Acute Surgery and Critical Care, Halifax, NS
| | - A Nathens
- From the Departments of Surgery, University of British Columbia, Vancouver, BC, University of Alberta, Edmonton, University of Calgary, Calgary, Alta, University of Toronto, Toronto, Ont., McGill University, Montréal, Que, Dalhousie University, CAGS Committee on Acute Surgery and Critical Care, Halifax, NS
| | - T Razek
- From the Departments of Surgery, University of British Columbia, Vancouver, BC, University of Alberta, Edmonton, University of Calgary, Calgary, Alta, University of Toronto, Toronto, Ont., McGill University, Montréal, Que, Dalhousie University, CAGS Committee on Acute Surgery and Critical Care, Halifax, NS
| | - S Widder
- From the Departments of Surgery, University of British Columbia, Vancouver, BC, University of Alberta, Edmonton, University of Calgary, Calgary, Alta, University of Toronto, Toronto, Ont., McGill University, Montréal, Que, Dalhousie University, CAGS Committee on Acute Surgery and Critical Care, Halifax, NS
| | - I Anderson
- From the Departments of Surgery, University of British Columbia, Vancouver, BC, University of Alberta, Edmonton, University of Calgary, Calgary, Alta, University of Toronto, Toronto, Ont., McGill University, Montréal, Que, Dalhousie University, CAGS Committee on Acute Surgery and Critical Care, Halifax, NS
| | - D Klassen
- From the Departments of Surgery, University of British Columbia, Vancouver, BC, University of Alberta, Edmonton, University of Calgary, Calgary, Alta, University of Toronto, Toronto, Ont., McGill University, Montréal, Que, Dalhousie University, CAGS Committee on Acute Surgery and Critical Care, Halifax, NS
| | - R Saadia
- From the Departments of Surgery, University of British Columbia, Vancouver, BC, University of Alberta, Edmonton, University of Calgary, Calgary, Alta, University of Toronto, Toronto, Ont., McGill University, Montréal, Que, Dalhousie University, CAGS Committee on Acute Surgery and Critical Care, Halifax, NS
| | - A Johner
- From the Departments of Surgery, University of British Columbia, Vancouver, BC, University of Alberta, Edmonton, University of Calgary, Calgary, Alta, University of Toronto, Toronto, Ont., McGill University, Montréal, Que, Dalhousie University, CAGS Committee on Acute Surgery and Critical Care, Halifax, NS
| | - S M Hameed
- From the Departments of Surgery, University of British Columbia, Vancouver, BC, University of Alberta, Edmonton, University of Calgary, Calgary, Alta, University of Toronto, Toronto, Ont., McGill University, Montréal, Que, Dalhousie University, CAGS Committee on Acute Surgery and Critical Care, Halifax, NS
| | - A P Qureshi
- From the Division of General Surgery, University of Toronto, University Health Network, Toronto Western Hospital, Toronto, the Departments of Surgery and Oncology, University of Western Ontario, London, Ont., and Duke University Medical Center, Durham, NC
| | - A Vergis
- From the Division of General Surgery, University of Toronto, University Health Network, Toronto Western Hospital, Toronto, the Departments of Surgery and Oncology, University of Western Ontario, London, Ont., and Duke University Medical Center, Durham, NC
| | - C M Jimenez
- From the Division of General Surgery, University of Toronto, University Health Network, Toronto Western Hospital, Toronto, the Departments of Surgery and Oncology, University of Western Ontario, London, Ont., and Duke University Medical Center, Durham, NC
| | - J Green
- From the Division of General Surgery, University of Toronto, University Health Network, Toronto Western Hospital, Toronto, the Departments of Surgery and Oncology, University of Western Ontario, London, Ont., and Duke University Medical Center, Durham, NC
| | - A D Pryor
- From the Division of General Surgery, University of Toronto, University Health Network, Toronto Western Hospital, Toronto, the Departments of Surgery and Oncology, University of Western Ontario, London, Ont., and Duke University Medical Center, Durham, NC
| | - C M Schlachta
- From the Division of General Surgery, University of Toronto, University Health Network, Toronto Western Hospital, Toronto, the Departments of Surgery and Oncology, University of Western Ontario, London, Ont., and Duke University Medical Center, Durham, NC
| | - A Okrainec
- From the Division of General Surgery, University of Toronto, University Health Network, Toronto Western Hospital, Toronto, the Departments of Surgery and Oncology, University of Western Ontario, London, Ont., and Duke University Medical Center, Durham, NC
| | - M T Perri
- From CSTAR, Division of Thoracic Surgery, University of Western Ontario, London, Ont
| | - A L Trejos
- From CSTAR, Division of Thoracic Surgery, University of Western Ontario, London, Ont
| | - M D Naish
- From CSTAR, Division of Thoracic Surgery, University of Western Ontario, London, Ont
| | - R V Patel
- From CSTAR, Division of Thoracic Surgery, University of Western Ontario, London, Ont
| | - R A Malthaner
- From CSTAR, Division of Thoracic Surgery, University of Western Ontario, London, Ont
| | - J Stanger
- From the Department of Surgery, Cross Cancer Institute, University of Alberta, Edmonton, Alta
| | - K Stewart
- From the Department of Surgery, Cross Cancer Institute, University of Alberta, Edmonton, Alta
| | - Y Yasui
- From the Department of Surgery, Cross Cancer Institute, University of Alberta, Edmonton, Alta
| | - C Cass
- From the Department of Surgery, Cross Cancer Institute, University of Alberta, Edmonton, Alta
| | - S Damaraju
- From the Department of Surgery, Cross Cancer Institute, University of Alberta, Edmonton, Alta
| | - K Graham
- From the Department of Surgery, Cross Cancer Institute, University of Alberta, Edmonton, Alta
| | - S Bharadwaj
- From the Department of Surgery, University of Manitoba, Winnipeg, Man
| | - S Srinathan
- From the Department of Surgery, University of Manitoba, Winnipeg, Man
| | - L Tan
- From the Department of Surgery, University of Manitoba, Winnipeg, Man
| | - H Unruh
- From the Department of Surgery, University of Manitoba, Winnipeg, Man
| | - C Finley
- From the Division of Thoracic Surgery, Department of Surgery, University of Toronto, Toronto, Ont
| | - L Miller
- From the Division of Thoracic Surgery, Department of Surgery, University of Toronto, Toronto, Ont
| | - L E Ferri
- From the Division of Thoracic Surgery, Department of Surgery, University of Toronto, Toronto, Ont
| | - D R Urbach
- From the Division of Thoracic Surgery, Department of Surgery, University of Toronto, Toronto, Ont
| | - G Darling
- From the Division of Thoracic Surgery, Department of Surgery, University of Toronto, Toronto, Ont
| | - J Spicer
- From the Division of Thoracic Surgery, McGill University Health Centre, Montréal, Que
| | - S Ergun
- From the Division of Thoracic Surgery, McGill University Health Centre, Montréal, Que
| | - B McDonald
- From the Division of Thoracic Surgery, McGill University Health Centre, Montréal, Que
| | - M Rousseau
- From the Division of Thoracic Surgery, McGill University Health Centre, Montréal, Que
| | - P Kaneva
- From the Division of Thoracic Surgery, McGill University Health Centre, Montréal, Que
| | - L E Ferri
- From the Division of Thoracic Surgery, McGill University Health Centre, Montréal, Que
| | - J Spicer
- From the Division of Thoracic Surgery, Department of Pathology, McGill University Health Centre, Montréal, Que
| | - A Andalib
- From the Division of Thoracic Surgery, Department of Pathology, McGill University Health Centre, Montréal, Que
| | - C Benay
- From the Division of Thoracic Surgery, Department of Pathology, McGill University Health Centre, Montréal, Que
| | - M Rousseau
- From the Division of Thoracic Surgery, Department of Pathology, McGill University Health Centre, Montréal, Que
| | - Y Kushner
- From the Division of Thoracic Surgery, Department of Pathology, McGill University Health Centre, Montréal, Que
| | - V Marcus
- From the Division of Thoracic Surgery, Department of Pathology, McGill University Health Centre, Montréal, Que
| | - L E Ferri
- From the Division of Thoracic Surgery, Department of Pathology, McGill University Health Centre, Montréal, Que
| | - I Hunt
- From the Division of Thoracic Surgery, Departments of Surgery and Cardiology, University of Alberta, Institute of Health Economics, Edmonton, Alta
| | - S Gazala
- From the Division of Thoracic Surgery, Departments of Surgery and Cardiology, University of Alberta, Institute of Health Economics, Edmonton, Alta
| | - R Razzak
- From the Division of Thoracic Surgery, Departments of Surgery and Cardiology, University of Alberta, Institute of Health Economics, Edmonton, Alta
| | - A Chuck
- From the Division of Thoracic Surgery, Departments of Surgery and Cardiology, University of Alberta, Institute of Health Economics, Edmonton, Alta
| | - A Valji
- From the Division of Thoracic Surgery, Departments of Surgery and Cardiology, University of Alberta, Institute of Health Economics, Edmonton, Alta
| | - K Stewart
- From the Division of Thoracic Surgery, Departments of Surgery and Cardiology, University of Alberta, Institute of Health Economics, Edmonton, Alta
| | - R Tsuyuki
- From the Division of Thoracic Surgery, Departments of Surgery and Cardiology, University of Alberta, Institute of Health Economics, Edmonton, Alta
| | - E L R Bédard
- From the Division of Thoracic Surgery, Departments of Surgery and Cardiology, University of Alberta, Institute of Health Economics, Edmonton, Alta
| | - D A Bottoni
- From the Division of Thoracic Surgery, London Health Sciences Centre, University of Western Ontario, London, Ont
| | - G Campbell
- From the Division of Thoracic Surgery, London Health Sciences Centre, University of Western Ontario, London, Ont
| | - R A Malthaner
- From the Division of Thoracic Surgery, London Health Sciences Centre, University of Western Ontario, London, Ont
| | - M Rousseau
- From the McGill University Health Centre, Montréal, Que
| | - P Guevremont
- From the McGill University Health Centre, Montréal, Que
| | - M Chasen
- From the McGill University Health Centre, Montréal, Que
| | - J Spicer
- From the McGill University Health Centre, Montréal, Que
| | - E Eckert
- From the McGill University Health Centre, Montréal, Que
| | - T Alcindor
- From the McGill University Health Centre, Montréal, Que
| | - S Ades
- From the McGill University Health Centre, Montréal, Que
| | - L E Ferri
- From the McGill University Health Centre, Montréal, Que
| | - R McGory
- From the Division of Thoracic Surgery, London Health Sciences Centre, London, Ont
| | - D Nagpal
- From the Division of Thoracic Surgery, London Health Sciences Centre, London, Ont
| | - D Fortin
- From the Division of Thoracic Surgery, London Health Sciences Centre, London, Ont
| | - R I Inculet
- From the Division of Thoracic Surgery, London Health Sciences Centre, London, Ont
| | - R A Malthaner
- From the Division of Thoracic Surgery, London Health Sciences Centre, London, Ont
| | - M Ko
- From the Division of Thoracic Surgery, St. Joseph's Health Centre, University of Toronto, Toronto, Ont
| | - Y Shargall
- From the Division of Thoracic Surgery, St. Joseph's Health Centre, University of Toronto, Toronto, Ont
| | - C Compeau
- From the Division of Thoracic Surgery, St. Joseph's Health Centre, University of Toronto, Toronto, Ont
| | - R Razzak
- From the Division of Thoracic Surgery, University of Alberta, Edmonton, Alta
| | - S Gazala
- From the Division of Thoracic Surgery, University of Alberta, Edmonton, Alta
| | - I Hunt
- From the Division of Thoracic Surgery, University of Alberta, Edmonton, Alta
| | - J Veenstra
- From the Division of Thoracic Surgery, University of Alberta, Edmonton, Alta
| | - A Valji
- From the Division of Thoracic Surgery, University of Alberta, Edmonton, Alta
| | - K Stewart
- From the Division of Thoracic Surgery, University of Alberta, Edmonton, Alta
| | - E L R Bédard
- From the Division of Thoracic Surgery, University of Alberta, Edmonton, Alta
| | - P J Davis
- From the Division of General Surgery, Department of Surgery, The Moncton Hospital, Moncton, NB, and Dalhousie University, Halifax, NS
| | - M Mancuso
- From the Division of General Surgery, Department of Surgery, The Moncton Hospital, Moncton, NB, and Dalhousie University, Halifax, NS
| | - A A Mujoomdar
- From the Division of General Surgery, Department of Surgery, The Moncton Hospital, Moncton, NB, and Dalhousie University, Halifax, NS
| | - S Gazala
- From the University of Alberta, Edmonton, Alta
| | | | - L Lee
- From the Division of Thoracic Surgery, McGill University Health Centre, Montréal, Que
| | - J Spicer
- From the Division of Thoracic Surgery, McGill University Health Centre, Montréal, Que
