Cancer In Alberta Research Articles

Real World Evidence Study to Assess Incidence, Treatment Patterns, Clinical Outcomes, and Health Care Resource Utilization in Early-Stage, High-Risk HER2-Negative Breast Cancer in Alberta, Canada

BackgroundData are needed to improve the current understanding of the epidemiology of patients with high-risk, HER2-negative, early breast cancer (eBC) (hormone receptor positive [HR+]/HER2-negative BC and triple-negative BC [TNBC]). Patients and MethodsThis retrospective longitudinal cohort study used real-world, population-level data that included all individuals newly diagnosed with high-risk, HER2-negative eBC in Alberta, Canada, between 2010 and 2019. Data on treatment, laboratory results and pathology findings were collected through electronic health records and administrative databases. ResultsThe annual cumulative incidence of high-risk, HER2-negative eBC ranged from 6% to 9% of all incident BC cases. Individuals with TNBC were more likely to be younger, had stage II disease, grade 3 histology and received systemic therapy at a community centre (P < .05) compared to individuals with HR+/HER2-negative eBC. Only 14% of individuals diagnosed in 2010-2017 underwent germline BRCA testing postdiagnosis. Neoadjuvant systemic therapy was given to 37% of individuals. Adjuvant systemic therapy use increased from 77% (2012-2015) to 84% (2019). The 5-year overall survival (OS) from initiation of adjuvant systemic therapy or date of surgery (for individuals who did not receive adjuvant systemic therapy) was 77% (95% CI: 75-79). OS was significantly worse among individuals who were older, had grade 3 histology, had stage III disease, or had nodal involvement (P < .05). OS among individuals with TNBC between 2016 and 2019 who initiated adjuvant capecitabine was markedly worse compared to the overall cohort (2-year OS: 70% vs. 89%). ConclusionOutcomes analyses in this high-risk, HER2-negative eBC population suggest a continued unmet clinical need.

Improving colorectal cancer in Alberta, Canada: a qualitative study of patients and close contacts’ perceptions on diagnosis following an emergency department presentation

BackgroundColorectal cancer (CRC) is globally the third most prevalent cancer and a leading cause of cancer-related deaths. In Alberta, Canada, a significant portion of CRC diagnoses occur following emergency department (ED) presentations. Gaps remain in understanding patient’s perspectives on CRC diagnosis after an ED visit. The aim of this study was to examine the experiences and perspectives of a group of patients diagnosed with CRC subsequent to an ED visit in Alberta and their close contacts.MethodsWe conducted a qualitative study using in-depth, semi-structured interviews with patients diagnosed with CRC after an ED visit at the Rockyview General Hospital, Calgary, and their close contacts, from November 2022 to June 2023. Interviews focused on symptom recognition, healthcare interactions, and the decision-making process leading to an ED visit. They were conducted in-person or over the phone, and analysed using thematic analysis.ResultsEighteen participants (12 patients and 6 close contacts) were interviewed, revealing four main themes: (1) variability in symptom recognition and interpretation; (2) inconsistencies in primary care consultations; (3) factors influencing decision-making leading to an ED visit; and (4) recommendations for expedited diagnosis outside of EDs.ConclusionThe findings highlight the complexity of the diagnostic journey for CRC patients in Alberta, pointing to significant gaps in symptom recognition and response by patients and healthcare providers. Improved diagnostic protocols and targeted support for healthcare providers, as well as approaches to address systemic delays may help streamline the diagnostic journey. Future research should focus on exploring innovative interventions to address the identified barriers to timely CRC diagnosis.

Geographic variation in breast reconstruction surgery after mastectomy for females with breast cancer in Alberta, Canada.

Breast cancer is the most common cancer affecting females in Canada, and about half of females with breast cancer are treated with mastectomy. We sought to evaluate geographic variation in breast reconstruction surgery in Alberta, Canada. Using linked population-based administrative databases, we extracted data on all Alberta females aged 18 years and older who were diagnosed with breast cancer and treated with mastectomy during 2004-2017. Analyses included regression modelling of odds of reconstruction at 1 year and a spatial scan to identify geographic clusters of lower numbers of reconstruction. A total of 16 198 females diagnosed with breast cancer were treated with a mastectomy, and 1932 (11.9%) had reconstruction within 1 year postmastectomy. Those with reconstruction were more likely to be younger (adjusted odds ratio [OR] 16.7, 95% confidence interval [CI] 13.7-20.3; aged 21-44 yr v. ≥ 65 yr) and were less likely to be from lower-income neighbourhoods. They were more likely to have at least 1 comorbidity and were more likely to have advanced stages of cancer and to require chemotherapy (adjusted OR 0.55, 95% CI 0.47-0.65) or radiotherapy after mastectomy (adjusted OR 0.59, 95% CI 0.39-0.87) than females without reconstruction. We identified rural northern and southeastern clusters with frequencies of reconstruction that were 69.6% and 41.6% of what was expected, respectively. We found an overall postmastectomy rate of breast reconstruction of 11.9%, and we identified geographic variation. Predictors of reconstruction in Alberta were similar to those previously described in the literature, specifically with patients in rural communities having lower rates of reconstruction than their urban counterparts. These results suggest that further interventions are required to identify the specific barriers to reconstruction within rural communities and to create strategies to ensure equitable access to all residents.

Exploring the Future of Cancer Impact in Alberta: Projections and Trends 2020-2040.

The impact of cancer in Alberta is expected to grow considerably, largely driven by population growth and aging. The Future of Cancer Impact (FOCI) initiative offers an overview of the present state of cancer care in Alberta and highlights potential opportunities for research and innovation across the continuum. In this paper, we present a series of detailed projections and analyses regarding cancer epidemiological estimates in Alberta, Canada. Data on cancer incidence and mortality in Alberta (1998-2018) and limited-duration cancer prevalence in Alberta (2000-2019) were collected from the Alberta Cancer Registry. We used the Canproj package in the R software to project these epidemiological estimates up to the year 2040. To estimate the direct management costs, we ran a series of microsimulations using the OncoSim All Cancers Model. Our findings indicate that from 2020, the total number of annual new cancer cases and cancer-related deaths are projected to increase by 56% and 49% by 2040, respectively. From 2019, the five-year prevalence of all cancers in Alberta is projected to increase by 86% by 2040. In line with these trends, the overall direct cost of cancer management is estimated to increase by 53% in 2040. These estimates and projections are integral to future strategic planning and investment.

Understanding Characteristics, Treatment Patterns, and Clinical Outcomes for Individuals with Advanced or Recurrent Endometrial Cancer in Alberta, Canada: A Retrospective, Population-Based Cohort Study.

Endometrial cancer (EC) incidence has increased in recent decades. However, population-based outcomes data are limited. In this retrospective cohort study, we examined characteristics, treatment patterns, and clinical outcomes, including time to next treatment (TNNT) and overall survival (OS), among advanced/recurrent (A/R) EC patients between 2010 and 2018 in Alberta, Canada. Kaplan-Meier statistics evaluated TTNT and OS, stratified by patient (A/R) and treatment. A total of 1053 patients were included: 620 (58.9%) advanced and 433 (41.1%) recurrent. A total of 713 (67.7%) patients received first-line therapy: 466 (75.2%) advanced and 247 (57.0%) recurrent. Platinum-based chemotherapy (PBCT) was the most common first-line regimen (overall: 