| | - C Robineau
- From the Division of Thoracic Surgery, McGill University Health Centre, Montréal, Que
| | - C Sirois
- From the Division of Thoracic Surgery, McGill University Health Centre, Montréal, Que
| | - D Mulder
- From the Division of Thoracic Surgery, McGill University Health Centre, Montréal, Que
| | - L E Ferri
- From the Division of Thoracic Surgery, McGill University Health Centre, Montréal, Que
| | - J Cools-Lartigue
- From the Departments of Surgery, Pathology and Medicine, McGill University, Montréal, Que
| | - S-Y Chang
- From the Departments of Surgery, Pathology and Medicine, McGill University, Montréal, Que
| | - S Mayrand
- From the Departments of Surgery, Pathology and Medicine, McGill University, Montréal, Que
| | - V Marcus
- From the Departments of Surgery, Pathology and Medicine, McGill University, Montréal, Que
| | - G M Fried
- From the Departments of Surgery, Pathology and Medicine, McGill University, Montréal, Que
| | - L E Ferri
- From the Departments of Surgery, Pathology and Medicine, McGill University, Montréal, Que
| | - T Perry
- From the Departments of Surgery and Diagnostic Imaging, University of Alberta, Edmonton, Alta
| | - I Hunt
- From the Departments of Surgery and Diagnostic Imaging, University of Alberta, Edmonton, Alta
| | - M Allegretto
- From the Departments of Surgery and Diagnostic Imaging, University of Alberta, Edmonton, Alta
| | - C Maguire
- From the Departments of Surgery and Diagnostic Imaging, University of Alberta, Edmonton, Alta
| | - J Abele
- From the Departments of Surgery and Diagnostic Imaging, University of Alberta, Edmonton, Alta
| | - D Williams
- From the Departments of Surgery and Diagnostic Imaging, University of Alberta, Edmonton, Alta
| | - K Stewart
- From the Departments of Surgery and Diagnostic Imaging, University of Alberta, Edmonton, Alta
| | - E L R Bédard
- From the Departments of Surgery and Diagnostic Imaging, University of Alberta, Edmonton, Alta
| | - H S Grover
- From the Division of Thoracic Surgery, Department of Surgery, William Osler Health Centre, Brampton, McMaster University, Hamilton, Ont
| | - S Basi
- From the Division of Thoracic Surgery, Department of Surgery, William Osler Health Centre, Brampton, McMaster University, Hamilton, Ont
| | - P Chiasson
- From the Division of Thoracic Surgery, Department of Surgery, William Osler Health Centre, Brampton, McMaster University, Hamilton, Ont
| | - S Basi
- From the Division of Thoracic Surgery, Department of Surgery, William Osler Health Centre, Brampton, McMaster University, Hamilton, Ont
| | - W Gregory
- From the Division of Thoracic Surgery, Department of Surgery, William Osler Health Centre, Brampton, McMaster University, Hamilton, Ont
| | - K Irshad
- From the Division of Thoracic Surgery, Department of Surgery, William Osler Health Centre, Brampton, McMaster University, Hamilton, Ont
| | - C Schieman
- From the Division of Thoracic Surgery, Departments of Surgery and Diagnostic Imaging, University of Calgary, Calgary, Alta
| | - J H MacGregor
- From the Division of Thoracic Surgery, Departments of Surgery and Diagnostic Imaging, University of Calgary, Calgary, Alta
| | - E Kelly
- From the Division of Thoracic Surgery, Departments of Surgery and Diagnostic Imaging, University of Calgary, Calgary, Alta
| | - G Gelfand
- From the Division of Thoracic Surgery, Departments of Surgery and Diagnostic Imaging, University of Calgary, Calgary, Alta
| | - A J Graham
- From the Division of Thoracic Surgery, Departments of Surgery and Diagnostic Imaging, University of Calgary, Calgary, Alta
| | - S P McFadden
- From the Division of Thoracic Surgery, Departments of Surgery and Diagnostic Imaging, University of Calgary, Calgary, Alta
| | - S C Grondin
- From the Division of Thoracic Surgery, Departments of Surgery and Diagnostic Imaging, University of Calgary, Calgary, Alta
| | - K P Croome
- From the Department of General Surgery, University of Western Ontario, London, Ont., Center for Transplant Outcomes and Quality Improvement, The Transplant Institute, Beth Israel Deaconess Medical Center, and the Department of Epidemiology, Harvard University, Boston, Mass
| | - R Chudzinski
- From the Department of General Surgery, University of Western Ontario, London, Ont., Center for Transplant Outcomes and Quality Improvement, The Transplant Institute, Beth Israel Deaconess Medical Center, and the Department of Epidemiology, Harvard University, Boston, Mass
| | - D W Hanto
- From the Department of General Surgery, University of Western Ontario, London, Ont., Center for Transplant Outcomes and Quality Improvement, The Transplant Institute, Beth Israel Deaconess Medical Center, and the Department of Epidemiology, Harvard University, Boston, Mass
| | - M H Jamal
- From the Department of Surgery, McGill University Health Centre, Montréal, Que., School of Population Health, University of Queensland, Brisbane, Australia
| | - S A Doi
- From the Department of Surgery, McGill University Health Centre, Montréal, Que., School of Population Health, University of Queensland, Brisbane, Australia
| | - J S Barkun
- From the Department of Surgery, McGill University Health Centre, Montréal, Que., School of Population Health, University of Queensland, Brisbane, Australia
| | - S L Wong
- From the Department of Surgery, Health Science Centre, St. John's, NL
| | - A H L Kwan
- From the Department of Surgery, Health Science Centre, St. John's, NL
| | - S Yang
- From the Sunnybrook Health Sciences Centre, Toronto, Ont
| | - C Law
- From the Sunnybrook Health Sciences Centre, Toronto, Ont
| | - Y Luo
- From the Hôtel-Dieu Grace Hospital, Windsor, Ont
| | - J Spiers
- From the Hôtel-Dieu Grace Hospital, Windsor, Ont
| | - A Forse
- From the Hôtel-Dieu Grace Hospital, Windsor, Ont
| | - W Taylor
- From the Hôtel-Dieu Grace Hospital, Windsor, Ont
| | - I Apriasz
- From the Departments of General Surgery and Gastroenterology, London Health Sciences Centre, University of Western Ontario, London, Ont
| | - B Mysliwiec
- From the Departments of General Surgery and Gastroenterology, London Health Sciences Centre, University of Western Ontario, London, Ont
| | - N Sarin
- From the Departments of General Surgery and Gastroenterology, London Health Sciences Centre, University of Western Ontario, London, Ont
| | - J Gregor
- From the Departments of General Surgery and Gastroenterology, London Health Sciences Centre, University of Western Ontario, London, Ont
| | - C E Moulton
- From Cancer Care Ontario HPB Surgical Oncology Community of Practice, Department of Surgery, University of Toronto, Surgical Oncology Program, Cancer Care Ontario, Toronto, Ont
| | - R S McLeod
- From Cancer Care Ontario HPB Surgical Oncology Community of Practice, Department of Surgery, University of Toronto, Surgical Oncology Program, Cancer Care Ontario, Toronto, Ont
| | - H Barnett
- From Cancer Care Ontario HPB Surgical Oncology Community of Practice, Department of Surgery, University of Toronto, Surgical Oncology Program, Cancer Care Ontario, Toronto, Ont
| | - C Nhan
- From Cancer Care Ontario HPB Surgical Oncology Community of Practice, Department of Surgery, University of Toronto, Surgical Oncology Program, Cancer Care Ontario, Toronto, Ont
| | - S Gallinger
- From Cancer Care Ontario HPB Surgical Oncology Community of Practice, Department of Surgery, University of Toronto, Surgical Oncology Program, Cancer Care Ontario, Toronto, Ont
| | - S V Demyttenaere
- From the Department of Surgery, Ohio State University Medical Centre, Columbus, Ohio
| | - P Nau
- From the Department of Surgery, Ohio State University Medical Centre, Columbus, Ohio
| | - P Muscarella
- From the Department of Surgery, Ohio State University Medical Centre, Columbus, Ohio
| | - W S Melvin
- From the Department of Surgery, Ohio State University Medical Centre, Columbus, Ohio
| | - E C Ellison
- From the Department of Surgery, Ohio State University Medical Centre, Columbus, Ohio
| | - S M Wiseman
- From St. Paul's Hospital, Department of Surgery, University of British Columbia, Vancouver, BC
| | - A L Melck
- From St. Paul's Hospital, Department of Surgery, University of British Columbia, Vancouver, BC
| | - K M Davidge
- From the Divisions of Plastic, Orthopedic, and General Surgery, University of Toronto, Toronto, Ont
| | - C Eskicioglu
- From the Divisions of Plastic, Orthopedic, and General Surgery, University of Toronto, Toronto, Ont
| | - J Lipa
- From the Divisions of Plastic, Orthopedic, and General Surgery, University of Toronto, Toronto, Ont
| | - P Ferguson
- From the Divisions of Plastic, Orthopedic, and General Surgery, University of Toronto, Toronto, Ont
| | - C J Swallow
- From the Divisions of Plastic, Orthopedic, and General Surgery, University of Toronto, Toronto, Ont
| | - F C Wright
- From the Divisions of Plastic, Orthopedic, and General Surgery, University of Toronto, Toronto, Ont
| | - J P Edwards
- From the Department of Surgery, Medicine, Community Health Sciences, Health Information Network Calgary, Centre for Health Policy Studies, University of Calgary, Calgary, Alta
| | - E J Kelly
- From the Department of Surgery, Medicine, Community Health Sciences, Health Information Network Calgary, Centre for Health Policy Studies, University of Calgary, Calgary, Alta
| | - Y Lin
- From the Department of Surgery, Medicine, Community Health Sciences, Health Information Network Calgary, Centre for Health Policy Studies, University of Calgary, Calgary, Alta
| | - T Lenders
- From the Department of Surgery, Medicine, Community Health Sciences, Health Information Network Calgary, Centre for Health Policy Studies, University of Calgary, Calgary, Alta
| | - W A Ghali
- From the Department of Surgery, Medicine, Community Health Sciences, Health Information Network Calgary, Centre for Health Policy Studies, University of Calgary, Calgary, Alta
| | - A Graham
- From the Department of Surgery, Medicine, Community Health Sciences, Health Information Network Calgary, Centre for Health Policy Studies, University of Calgary, Calgary, Alta
| | - V Francescutti
- From the Division of General Surgery, Department of Medical Oncology, McMaster University, Hamilton, Ont
| | - F Farrokhyar
- From the Division of General Surgery, Department of Medical Oncology, McMaster University, Hamilton, Ont
| | - R Tozer
- From the Division of General Surgery, Department of Medical Oncology, McMaster University, Hamilton, Ont
| | - B Heller
- From the Division of General Surgery, Department of Medical Oncology, McMaster University, Hamilton, Ont
| | - P Lovrics
- From the Division of General Surgery, Department of Medical Oncology, McMaster University, Hamilton, Ont
| | - G Jansz
- From the Division of General Surgery, Department of Medical Oncology, McMaster University, Hamilton, Ont
| | - K Kahnamoui
- From the Division of General Surgery, Department of Medical Oncology, McMaster University, Hamilton, Ont
| | - G Spiegle
- From the Department of Surgery, Toronto General Hospital, Sunnybrook Health Science Centre, Mount Sinai Hospital, University of Toronto, Toronto, Ont
| | - S Schmocker
- From the Department of Surgery, Toronto General Hospital, Sunnybrook Health Science Centre, Mount Sinai Hospital, University of Toronto, Toronto, Ont
| | - H Huang
- From the Department of Surgery, Toronto General Hospital, Sunnybrook Health Science Centre, Mount Sinai Hospital, University of Toronto, Toronto, Ont
| | - C Victor
- From the Department of Surgery, Toronto General Hospital, Sunnybrook Health Science Centre, Mount Sinai Hospital, University of Toronto, Toronto, Ont
| | - C Law
- From the Department of Surgery, Toronto General Hospital, Sunnybrook Health Science Centre, Mount Sinai Hospital, University of Toronto, Toronto, Ont
| | - E D Kennedy
- From the Department of Surgery, Toronto General Hospital, Sunnybrook Health Science Centre, Mount Sinai Hospital, University of Toronto, Toronto, Ont
| | - J A McCart
- From the Department of Surgery, Toronto General Hospital, Sunnybrook Health Science Centre, Mount Sinai Hospital, University of Toronto, Toronto, Ont
| | - N Aslani
- From the British Columbia Cancer Agency, Vancouver, BC
| | - T Swanson
- From the British Columbia Cancer Agency, Vancouver, BC
| | - H Kennecke
- From the British Columbia Cancer Agency, Vancouver, BC
| | - R Woods
- From the British Columbia Cancer Agency, Vancouver, BC
| | - N Davis
- From the British Columbia Cancer Agency, Vancouver, BC
| | - A E Klevan
- From the Departments of Surgery, Pathology and Molecular Medicine, Hamilton Health Sciences, McMaster University, Hamilton, Ont
| | - J A Ramsay
- From the Departments of Surgery, Pathology and Molecular Medicine, Hamilton Health Sciences, McMaster University, Hamilton, Ont
| | - W J Stephen
- From the Departments of Surgery, Pathology and Molecular Medicine, Hamilton Health Sciences, McMaster University, Hamilton, Ont
| | - M Smith
- From the Division of General Surgery, Dalhousie University, Halifax, NS
| | - M Plourde
- From the Division of General Surgery, Dalhousie University, Halifax, NS
| | - P M Johnson
- From the Division of General Surgery, Dalhousie University, Halifax, NS
| | - P Yaffe
- From the Departments of Medical Sciences, Surgery, Pathology, and Microbiology and Immunology, Dalhousie University, Halifax, NS
| | - M Walsh
- From the Departments of Medical Sciences, Surgery, Pathology, and Microbiology and Immunology, Dalhousie University, Halifax, NS
| | - D Hoskin
- From the Departments of Medical Sciences, Surgery, Pathology, and Microbiology and Immunology, Dalhousie University, Halifax, NS
| | - H P Huynh
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - D C Trottier
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - C Soto
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - R Auer
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - E C Poulin
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - J Mamazza
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - R P Boushey
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - H Moloo
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - H P Huynh
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - D C Trottier
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - C Soto
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - H Moloo
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - E C Poulin
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - J Mamazza
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - R P Boushey
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - C Nhan
- From the Surgical Oncology Program, Cancer Care Ontario, the Department of Surgery, University of Toronto, Toronto, and the Department of Pathology, University of Western Ontario, London, Ont
| | - D K Driman
- From the Surgical Oncology Program, Cancer Care Ontario, the Department of Surgery, University of Toronto, Toronto, and the Department of Pathology, University of Western Ontario, London, Ont
| | - A J Smith
- From the Surgical Oncology Program, Cancer Care Ontario, the Department of Surgery, University of Toronto, Toronto, and the Department of Pathology, University of Western Ontario, London, Ont
| | - A Hunter
- From the Surgical Oncology Program, Cancer Care Ontario, the Department of Surgery, University of Toronto, Toronto, and the Department of Pathology, University of Western Ontario, London, Ont
| | - R S McLeod
- From the Surgical Oncology Program, Cancer Care Ontario, the Department of Surgery, University of Toronto, Toronto, and the Department of Pathology, University of Western Ontario, London, Ont
| | - C Eskicioglu
- From the Division of General Surgery, University of Toronto, Toronto, Ont
| | - D S Fenech
- From the Division of General Surgery, University of Toronto, Toronto, Ont
| | - C Victor
- From the Division of General Surgery, University of Toronto, Toronto, Ont
| | - R S McLeod
- From the Division of General Surgery, University of Toronto, Toronto, Ont
| | - D C Trottier
- From the Department of Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ont
| | - H Huynh
- From the Department of Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ont
| | - E Sabri
- From the Department of Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ont
| | - C Soto
- From the Department of Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ont
| | - A Scheer
- From the Department of Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ont
| | - S Zolfaghari
- From the Department of Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ont
| | - H Moloo
- From the Department of Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ont
| | - J Mamazza
- From the Department of Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ont
| | - E C Poulin
- From the Department of Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ont
| | - R P Boushey
- From the Department of Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ont
| | - J Hallet
- From the Centre de chirurgie minimalement invasive de Québec, Centre hospitalier universitaire de Québec, Université Laval, Québec, Que
| | - M Guénette-Lemieux
- From the Centre de chirurgie minimalement invasive de Québec, Centre hospitalier universitaire de Québec, Université Laval, Québec, Que
| | - A Bouchard
- From the Centre de chirurgie minimalement invasive de Québec, Centre hospitalier universitaire de Québec, Université Laval, Québec, Que
| | - R C Grégoire
- From the Centre de chirurgie minimalement invasive de Québec, Centre hospitalier universitaire de Québec, Université Laval, Québec, Que
| | - C Thibault
- From the Centre de chirurgie minimalement invasive de Québec, Centre hospitalier universitaire de Québec, Université Laval, Québec, Que
| | - G Dionne
- From the Centre de chirurgie minimalement invasive de Québec, Centre hospitalier universitaire de Québec, Université Laval, Québec, Que
| | - F Côté
- From the Centre de chirurgie minimalement invasive de Québec, Centre hospitalier universitaire de Québec, Université Laval, Québec, Que
| | - P Langis
- From the Centre de chirurgie minimalement invasive de Québec, Centre hospitalier universitaire de Québec, Université Laval, Québec, Que
| | - J-P Gagné
- From the Centre de chirurgie minimalement invasive de Québec, Centre hospitalier universitaire de Québec, Université Laval, Québec, Que
| | - M J Raval
- From the Department of Surgery, St. Paul's Hospital and University of British Columbia, Vancouver, BC
| | - P T Phang
- From the Department of Surgery, St. Paul's Hospital and University of British Columbia, Vancouver, BC
| | - C J Brown
- From the Department of Surgery, St. Paul's Hospital and University of British Columbia, Vancouver, BC
| | - A Kuzmanovic
- From the Department of Surgery, St. Paul's Hospital and University of British Columbia, Vancouver, BC
| | - A Planting
- From the Department of Colorectal Surgery, St. Paul's Hospital, University of British Columbia, Vancouver, BC
| | - M J Raval
- From the Department of Colorectal Surgery, St. Paul's Hospital, University of British Columbia, Vancouver, BC
| | - P T Phang
- From the Department of Colorectal Surgery, St. Paul's Hospital, University of British Columbia, Vancouver, BC
| | - C J Brown
- From the Department of Colorectal Surgery, St. Paul's Hospital, University of British Columbia, Vancouver, BC
| | - H P Huynh
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - D C Trottier
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - H Moloo
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - E C Poulin
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - J Mamazza
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - M Friedlich
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - H S Stern
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - R P Boushey
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - B Q Tang
- From the Department of Surgery, Division of General Surgery, Royal Jubilee Hospital, Vancouver Island Health Authority, Victoria, BC
| | - H Moloo
- From the Department of Colorectal Surgery, University of Minnesota, Minneapolis, Minn., the Department of Surgery, University of Ottawa, Ottawa, Ont., and the Department of Colorectal Surgery, University of Pennsylvania, Philadelphia, Pa
| | - J Bleier
- From the Department of Colorectal Surgery, University of Minnesota, Minneapolis, Minn., the Department of Surgery, University of Ottawa, Ottawa, Ont., and the Department of Colorectal Surgery, University of Pennsylvania, Philadelphia, Pa
| | - S M Goldberg
- From the Department of Colorectal Surgery, University of Minnesota, Minneapolis, Minn., the Department of Surgery, University of Ottawa, Ottawa, Ont., and the Department of Colorectal Surgery, University of Pennsylvania, Philadelphia, Pa
| | - J Alsharif
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - G Martel
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - A Bouchard
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - E Sabri
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - C R Ramsay
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - J Mamazza
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - E C Poulin
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - R P Boushey
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - D Richardson
- From the Division of General Surgery, Dalhousie University, Halifax, NS
| | - G Porter
- From the Division of General Surgery, Dalhousie University, Halifax, NS
| | - P Johnson
- From the Division of General Surgery, Dalhousie University, Halifax, NS
| | - E Al-Sukhni
- From the Mount Sinai Hospital, University of Toronto, Toronto, Ont
| | - P F Ridgway
- From the Mount Sinai Hospital, University of Toronto, Toronto, Ont
| | - B O'Connor
- From the Mount Sinai Hospital, University of Toronto, Toronto, Ont
| | - R S McLeod
- From the Mount Sinai Hospital, University of Toronto, Toronto, Ont
| | - C J Swallow
- From the Mount Sinai Hospital, University of Toronto, Toronto, Ont
| | - S S Forbes
- From the Department of Surgery, University of Toronto, Toronto, Ont
| | - D R Urbach
- From the Department of Surgery, University of Toronto, Toronto, Ont
| | - R Sutradhar
- From the Department of Surgery, University of Toronto, Toronto, Ont
| | - L Paszat
- From the Department of Surgery, University of Toronto, Toronto, Ont
| | - L Rabeneck
- From the Department of Surgery, University of Toronto, Toronto, Ont
| | - N N Baxter
- From the Department of Surgery, University of Toronto, Toronto, Ont
| | - W Chung
- From the Division of General Surgery, St. Paul's Hospital, University of British Columbia, Vancouver, BC
| | - D Ko
- From the Division of General Surgery, St. Paul's Hospital, University of British Columbia, Vancouver, BC
| | - C Sun
- From the Division of General Surgery, St. Paul's Hospital, University of British Columbia, Vancouver, BC
| | - C J Brown
- From the Division of General Surgery, St. Paul's Hospital, University of British Columbia, Vancouver, BC
| | - M Raval
- From the Division of General Surgery, St. Paul's Hospital, University of British Columbia, Vancouver, BC
| | - P T Phang
- From the Division of General Surgery, St. Paul's Hospital, University of British Columbia, Vancouver, BC
| | - J S Pao
- From the Department of Surgery, St. Paul's Hospital, BC Cancer Agency, Vancouver, BC
| | - R Woods
- From the Department of Surgery, St. Paul's Hospital, BC Cancer Agency, Vancouver, BC
| | - M J Raval
- From the Department of Surgery, St. Paul's Hospital, BC Cancer Agency, Vancouver, BC
| | - P T Phang
- From the Department of Surgery, St. Paul's Hospital, BC Cancer Agency, Vancouver, BC
| | - C J Brown
- From the Department of Surgery, St. Paul's Hospital, BC Cancer Agency, Vancouver, BC
| | - A Power
- From the Department of Surgery, McMaster University, Hamilton, Ont
| | - V Francescutti
- From the Department of Surgery, McMaster University, Hamilton, Ont
| | - D Ramsey
- From the Department of Surgery, McMaster University, Hamilton, Ont
| | - S Kelly
- From the Department of Surgery, McMaster University, Hamilton, Ont
| | - W Stephen
- From the Department of Surgery, McMaster University, Hamilton, Ont
| | - M Simunovic
- From the Department of Surgery, Clinical Epidemiology and Biostatistics, Hamilton Health Sciences, McMaster University, Hamilton, Ont
| | - A Coates
- From the Department of Surgery, Clinical Epidemiology and Biostatistics, Hamilton Health Sciences, McMaster University, Hamilton, Ont
| | - C H Goldsmith
- From the Department of Surgery, Clinical Epidemiology and Biostatistics, Hamilton Health Sciences, McMaster University, Hamilton, Ont
| | - L Thabane
- From the Department of Surgery, Clinical Epidemiology and Biostatistics, Hamilton Health Sciences, McMaster University, Hamilton, Ont
| | - D Reeson
- From the Department of Surgery, Clinical Epidemiology and Biostatistics, Hamilton Health Sciences, McMaster University, Hamilton, Ont
| | - A J Smith
- From the Department of Surgery, Clinical Epidemiology and Biostatistics, Hamilton Health Sciences, McMaster University, Hamilton, Ont
| | - R S McLeod
- From the Department of Surgery, Clinical Epidemiology and Biostatistics, Hamilton Health Sciences, McMaster University, Hamilton, Ont
| | - F DeNardi
- From the Department of Surgery, Clinical Epidemiology and Biostatistics, Hamilton Health Sciences, McMaster University, Hamilton, Ont
| | - T J Whelan
- From the Department of Surgery, Clinical Epidemiology and Biostatistics, Hamilton Health Sciences, McMaster University, Hamilton, Ont
| | - M N Levine
- From the Department of Surgery, Clinical Epidemiology and Biostatistics, Hamilton Health Sciences, McMaster University, Hamilton, Ont
| | - K A Al-Khayal
- From the Department of Surgery, University of Calgary, Calgary, Alta
| | - W D Buie
- From the Department of Surgery, University of Calgary, Calgary, Alta
| | - L Wallace
- From the Department of Surgery, University of Calgary, Calgary, Alta
| | - D Sigalet
- From the Department of Surgery, University of Calgary, Calgary, Alta
| | - C Eskicioglu
- From the Division of General Surgery, University of Toronto, Toronto, Ont
| | - A Gagliardi
- From the Division of General Surgery, University of Toronto, Toronto, Ont
| | - D S Fenech
- From the Division of General Surgery, University of Toronto, Toronto, Ont
| | - C Victor
- From the Division of General Surgery, University of Toronto, Toronto, Ont
| | - R S McLeod
- From the Division of General Surgery, University of Toronto, Toronto, Ont
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Burnell MJ, O'Connor EM, Chapman JW, Levine MN, Pritchard KI, O'Brien PS, Howarth KJ, Ding Z, Whelan TJ, Shepherd LE. Triple-negative receptor status and prognosis in the NCIC CTG MA. 21 adjuvant breast cancer trial. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.550] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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20
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Pollak MN, Chapman JW, Pritchard KI, Krook JE, Dhaliwal HS, Vandenberg TA, Norris BD, Whelan TJ, Wilson CF, Shepherd LE. NCIC-CTG MA14 Trial: Tamoxifen (tam) vs. tam + octreotide (oct) for adjuvant treatment of stage I or II postmenopausal breast cancer. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.532] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Dayes IS, Levine MN, Julian JA, Pritchard KI, D'Souza DP, Kligman L, Reise D, Wiernikowski JA, Bonilla L, Whelan TJ. Lymphedema in women with breast cancer: characteristics of patients screened for a randomized trial. Breast Cancer Res Treat 2007; 110:337-42. [PMID: 17851756 DOI: 10.1007/s10549-007-9727-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2007] [Accepted: 07/31/2007] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Accrual rates for a randomized trial of decongestive therapy in breast cancer patients with lymphedema were lower than anticipated. In two centres, patients presenting to lymphedema clinic were screened for eligibility to understand the accrual process and help define the patient population. MATERIALS AND METHODS All breast cancer patients presenting to two lymphedema clinics in regional cancer centres were screened for study entry. Circumferential arm measurements were taken and volumes calculated. Patients were then screened for trial eligibility. All report forms were sent to the trial coordinating centre. RESULTS A total of 408 patients were screened. Median arm volume excess was 239 ml (9.5%). One third of patients had little or no excess volume. Only 28.3% of patients had sufficient excess volume for trial eligibility. Of these, a significant number of patients were excluded because of active malignancy or previous decongestive therapy. CONCLUSIONS The finding of moderate to severe lymphedema observed in clinics screening for trial eligibility was less than expected. The natural history of lymphedema in breast cancer patients is potentially changing. Some patients may be presenting with sensory changes suggestive of lymphedema but due to other causes, such as nerve disruption following axillary dissection.
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Affiliation(s)
- Ian S Dayes
- Department of Oncology, McMaster University, Hamilton, Ontario, Canada.
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Ellis PM, Dimitry S, Charles C, O’Brien M, Whelan TJ. What can physicians do to promote patient involvement in decision making (DM) in the oncology consultation? J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.19553] [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
19553 Background: Facilitating patient involvement in TDM is a desirable feature of the oncology consultation. Greater patient involvement in TDM may lead to improved patient satisfaction, compliance and reduced psychological morbidity. However, there is little empiric evidence defining physician behaviors and attributes that facilitate patient involvement in TDM. This study used qualitative methods to identify such behaviors and attributes suggested by both practicing oncologists and patients. Methods: Semi-structured interviews were conducted with 11 medical, 10 radiation oncologists and 19 patients with breast, lung, GI, or GU cancer to determine physician behaviors and attributes that facilitate patient involvement in TDM. Interviews were audiotaped and transcribed verbatim, then analyzed independently by two researchers using inductively derived coding categories and predetermined coding rules. Behaviors and attributes were identified and coded into common themes. Six focus groups with an additional 37 patients were conducted to review these behaviors and attributes. Results: A total of 231 individual physician behaviors and attributes were identified by physicians (179) and patients (52) that facilitate patient involvement in DM. Common behaviors and attributes identified from the interviews include: assessing patient’s understanding and preferences, providing information, explaining the DM process, providing information on treatment options, allowing time to consider treatment options, checking patient understanding of options and inviting patient input into decisions. Other behaviors such as physicians’ communication skills were reported as facilitating TDM. Specific physician personality attributes, such as empathy, were identified as important facilitators. Conclusions: Physicians and patients identify a large number of physician behaviors and attributes that may facilitate patient involvement in TDM. These include both behaviors that are important in general physician-patient communication, as well as those that are specifically related to the decision making process. Further research is ongoing to determine the importance of these factors and approaches to encourage their use in the oncology consultation. No significant financial relationships to disclose.
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Affiliation(s)
- P. M. Ellis
- Juravinski Cancer Centre, Hamilton, ON, Canada; McMaster University, Hamilton, ON, Canada
| | - S. Dimitry
- Juravinski Cancer Centre, Hamilton, ON, Canada; McMaster University, Hamilton, ON, Canada
| | - C. Charles
- Juravinski Cancer Centre, Hamilton, ON, Canada; McMaster University, Hamilton, ON, Canada
| | - M. O’Brien
- Juravinski Cancer Centre, Hamilton, ON, Canada; McMaster University, Hamilton, ON, Canada
| | - T. J. Whelan
- Juravinski Cancer Centre, Hamilton, ON, Canada; McMaster University, Hamilton, ON, Canada
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Whelan TJ, Gafni A, Julian J, Sebaldt RJ, Tozer R, Heller B, Ellis P, Hodgson N, Mukherjee S, Levine MN. A randomized trial of computer and pamphlet-based versions of the Decision Board (DB). J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.6508] [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
6508 Background: Many women with breast cancer want to be involved in treatment decision making. The DB is a visual aid poster board which sequentially presents written and graphical information from clinical trials regarding treatment options for early breast cancer. The physician presents the DB to the patient during the consultation. Randomized trials have demonstrated that the standard version of the DB improves patient comprehension, satisfaction and comfort with decision making. The standard DB is cumbersome to use and hard to update. Computer based instruments are attractive as they provide more flexibility in presenting information, and can be easily updated and accessed via the Internet. On the other hand pamphlet based versions may be easier to use. We developed computer versions of the DB for breast cancer surgery and adjuvant chemotherapy options using a Windows type format. Pamphlet versions were also developed. The objective of this study was to compare the computer and pamphlet versions of the DB to the proven standard version. Methods: 309 women were randomized to the physician consultation plus the standard (105), computer (103) or pamphlet (101) versions of the DB. Patients were stratified according to type of decision: surgical treatment or adjuvant chemotherapy. Patients were evaluated following the consultation for their knowledge about the breast cancer treatments offered, decisional conflict, and satisfaction with preparation for decision making using established validated instruments. Usefulness of the instrument for the patient and physician was also assessed. Results: Study outcomes were similar between the three versions of the DB ( Table ). Usefulness of the instrument for the patient and physician was also similar for the different versions. Conclusions: The different versions of the DB appeared equally effective in facilitating shared decision making. Physicians and patients now have the option of choosing which instrument best suits their needs. Such versatility may encourage wider use of the DB. No significant financial relationships to disclose. [Table: see text]
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Affiliation(s)
- T. J. Whelan
- McMaster University and Juravinski Cancer Centre, Hamilton, ON, Canada
| | - A. Gafni
- McMaster University and Juravinski Cancer Centre, Hamilton, ON, Canada
| | - J. Julian
- McMaster University and Juravinski Cancer Centre, Hamilton, ON, Canada
| | - R. J. Sebaldt
- McMaster University and Juravinski Cancer Centre, Hamilton, ON, Canada
| | - R. Tozer
- McMaster University and Juravinski Cancer Centre, Hamilton, ON, Canada
| | - B. Heller
- McMaster University and Juravinski Cancer Centre, Hamilton, ON, Canada
| | - P. Ellis
- McMaster University and Juravinski Cancer Centre, Hamilton, ON, Canada
| | - N. Hodgson
- McMaster University and Juravinski Cancer Centre, Hamilton, ON, Canada
| | - S. Mukherjee
- McMaster University and Juravinski Cancer Centre, Hamilton, ON, Canada
| | - M. N. Levine
- McMaster University and Juravinski Cancer Centre, Hamilton, ON, Canada
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Moy B, Tu D, Pater JL, Ingle JN, Shepherd LE, Whelan TJ, Goss PE. Clinical outcomes of ethnic minority women in MA.17: a trial of letrozole after 5 years of tamoxifen in postmenopausal women with early stage breast cancer. Ann Oncol 2006; 17:1637-43. [PMID: 16936184 DOI: 10.1093/annonc/mdl177] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [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: 11/14/2022] Open
Abstract
BACKGROUND Aromatase inhibitors are widely employed in the adjuvant treatment of early stage breast cancer. The impact of aromatase inhibitors has not been established in ethnic minority women. PATIENTS AND METHODS The purpose of this study was to evaluate the impact of letrozole on minority women in MA.17, a placebo-controlled trial of letrozole following 5 years of tamoxifen in postmenopausal women with early stage breast cancer. Retrospective comparison of disease-free survival (DFS), side effects, and mean changes in quality of life (QOL) scores from baseline between Caucasian and minority women was performed. RESULTS Minority (n = 352) and Caucasian (n = 4708) women were analyzed. There was no difference between these groups in DFS (91.6% versus 92.4% respectively for 4 year DFS). Letrozole, compared with placebo, significantly improved DFS for Caucasians (HR = 0.55; P < 0.0001) but not for minorities (HR = 1.39; P = 0.53). Among women who received letrozole, minorities had a significantly lower incidence of hot flashes (49% versus 58%; P = 0.02), fatigue (29% versus 39%; P = 0.005), and arthritis (2% versus 7%; P = 0.006) compared with Caucasians. Mean change in QOL scores for minority women who received letrozole demonstrated improved mental health at the 6-month assessment (P = 0.02) and less bodily pain at the 12-month assessment (P = 0.046). CONCLUSION Letrozole improved DFS in Caucasians but a definite benefit in minority women has not yet been demonstrated. Minority women tolerated letrozole better than Caucasians in terms of toxicity. These results need confirmation in other trials of aromatase inhibitors.
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Affiliation(s)
- B Moy
- Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.
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Dayes IS, Whelan TJ, Julian JA, Kuettel MR, Regmi D, Okawara GS, Patel M, Reiter HI, Dubois S. Cross-border referral for early breast cancer: an analysis of radiation fractionation patterns. Curr Oncol 2006; 13:124-9. [PMID: 17576453 PMCID: PMC1891182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Because of increasing waiting times for adjuvant radiation in the province of Ontario, patients from one Canadian centre were referred to two centres in the United States. This situation provided an opportunity to compare radiation practices.We performed a retrospective review of radiation prescribed to patients following breast-conserving surgery for invasive breast cancer. Patients with positive margins, 4 or more positive lymph nodes, recurrent disease, or large tumours (>5 cm) were excluded. For comparison, we reviewed a random sample of similar patients treated at the Canadian centre during the same period. A total of 120 referred and 217 non-referred patients were eligible for comparison. The analysis included 98 pairs of patients (N = 196), fully matched on age, nodal status, T stage, grade, and estrogen receptor (er) status.Mean patient age was 60.7 years. The median total dose and number of fractions differed between centres [6040 cGy in 32 fractions (United States) vs. 4250 cGy in 16 fractions (Canadian), both p < 0.001). Boost was used more often in the United States (97% vs. 9%, p < 0.001). Variation in prescribing patterns was seen. In the United States, seven different schedules for whole-breast irradiation were used; at the Canadian centre, two schedules were prescribed. Predicted radiobiologic effects of these schedules were calculated to be similar.Differences in fractionation patterns were observed between and within U.S. and Canadian centres. Such variability is likely to affect patient convenience and resource utilization. Although patient selection, referring surgeon, and change in policies may account for some of the observed differences, further research is necessary to better understand the causes.
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Affiliation(s)
- I S Dayes
- Department of Radiation Oncology, Juravinski Cancer Centre; and Department of Medicine, McMaster University, Hamilton, Ontario.
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Ellis PM, Dimitry SJ, O’Brien MA, Charles CA, Whelan TJ. A comparison of patient and physician attributes that promote patient involvement in treatment decision making in the oncology consultation. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.6098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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
6098 Background: Cancer patients have indicted a desire to be more involved in treatment decision making (TDM). However, little is known about the attributes of patients, physicians and their interaction that promotes patient involvement in TDM in the oncology consultation. This study compared attributes generated by patients and physicians that make it easier for patients to be involved in TDM. Methods: Semi-structured interviews were undertaken with 19 patients with cancer (lung, breast, prostate, GI) and 21 medical and radiation oncologists at a regional cancer centre. Participants were asked to identify attributes of physicians, patients and their interaction that promotes patient involvement in TDM. Interview transcripts were independently coded by 2 analysts using decision rules to identify specific attributes. Attributes identified by each analyst were compared and a high level of agreement was found. The analysts then independently compared the physician and patient generated lists and identified common vs unique items. There was a high level of agreement on which attributes were common to both lists versus unique. Results: Oncologists identified 173 physician, 59 patient and 9 interaction items. Patients identified 50 physician, 42 patient and 11 interaction items. Patients and physicians identified 17 common physician items, 29 common patients items and 1 common interaction item. Physicians identified 138 more attributes than patients, most of which were physician related. Common patient attributes centred on information seeking (eg prepare for the consultation by reading, be aware of all treatment options and question the options). Common physician attributes focused on specific communication behaviors (eg, make eye contact, tailor information to patient needs, be direct with patients, ensure patient understands information). The common interaction item was to keep the discussion informal. Conclusions: Patients and physicians appear to have different ideas about what is important to promote patient involvement in TDM. Many of the attributes identified can be easily incorporated into current practice. There is a need to develop and evaluate communication skills training to promote patient involvement in TDM. No significant financial relationships to disclose.
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Affiliation(s)
- P. M. Ellis
- Juravinski Cancer Centre, Hamilton, ON, Canada; McMaster University, Hamilton, ON, Canada
| | - S. J. Dimitry
- Juravinski Cancer Centre, Hamilton, ON, Canada; McMaster University, Hamilton, ON, Canada
| | - M. A. O’Brien
- Juravinski Cancer Centre, Hamilton, ON, Canada; McMaster University, Hamilton, ON, Canada
| | - C. A. Charles
- Juravinski Cancer Centre, Hamilton, ON, Canada; McMaster University, Hamilton, ON, Canada
| | - T. J. Whelan
- Juravinski Cancer Centre, Hamilton, ON, Canada; McMaster University, Hamilton, ON, Canada
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Charles CA, Ellis PM, Dimitry SJ, O’Brien MA, Whelan TJ. Agreement between physicians and patients about what constitutes shared decision making. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.6065] [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
6065 Background: Involving patients in making decisions about their own care is increasingly desirable for patients with serious illness. Shared decision making is one such model, the attributes of which have been well defined (Charles et al., Soc Sci Med,1997,1999). However, it is unclear whether physicians and patients agree on what constitutes a SDM interaction. Methods: Semi-structured interviews were undertaken with 21 medical and radiation oncologists and 14 cancer patients attending a regional cancer centre. Participants were asked what they thought it meant for the patient and physician to share in DM. Responses were compared to the theoretical constructs of SDM defined by Charles et al: information exchange (flow, direction, type, amount), deliberation, and who makes the decision. Two analysts independently reviewed the interviews for patient and physician definitions of SDM and compared these with the Charles et al. model of SDM using explicit classification decision rules. There were few discrepancies between analysts and agreement was reached in all cases. Results: 71% of physicians and 29% of patients described a two-way flow and direction of information exchange as necessary for SDM. Only 24% of physicians and 21% of patients described the exchange of both medical and personal information. All participants indicated that more than the minimum legally required amount of information was needed. 67% of physicians and 36% of patients described both patient and physician involvement in deliberation about treatment as a component of SDM. 48% of physicians and 21% of patients identified both patients and physicians are involved in deciding what treatment to implement in a shared approach. Overall, none of the participant definitions identified all the components of the SDM model. Physicians in their definitions, identified more components than did patients. Conclusions: Physicians appear to have a stronger understanding of the elements involved in SDM. These differences may lead to different expectations about patient involvement in DM. Physicians have a responsibility for ensuring that patients are invited to contribute to all components of SDM in the oncology consultation. No significant financial relationships to disclose.
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Affiliation(s)
- C. A. Charles
- McMaster University, Hamilton, ON, Canada; Juravinski Cancer Centre, Hamilton, ON, Canada
| | - P. M. Ellis
- McMaster University, Hamilton, ON, Canada; Juravinski Cancer Centre, Hamilton, ON, Canada
| | - S. J. Dimitry
- McMaster University, Hamilton, ON, Canada; Juravinski Cancer Centre, Hamilton, ON, Canada
| | - M. A. O’Brien
- McMaster University, Hamilton, ON, Canada; Juravinski Cancer Centre, Hamilton, ON, Canada
| | - T. J. Whelan
- McMaster University, Hamilton, ON, Canada; Juravinski Cancer Centre, Hamilton, ON, Canada
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30
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Wright J, Dimitry S, Sussman J, Whelan TJ. Understanding decision supports (DS) for women with breast cancer eligible for clinical trials (CT). J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.10534] [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
10534 Background: CTs are vital to the development of treatments for patients with cancer, but a low proportion of patients participate in trials, resulting in decreased access to new options. Methods: The study purpose was to explore DS for CT participation decision-making with women diagnosed with breast cancer who were offered a CT. 31 women took part in 6 focus groups - 3 groups of women who consented to a CT, 3 groups who declined a CT. Open-ended questions were asked about specific DS and ideas for new ones. Information rich cases were selected for the sample. Data analyses were conducted by 2 independent coders using a line-by-line, open coding process. Reliability was checked by a 3rd coder. Data was organized with template and editing approaches. Results were compared by group type (declined/consented to CT). Results: Common themes emerged from both group types: too much information is given at the first oncology consult; patients prefer to get CT information from the cancer centre, after their surgery, but prior to their oncology consult; no strong preference about who acts as a DS—family doctor, surgeon, other—as long as good relationship exists; oncologist (to lesser degree surgeon) is seen as most informed about their case; preference for oncologist vs trials nurse to describe CT concept, answer questions, direct them to other information sources; patients doubt family doctors or surgeons have detailed knowledge of CTs, know specific trial data; patients want to feel prepared, know what may happen before they come to oncologist - consult process, CT may be option - to avoid surprise; helpful to know that there is time to make CT decision; other patients are a good source of DS and information. Conclusions: Patients had strong preference to receive information about CTs prior to their consultation with an oncologist; this timing was seen as helpful for decision-making about a CT by both group types. No significant financial relationships to disclose.
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Affiliation(s)
- J. Wright
- Juravinski Cancer Centre, Hamilton, ON, Canada
| | - S. Dimitry
- Juravinski Cancer Centre, Hamilton, ON, Canada
| | - J. Sussman
- Juravinski Cancer Centre, Hamilton, ON, Canada
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Moy B, Tu D, Shepherd LE, Pater JL, Whelan TJ, Ingle JN, Goss PE. NCIC CTG MA.17: Tolerability of letrozole among ethnic minority women. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.6018] [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
6018 Background: Disease free survival was significantly improved in women receiving letrozole after standard adjuvant tamoxifen in the MA.17 trial. Based on the results of MA.17 and of other trials of aromatase inhibitors in early stage breast cancer, chronic aromatase inhibitor therapy, in postmenopausal women free of breast cancer recurrence, is now being widely employed. We analyzed the toxicity of letrozole according to ethnic status among women enrolled in MA.17. Methods: The chi-square test was used for comparison of rates of side effects between the two groups, Caucasian vs. ethnic minority (defined as all non-Caucasians). In a subset of women, quality of life (QOL) was assessed by the SF-36 Health Survey. Mean change scores in QOL from baseline were compared between groups for summary measures and domains using the Wilcoxon test. Results: 352 minority women and 4,708 Caucasians were enrolled in MA.17, of which 183 minority women and 2,339 Caucasians were randomized to receive letrozole. Caucasians were older than minority women and had a slightly longer duration of treatment with prior tamoxifen. Tumor size and nodal status were not significantly different between the two groups. In women who received letrozole, minority women had significantly lower incidence of hot flashes (49% vs. 58%; p = 0.02), fatigue (29% vs. 39%; p = 0.005), and arthritis (2% vs. 7%; p = 0.006) compared with Caucasians. Mean QOL change scores of SF-36 domains for women who received letrozole were not different but minority women had better mental health at 6 month assessment (p = 0.02) and worse bodily pain at 12 month assessment (p = 0.046). Conclusions: Minority women tolerated letrozole considerably better than Caucasians in the MA.17 trial. These preliminary findings suggest that minority women respond differently to letrozole in terms of toxicity. Recent demonstration of genotypic variations in the aromatase gene in different ethnic groups plus likely pharmacogenomic differences suggests that further research is needed to clarify the clinical outcomes of aromatase inhibition in women of diverse ethnicities. Future research strategies should focus on examining in vivo genotype-phenotype correlations to determine the effects of genetic variation on response to anticancer therapy and on toxicities and end-organ effects. [Table: see text]
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Affiliation(s)
- B. Moy
- Massachusetts General Hospital, Boston, MA; National Cancer Institute Canada Clinical Trials Group, Kingston, ON, Canada; Queen’s University, Kingston, ON, Canada; Juravinski Cancer Centre, Hamilton, ON, Canada; Mayo Clinic, Rochester, MN
| | - D. Tu
- Massachusetts General Hospital, Boston, MA; National Cancer Institute Canada Clinical Trials Group, Kingston, ON, Canada; Queen’s University, Kingston, ON, Canada; Juravinski Cancer Centre, Hamilton, ON, Canada; Mayo Clinic, Rochester, MN
| | - L. E. Shepherd
- Massachusetts General Hospital, Boston, MA; National Cancer Institute Canada Clinical Trials Group, Kingston, ON, Canada; Queen’s University, Kingston, ON, Canada; Juravinski Cancer Centre, Hamilton, ON, Canada; Mayo Clinic, Rochester, MN
| | - J. L. Pater
- Massachusetts General Hospital, Boston, MA; National Cancer Institute Canada Clinical Trials Group, Kingston, ON, Canada; Queen’s University, Kingston, ON, Canada; Juravinski Cancer Centre, Hamilton, ON, Canada; Mayo Clinic, Rochester, MN
| | - T. J. Whelan
- Massachusetts General Hospital, Boston, MA; National Cancer Institute Canada Clinical Trials Group, Kingston, ON, Canada; Queen’s University, Kingston, ON, Canada; Juravinski Cancer Centre, Hamilton, ON, Canada; Mayo Clinic, Rochester, MN
| | - J. N. Ingle
- Massachusetts General Hospital, Boston, MA; National Cancer Institute Canada Clinical Trials Group, Kingston, ON, Canada; Queen’s University, Kingston, ON, Canada; Juravinski Cancer Centre, Hamilton, ON, Canada; Mayo Clinic, Rochester, MN
| | - P. E. Goss
- Massachusetts General Hospital, Boston, MA; National Cancer Institute Canada Clinical Trials Group, Kingston, ON, Canada; Queen’s University, Kingston, ON, Canada; Juravinski Cancer Centre, Hamilton, ON, Canada; Mayo Clinic, Rochester, MN
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Luk C, Goss P, Pritchard K, Whelan TJ, Liu S, Shepherd L, Pater J. Determinants of preferences for starting extended adjuvant letrozole (L) in postmenopausal women following five years of tamoxifen. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.642] [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: 11/20/2022] Open
Affiliation(s)
- C. Luk
- NCIC Clin Trials Group, Queen’s Univ, Kingston, ON, Canada; MA Gen Hosp Cancer Ctr, Boston, MA; Toronto Sunnybrook Regional Cancer Ctr, Toronto, ON, Canada; Juravinski Cancer Ctr, Hamilton, ON, Canada
| | - P. Goss
- NCIC Clin Trials Group, Queen’s Univ, Kingston, ON, Canada; MA Gen Hosp Cancer Ctr, Boston, MA; Toronto Sunnybrook Regional Cancer Ctr, Toronto, ON, Canada; Juravinski Cancer Ctr, Hamilton, ON, Canada
| | - K. Pritchard
- NCIC Clin Trials Group, Queen’s Univ, Kingston, ON, Canada; MA Gen Hosp Cancer Ctr, Boston, MA; Toronto Sunnybrook Regional Cancer Ctr, Toronto, ON, Canada; Juravinski Cancer Ctr, Hamilton, ON, Canada
| | - T. J. Whelan
- NCIC Clin Trials Group, Queen’s Univ, Kingston, ON, Canada; MA Gen Hosp Cancer Ctr, Boston, MA; Toronto Sunnybrook Regional Cancer Ctr, Toronto, ON, Canada; Juravinski Cancer Ctr, Hamilton, ON, Canada
| | - S. Liu
- NCIC Clin Trials Group, Queen’s Univ, Kingston, ON, Canada; MA Gen Hosp Cancer Ctr, Boston, MA; Toronto Sunnybrook Regional Cancer Ctr, Toronto, ON, Canada; Juravinski Cancer Ctr, Hamilton, ON, Canada
| | - L. Shepherd
- NCIC Clin Trials Group, Queen’s Univ, Kingston, ON, Canada; MA Gen Hosp Cancer Ctr, Boston, MA; Toronto Sunnybrook Regional Cancer Ctr, Toronto, ON, Canada; Juravinski Cancer Ctr, Hamilton, ON, Canada
| | - J. Pater
- NCIC Clin Trials Group, Queen’s Univ, Kingston, ON, Canada; MA Gen Hosp Cancer Ctr, Boston, MA; Toronto Sunnybrook Regional Cancer Ctr, Toronto, ON, Canada; Juravinski Cancer Ctr, Hamilton, ON, Canada
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Goffin JR, Savage C, Tu D, Shepherd L, Whelan TJ, Olivotto IA. The difference between study recommendations, stated policy, and actual practice in a clinical trial. Ann Oncol 2004; 15:1267-73. [PMID: 15277269 DOI: 10.1093/annonc/mdh303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 11/13/2022] Open
Abstract
BACKGROUND We determined whether physicians involved in a clinical trial adhere to the study recommendations or the stated policy of their treatment centre with respect to the administration of boost radiation after breast conserving surgery. PATIENTS AND METHODS Boost radiation treatment policy was determined by survey at 25 oncology centres involved in a randomised trial of breast or breast plus nodal radiation in Canada. Actual practice was compared with stated policy and study recommendations. RESULTS Among 248 subjects, 201 (81%) were treated according to stated policy [kappa=0.40, 95% confidence intervals (CI) 0.27-0.52; P<0.0001], indicating only a fair to moderate agreement between stated and actual practice, while 232 (94%) were treated according to study recommendations (kappa=0.59, 95% CI 0.40-0.77; P<0.0001), indicating moderate to near substantial agreement between study recommendations and actual practice (P=0.88 for z-test of difference). In a multivariate analysis, subjects who had invasive disease at a resection margin were more likely to get a boost than those with margins clear of invasive tumour by 2 mm [odds ratio (OR) 49, 95% CI 7.6-322; P<0.0001]. CONCLUSIONS Physicians appear compliant with study recommendations for a non-randomised manoeuvre in a clinical trial, possibly at the expense of compliance with stated local policy. Clinical trial protocols should incorporate standard practice.
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Affiliation(s)
- J R Goffin
- National Cancer Institute of Canada, Clinical Trials Group, Kingston, Ontario, Canada.
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Ellis PM, Dimitry SJD, Browman G, Whelan TJ. Cancer patients and the Internet: A randomized controlled trial (RCT) evaluating an intervention to facilitate physician and patient information exchange from the Internet (I). J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.6139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- P. M. Ellis
- Juravinski Cancer Centre, Hamilton, ON, Canada
| | | | - G. Browman
- Juravinski Cancer Centre, Hamilton, ON, Canada
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Recht A, Edge SB, Solin LJ, Robinson DS, Estabrook A, Fine RE, Fleming GF, Formenti S, Hudis C, Kirshner JJ, Krause DA, Kuske RR, Langer AS, Sledge GW, Whelan TJ, Pfister DG. Postmastectomy radiotherapy: clinical practice guidelines of the American Society of Clinical Oncology. J Clin Oncol 2001; 19:1539-69. [PMID: 11230499 DOI: 10.1200/jco.2001.19.5.1539] [Citation(s) in RCA: 659] [Impact Index Per Article: 28.7] [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: 11/20/2022] Open
Abstract
OBJECTIVE To determine indications for the use of postmastectomy radiotherapy (PMRT) for patients with invasive breast cancer with involved axillary lymph nodes or locally advanced disease who receive systemic therapy. These guidelines are intended for use in the care of patients outside of clinical trials. POTENTIAL INTERVENTION The benefits and risks of PMRT in such patients, as well as subgroups of these patients, were considered. The details of the PMRT technique were also evaluated. OUTCOMES The outcomes considered included freedom from local-regional recurrence, survival (disease-free and overall), and long-term toxicity. EVIDENCE An expert multidisciplinary panel reviewed pertinent information from the published literature through July 2000; certain investigators were contacted for more recent and, in some cases, unpublished information. A computerized search was performed of MEDLINE data; directed searches based on the bibliographies of primary articles were also performed. VALUES Levels of evidence and guideline grades were assigned by the Panel using standard criteria. A "recommendation" was made when level I or II evidence was available and there was consensus as to its meaning. A "suggestion" was made based on level III, IV, or V evidence and there was consensus as to its meaning. Areas of clinical importance were pointed out where guidelines could not be formulated due to insufficient evidence or lack of consensus. RECOMMENDATIONS The recommendations, suggestions, and expert opinions of the Panel are described in this article. VALIDATION Seven outside reviewers, the American Society of Clinical Oncology (ASCO) Health Services Research Committee members, and the ASCO Board of Directors reviewed this document.
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Affiliation(s)
- A Recht
- Beth Israel Deaconess Medical Center, Boston, MA, USA
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36
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Grunfeld E, Whelan TJ, Zitzelsberger L, Willan AR, Montesanto B, Evans WK. Cancer care workers in Ontario: prevalence of burnout, job stress and job satisfaction. CMAJ 2000; 163:166-9. [PMID: 10934978 PMCID: PMC80206] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND Cancer Care Ontario's Systemic Therapy Task Force recently reviewed the medical oncology system in the province. There has been growing concern about anecdotal reports of burnout, high levels of stress and staff leaving or decreasing their work hours. However, no research has systematically determined whether there is evidence to support or refute these reports. To this end, a confidential survey was undertaken. METHODS A questionnaire was mailed to all 1016 personnel of the major providers of medical oncology services in Ontario. The questionnaire consisted of the Maslach Burnout Inventory, the 12-item General Health Questionnaire, a questionnaire to determine job satisfaction and stress, and questions to obtain demographic characteristics and to measure the staff's consideration of alternative work situations. RESULTS The overall response rate was 70.9% (681 of 961 eligible subjects): by group it was 63.3% (131/207) for physicians, 80.9% (314/388) for allied health professionals and 64.5% (236/366) for support staff. The prevalence of emotional exhaustion were significantly higher among the physicians (53.3%) than among the allied health professionals (37.1%) and the support staff (30.5%) (p < or = 0.003); the same was true for feelings of depersonalization (22.1% v. 4.3% and 5.5% respectively) (p < or = 0.003). Feelings of low personal accomplishment were significantly higher among physicians (48.4%) and allied health professionals (54.0%) than among support staff (31.4%) (p < or = 0.002). About one-third of the respondents in each group reported that they have considered leaving for a job outside the cancer care system. Significantly more physicians (42.6%) than allied health professionals (7.6%) or support staff (4.5%) stated that they have considered leaving for a job outside the province. INTERPRETATION The findings support the concern that medical oncology personnel are experiencing burnout and high levels of stress and that large numbers are considering leaving or decreasing their work hours. This is an important finding for the cancer care system, where highly trained and experienced health care workers are already in short supply.
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Affiliation(s)
- E Grunfeld
- Division of Medical Oncology, Faculty of Medicine, University of Ottawa, Ont.
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Whelan TJ, Levine M, Julian J, Kirkbride P, Skingley P. The effects of radiation therapy on quality of life of women with breast carcinoma: results of a randomized trial. Ontario Clinical Oncology Group. Cancer 2000; 88:2260-6. [PMID: 10820347] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
BACKGROUND The purpose of this study was to evaluate the effect of breast irradiation on quality of life, including cosmetic outcome, for patients enrolled in a clinical trial. METHODS Between 1984 and 1989, a randomized trial was conducted in Ontario, Canada, in which women with lymph node negative breast carcinoma who had undergone lumpectomy and axillary lymph node dissection were randomized to either breast irradiation or no further treatment. A modified version of the Breast Cancer Chemotherapy Questionnaire (BCQ) was administered to women at baseline, 1 month (4 weeks), and 2 months (8 weeks) after randomization. Irritation of the skin of the breast, breast pain, and appearance of the breast to the patient were also assessed every 3 months for the first 2 years of the study. RESULTS Of 837 patients, 416 were randomly allocated to radiation therapy and 421 to no further treatment. The mean change in quality of life from baseline to 2 months was -0.05 for the radiation group and +0.30 for the control group. The difference between groups was statistically significant (P = 0.0001). Longer term radiation therapy increased the proportion of patients who were troubled by irritation of the skin of the breast and breast pain. Radiation therapy did not increase the proportion of patients at 2 years who were troubled by the appearance of the treated breast; 4.8% in irradiated and nonirradiated patients (P = 0.62). CONCLUSIONS Breast irradiation therapy had an effect on quality of life during treatment. After treatment, irradiated patients reported increased breast symptoms compared with controls. However, no difference was detected between groups at 2 years in the rates of skin irritation, breast pain, and being upset by the appearance of the breast.
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Affiliation(s)
- T J Whelan
- Department of Medicine, McMaster University, Cancer Care Ontario, Hamilton Regional Cancer Centre, Canada
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Critchley P, Jadad AR, Taniguchi A, Woods A, Stevens R, Reyno L, Whelan TJ. Are some palliative care delivery systems more effective and efficient than others? A systematic review of comparative studies. J Palliat Care 2000; 15:40-7. [PMID: 10693305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Affiliation(s)
- P Critchley
- Department of Family Medicine, St. Joseph's Hospital, Hamilton Health Sciences Corporation, Ontario, Canada
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Abstract
PURPOSE Recent randomized trials in women with node-positive breast cancer who received systemic treatment report that locoregional radiation therapy improves survival. Previous trials failed to detect a difference in survival that results from its use. A systematic review of randomized trials that examine the effectiveness of locoregional radiation therapy in patients treated by definitive surgery and adjuvant systemic therapy was conducted. METHODS Randomized trials published between 1967 and 1999 were identified through MEDLINE database, CancerLit database, and reference lists of relevant articles. Relevant data was abstracted. The results of randomized trials were pooled using meta-analyses to estimate the effect of treatment on any recurrence, locoregional recurrence, and mortality. RESULTS Eighteen trials that involved a total of 6,367 patients were identified. Most trials included both pre- and postmenopausal women with node-positive breast cancer treated with modified radical mastectomy. The type of systemic therapy received, sites irradiated, techniques used, and doses of radiation delivered varied between trials. Data on toxicity were infrequently reported. Radiation was shown to reduce the risk of any recurrence (odds ratio, 0.69; 95% confidence interval [CI], 0.58 to 0.83), local recurrence (odds ratio, 0.25; 95% CI, 0.19 to 0.34), and mortality (odds ratio, 0.83; 95% CI, 0.74 to 0.94). CONCLUSION Locoregional radiation after surgery in patients treated with systemic therapy reduced mortality. Several questions remain on how these results should be translated into current-day clinical practice.
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Affiliation(s)
- T J Whelan
- Departments of Medicine, Clinical Epidemiology, and Biostatistics, McMaster University, and Cancer Care Ontario, Hamilton Regional Cancer Centre, Hamilton, ON, Canada.
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Mulholland M, Whelan TJ, Rose H, Keegan J. Direct identification and quantitation of prednisone in the presence of overlapping hydrocortisone by liquid chromatography with electrospray and atmospheric-pressure chemical-ionisation mass spectrometry. J Chromatogr A 2000; 870:135-41. [PMID: 10722070 DOI: 10.1016/s0021-9673(99)00916-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [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: 11/30/2022]
Abstract
The paper describes the application of liquid chromatography interfaced to a triple quadrupole mass spectrometer utilising the multiple reaction monitoring (MRM) mode. The technique was shown to provide detection limits lower than 0.01% for the analysis of prednisone in the presence of hydrocortisone. Prednisone was mixed in concentrations from 0.500 to 0.0005 ppm (corresponding to 1% to 0.001% of the hydrocortisone concentration). These solutions were assayed using MRM observing the product ion transitions of 359.2-->147.1 and 359.2-->171.2 and was shown to be capable of detecting co-eluting impurities at concentrations of less than 0.001% of the major component. The assay of prednisone was shown to be linear over the range 0.500-0.0005 ppm with a correlation coefficient of 0.999 and a precision of 6.9% at the concentration of 0.005 ppm. The analysis was carried out using both atmospheric pressure chemical ionisation (APCI) and electrospray ionisation (ESI) as an interface. However, for these compounds APCI provided significantly more sensitive data compared to ESI.
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Affiliation(s)
- M Mulholland
- Department of Chemistry, Materials and Forensic Science, University of Technology, Sydney, Australia, NSW
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Irwin E, Arnold A, Whelan TJ, Reyno LM, Cranton P. Offering a choice between two adjuvant chemotherapy regimens: a pilot study to develop a decision aid for women with breast cancer. Patient Educ Couns 1999; 37:283-291. [PMID: 14528554 DOI: 10.1016/s0738-3991(98)00117-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
BACKGROUND The primary objective of this study was to develop a decision aid which would encourage and assist patients to become involved in treatment decision making, and help clinicians to objectively educate patients about the benefits and risks of adjuvant chemotherapy for breast cancer. A secondary objective was to investigate the factors influencing this treatment decision-making process for women when choosing between adriamycin and cyclophosphamide (AC) versus cyclophosphamide, methotrexate and 5-fluorouracil (CMF) chemotherapy. METHODS An educational visual instrument called a Decision Board was developed consisting of written and graphical material. The Decision Board displays general information about chemotherapy and detailed information about each chemotherapy regimen, including the schedule and side effects, and was presented to patients with a scripted standardized oral explanation. The instrument was evaluated in 46 premenopausal women newly diagnosed with node-positive breast cancer. Following presentation of the board, the patients were given a take home version to review and asked to return 1-2 weeks later with a decision. During the second visit each patient was asked to complete a questionnaire regarding demographics, learning and comprehension, treatment preference, and factors influencing their decision. RESULTS Recall of information was acceptable (> or = 80%). The Decision Board was found helpful by all, but the level of difficulty with decision making was variable. Out of 46 women, 23 women chose AC, 21 chose CMF, and two chose no treatment. The major factors affecting treatment preference were related to the impact on quality of life, the length of therapy, and the side effects, in particular, vomiting and alopecia. CONCLUSIONS The Decision Board appears to be a valuable educational tool that enables patients to become well-informed and directly involved in their treatment decisions.
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Affiliation(s)
- E Irwin
- McMaster University, School of Nursing, OCTRF Hamilton Regional Cancer Centre, Hamilton, Ontario, Canada
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Wright JR, Whelan TJ, McCready DR, O'Malley FP. Management of ductal carcinoma in situ of the breast. Provincial Breast Cancer Disease Site Group. Cancer Prev Control 1998; 2:312-9. [PMID: 10470463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
MESH Headings
- Breast Neoplasms/mortality
- Breast Neoplasms/radiotherapy
- Breast Neoplasms/surgery
- Breast Neoplasms/therapy
- Carcinoma in Situ/mortality
- Carcinoma in Situ/radiotherapy
- Carcinoma in Situ/surgery
- Carcinoma in Situ/therapy
- Carcinoma, Ductal, Breast/mortality
- Carcinoma, Ductal, Breast/radiotherapy
- Carcinoma, Ductal, Breast/surgery
- Carcinoma, Ductal, Breast/therapy
- Cohort Studies
- Combined Modality Therapy
- Female
- Follow-Up Studies
- Humans
- Lymph Node Excision
- MEDLINE
- Mammaplasty
- Mammography
- Mastectomy, Radical
- Mastectomy, Segmental
- Meta-Analysis as Topic
- Neoplasm Recurrence, Local
- Postoperative Care
- Preoperative Care
- Prognosis
- Prospective Studies
- Radiotherapy Dosage
- Randomized Controlled Trials as Topic
- Retrospective Studies
- Risk Factors
- Time Factors
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Abstract
BACKGROUND Many cancer centers make available to patients written information material to supplement verbal information provided by clinicians. Randomized trials have demonstrated that providing such information can increase patient knowledge and satisfaction. However, little data are available regarding effective means of dissemination of such materials. The purpose of this study was to determine whether providing patients with a personal file folder after their first clinic appointment would improve the dissemination of written information materials and increase patient satisfaction. METHODS A before/after study was performed. Consecutive patients with newly diagnosed cancer attending the Hamilton Regional Cancer Centre were selected randomly and interviewed by telephone within 1-2 weeks of the first clinic appointment regarding the number of information pamphlets received, patient satisfaction, and general preference for written information materials. The preintervention evaluation (T1) occurred over a 4-month period followed by the introduction of the personal file folder into the clinical practice. Six weeks after its introduction, the postintervention (T2) evaluation took place over the ensuing 4 months. RESULTS A total of 300 patients completed the evaluation (150 each in T1 and T2). Responding patients in the two time periods were comparable with respect to background demographic variables. The mean number of information pamphlets received by patients increased with the introduction of the personal file folder from 2.4+/-2.0 standard deviations (SD) in T1 to 3.6+/-2.5 SD in T2 (P=0.0001). The percentage of patients planned for treatment who received treatment-related information increased from 36% (42 of 116 patients) in T1 to 65% (68 of 105 patients) in T2 (P=0.002). Mean patient satisfaction increased from 3.3+/-1.1 SD to 3.8+/-1.0 SD over the 2 time periods (P=0.0001). The majority of patients (87%) believed it was important to receive written information materials. CONCLUSIONS The patient file folder increased the dissemination of written information materials and currently is being incorporated into routine practice.
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Affiliation(s)
- T J Whelan
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
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Mirsky D, O'Brien SE, McCready DR, Newman TE, Whelan TJ, Levine MN. Surgical management of early stage invasive breast cancer (stage I and II). Provincial Breast Disease Site Group. Cancer Prev Control 1998; 1:10-7. [PMID: 9765722] [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: 02/09/2023]
Abstract
GUIDELINE QUESTION What is the optimal surgical management of early stage invasive breast cancer (stage I and II)? More specifically, what is the relative efficacy (and safety) of breast conservation therapy (lumpectomy with axillary dissection) compared with modified radical mastectomy? OBJECTIVE To make recommendations about surgical management and techniques in the treatment of early stage invasive breast disease (stage I and II). OUTCOMES Survival, local recurrence (for lumpectomy patients) and quality of life are the primary outcomes of interest. PERSPECTIVE (VALUES) Evidence was selected and reviewed by 6 members of the Ontario Cancer Treatment Practice Guidelines Initiative, Disease Site Group for Breast Cancer (Breast DSG). Earlier drafts of this evidence-based recommendation have been reviewed, discussed and approved by the Breast DSG, which comprises surgeons, medical oncologists, radiation oncologists, epidemiologists, a pathologist and a medical sociologist. There was no consumer participation in the development of this guideline. QUALITY OF EVIDENCE There are 7 randomized controlled trials (RCTs) comparing breast conservation therapy with mastectomy in women with early stage breast cancer. BENEFITS In 6 RCTs, no statistically significant differences were detected in survival rate between the mastectomy and conservative therapy (lumpectomy) groups. In 1 RCT, a statistically significant differences was detected in favour of the mastectomy arm; however, this was an early trial with substantial methodologic weaknesses. HARMS None. PRACTICE GUIDELINE Women with early stage invasive breast cancer (stage I and II) who are candidates for breast conservation therapy (see discussion of technical factors) should be offered the choice of either breast conservation therapy (excision of tumour with clear margins and axillary dissection) or modified radical mastectomy. The choice is an individual one for the patient, and thus she should be fully informed of the options, including the risks and benefits of each procedure. She should be informed that breast irradiation is part of the procedure for breast conservation therapy. In addition, she should be aware of the potential need for further surgery if the margins are positive. For further information about the use of radiotherapy in the management of early stage breast cancer, please refer to the Ontario Cancer Treatment Practice Guidelines Initiative's practice guideline Breast Irradiation in Women with Early Stage Invasive Breast Cancer Following Breast Conserving Surgery.
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Affiliation(s)
- D Mirsky
- McMaster University, Hamilton, Ont
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Abstract
BACKGROUND The objective of this study was to examine the physical and emotional health status, self-perceived problems, and needs of newly diagnosed cancer patients to determine and plan supportive care strategies. METHODS A cross-sectional survey of newly diagnosed cancer patients attending a regional cancer center during a 6-month period was performed. Patients with breast, colorectal, head and neck, lung, and prostate carcinoma as well as nonmelanoma of the skin were selected randomly. Patients were interviewed prior to their first appointment at the clinic. Physical health status was assessed using the Symptom Distress Scale, psychologic health status was assessed with the General Health Questionnaire (GHQ), day-to-day functioning with the Rapid Disability Scale, and social support with the modified Sarason's Social Support Scale. Perceived needs were assessed in a number of ways, including identification of patients' specific social concerns and informational needs, and by asking them to list their current problems or concerns. RESULTS Of 156 eligible patients, 134 completed the interview. One hundred and twenty-nine patients (96%) reported current symptoms that included fatigue (66%), worried outlook (61%), difficulty sleeping (48%), and pain (42%). Forty-four patients (33%) were identified as psychologically distressed with a GHQ score of > or = 6. One hundred and fourteen patients (85%) had informational needs, 89 (66%) indicated > or = 1 social concerns, and 55 (41%) reported a need for assistance with day-to-day living. CONCLUSIONS Patients with newly diagnosed cancer commonly report symptoms related to fatigue, pain, and psychologic distress. Other frequently reported issues relate to the need for information and social concerns regarding the patients' ability to take care of their home and maintain family and other relationships. Awareness of these issues is important for planning supportive care interventions for newly diagnosed cancer patients.
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Affiliation(s)
- T J Whelan
- Department of Medicine, McMaster University and the OCTRF Hamilton Regional Cancer Centre, Ontario, Canada
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Whelan TJ, Lada BM, Laukkanen E, Perera FE, Shelley WE, Levine MN. Breast irradiation in women with early stage invasive breast cancer following breast conservation surgery. Provincial Breast Disease Site Group. Cancer Prev Control 1997; 1:228-40. [PMID: 9765748] [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: 04/11/2023]
Abstract
GUIDELINE QUESTIONS 1) Should breast irradiation be given to women with early stage invasive breast cancer (stage I and II) following breast conservation surgery (lumpectomy with clear resection margins and axillary dissection)? 2) Is there an optimal schedule for breast irradiation? 3) What is a reasonable interval between definitive surgery and the start of breast irradiation? 4) Are there patients who can be spared breast irradiation after lumpectomy? OBJECTIVE To make recommendations about the use of breast irradiation in women with early stage invasive breast cancer following breast conservation surgery. OUTCOMES Local control is the primary endpoint of interest. Survival, quality of life (addressed through the adverse effects of radiotherapy) and cosmesis are also considered. PERSPECTIVE (VALUES) Evidence was selected and reviewed by 6 members of the Breast Disease Site Group (Breast DSG) of the Ontario Cancer Treatment Practice Guidelines Initiative. Earlier drafts of the evidence-based recommendation were reviewed, discussed and approved by the Breast DSG, which comprises medical oncologists, radiation oncologists, surgeons, epidemiologists, pathologists and a medical sociologist. There was no participation by a community representative in the development of this guideline. QUALITY OF EVIDENCE There are 5 randomized controlled trials (RCTs) and 1 meta-analysis comparing breast irradiation with no breast irradiation following breast conservation surgery; 6 randomized trials comparing breast conservation surgery plus breast irradiation with mastectomy are also included, as well as several retrospective studies. BENEFITS All of the 5 RCTs showed a significant decrease in local recurrence rates among patients receiving radiotherapy. In the 4 trials with a median follow-up of 5 years or longer, the relative risk reduction with breast irradiation ranged from 69% to 88%. The absolute differences ranged from 16% (p < 0.001) to 25% (p < 0.001). Despite the effect on local recurrence, no difference in survival was detected in any of the 5 trials. Most of the patients with local recurrence in these trials underwent mastectomy. HARMS Major adverse effects of breast irradiation occur very infrequently. PRACTICE GUIDELINE Women with early stage invasive breast cancer (stage I and II) who have undergone breast conservation surgery should be offered postoperative breast irradiation. The optimal fractionation schedule for breast irradiation has not been established, and the role of boost irradiation is unclear. Outside of a clinical trial, 2 commonly used fractionation schedules are suggested: 50 Gy in 25 fractions to the whole breast, or 40 Gy in 16 fractions to the whole breast with a local boost to the primary site of 12.5 Gy in 5 fractions. Shorter schedules (e.g., 40 or 44 Gy in 16 fractions) have also been used routinely in some centres. The enrollment of patients in ongoing clinical trials is encouraged. Women who have undergone breast conservation surgery should receive local breast irradiation as soon as possible after wound healing. A safe interval between surgery and the start of radiotherapy is unknown, but it is reasonable to start breast irradiation within 12 weeks after definitive surgery. For women who are candidates for chemotherapy, the optimal sequencing of chemotherapy and breast irradiation is unknown. It is reasonable to start radiotherapy after the completion of chemotherapy, or concurrently if anthracycline-containing regimens are not used. For further information, please refer to Ontario Cancer Treatment Practice Guidelines Initiative's practice guideline "Surgical Management of Early Stage Invasive Breast Cancer (stage I and II)."
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Affiliation(s)
- T J Whelan
- Hamilton Regional Cancer Centre and McMaster University, Hamilton, Ont
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Elit LM, Levine MN, Gafni A, Whelan TJ, Doig G, Streiner DL, Rosen B. Patients' preferences for therapy in advanced epithelial ovarian cancer: development, testing, and application of a bedside decision instrument. Gynecol Oncol 1996; 62:329-35. [PMID: 8812525 DOI: 10.1006/gyno.1996.0244] [Citation(s) in RCA: 78] [Impact Index Per Article: 2.8] [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: 02/02/2023]
Abstract
The objective of this study was to determine a patient's preference for treatment in the poor prognostic situation of advanced epithelial ovarian cancer. A standardized method of information transfer was developed and pretested for feasibility, acceptability, comprehension, interobserver reliability, and validity. The Decision Board (DB) describes to the patient who has completed surgery for suboptimally debulked ovarian cancer two treatment options, their potential side effects, and possible outcomes. The psychometric properties of the DB were determined in 37 volunteers without cancer and 11 women following first-line chemotherapy for ovarian cancer. The Board was then administered to 12 patients with stage IIIc and IV ovarian cancer at the point of deciding future chemotherapy. The feasibility of presenting poor prognostic information, patient comprehension in an emotionally charged situation, and her treatment choice were determined. Observation of patient-physician interviews revealed that survival information is not usually discussed on the initial consultation. Using the DB, it was feasible to provide survival information to 98% of the healthy women. Comprehension was high, with 96% of the questions being correctly answered. Interobserver reliability was high (kappa = 1.00). The construct that hypothesized that understanding information is a determinant of choice was verified, as 95.2% of women had predictable shifts in expressed preference. The strength of preference in healthy women was statistically significantly higher for Plan B (paclitaxel-cisplatin) than for Plan A (cisplatin-cyclophosphamide) (P < 0.001). The method of presenting survival information (median survival versus percentage survival at 3.5 years) influenced choice (P < 0.04). At the point of decision making, 33% of patients with advanced ovarian cancer chose Plan A and 67% chose Plan B. All volunteers and patients stated that they wanted to be fully informed of the choices of therapy for their disease and to be involved in treatment decisions. The DB is a reliable and valid method for sharing information about advanced ovarian cancer with patients. At the point of deciding first-line chemotherapy in this poor prognostic situation, patients still value survival more highly than the quality of life during chemotherapy.
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Affiliation(s)
- L M Elit
- Department of Obstetrics and Gynaecology, University of Western Ontario, London, Canada
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Mohide EA, Whelan TJ, Rath D, Gafni A, Willan AR, Czukar D, Campbell IB, Okawara GS, Neimanis M, Levine MN. A randomised trial of two information packages distributed to new cancer patients before their initial appointment at a regional cancer centre. Br J Cancer 1996; 73:1588-93. [PMID: 8664135 PMCID: PMC2074537 DOI: 10.1038/bjc.1996.299] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
The purpose of this study was to evaluate the extent to which a new patient information package (NPIP) or a mini version of the same package (mini-NPIP) reduces emotional distress and meets the informational needs of patients arriving at a tertiary cancer centre for the first time. A comprehensive package, NPIP, consisting of procedural information regarding cancer centre location, description of the health care team, treatment services, research, educational activities, accommodation and community services provided at the centre; and a condensed version of the same package, mini-NPIP, were developed. Consecutive patients with newly diagnosed breast, gynaecological, lung and prostate cancer, referred to the centre for the first time were prerandomised to receive NPIP, mini-NPIP or no information package. Patients randomised to NPIP or mini-NPIP were mailed the information package at least one week before their first appointment. On arrival at the centre, patients were administered the Brief Symptom Inventory (BSI) which measures psychological distress, and interviewed regarding preferences for information and acceptability of the information packages. Of 465 randomised patients, 161 were excluded post-randomisation and 304 completed the entire interview: 100 were randomised to the NPIP, 102 to the mini-NPIP and 102 to the control group. Emotional distress as measured by the BSI was similar for all groups (P = 0.98). Most patients preferred to receive the information (98%), receive it before the first appointment (84%) and by mail (79%). These preferences were more evident for those given the information packages. The majority of patients found the information packages easy to understand (88%) and useful (89%), and no differences were detected between packages. The cost of production and dissemination of NPIP was more than double the cost for mini-NPIP: $ 8.93 vs $ 3.98 (Canadian dollars) per patient. For patients presenting to a cancer centre for the first time, packages of procedural information do not appear to reduce psychological distress, but are preferred by patients. Given the cost of producing NPIP, mini-NPIP is the preferred approach.
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Affiliation(s)
- E A Mohide
- School of Nursing, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
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Whelan TJ, Levine MN, Gafni A, Lukka H, Mohide EA, Patel M, Streiner DL. Breast irradiation postlumpectomy: development and evaluation of a decision instrument. J Clin Oncol 1995; 13:847-53. [PMID: 7707110 DOI: 10.1200/jco.1995.13.4.847] [Citation(s) in RCA: 88] [Impact Index Per Article: 3.0] [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: 01/26/2023] Open
Abstract
PURPOSE To develop an instrument to help clinicians inform patients about the benefits and risks of breast irradiation following lumpectomy and to help an informed patient decide whether she prefers this treatment. METHODS A Decision Board consisting of written material and visual aids was developed. It provides the patient with detailed information about her choices (breast irradiation or not), outcomes (breast recurrence and survival), probability of those outcomes, and quality of life associated with treatment and outcome. We studied the decision-making process in 82 consecutive node-negative lumpectomy patients who were seen in consultation by a radiation oncologist and oncology nurse. The Decision Board was used in the last 30 patients in the cohort. RESULTS Patient comprehension following the consultation without the Decision Board was greater than 65% for all questions addressed, except for poor understanding of the lack of survival benefit associated with breast irradiation (12% of patients answered correctly) and that it could not be repeated (15% of patients answered correctly). Comprehension following the consultation with the Decision Board was similar, but understanding regarding the repetition of radiation (83%) was improved. Only 70% of patients in the no-Decision Board group felt they were offered a choice. This was increased to 97% in the Decision-Board group. Overall, 95% of patients chose breast irradiation, and this did not differ between groups. Patients reported several reasons for choosing breast irradiation, all of equal importance. CONCLUSION The Decision Board facilitated shared decision making in node-negative lumpectomy patients who chose breast irradiation, but it did not affect a patient's choice to select breast irradiation.
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Affiliation(s)
- T J Whelan
- Ontario Cancer Treatment and Research Foundation-Hamilton Regional Cancer Center, Division of Radiation Oncology, Ontario, Canada
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Abstract
Ninety surgical cases of cecal diverticulitis at the University of Hawaii hospitals were reviewed from 1980 to 1991. Seventy-eight percent of the study group were of Asian descent, with a mean age of 41.7 years. Right lower quadrant pain and tenderness were the only constant findings, occurring in 86 and 87 of the 90 patients, respectively. The most common preoperative diagnosis was acute appendicitis, occurring in 73% of patients. A right colectomy or cecectomy was performed in 49 patients, an appendectomy in 29, and a diverticulectomy in 10. Seventeen complications occurred, only 1 of which was in the appendectomy group. Follow-up of up to 10 years was successful in 27 of 29 appendectomy patients, only 4 of whom had recurrent pain. There were no instances of a missed cecal carcinoma. We concluded that in those patients in whom carcinoma can be ruled out and in whom there is no evidence of abscess formation, appendectomy combined with postoperative antibiotics is a safe and effective method for the treatment of cecal diverticulitis.
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Affiliation(s)
- R N Harada
- Department of Surgery, University of Hawaii, Honolulu
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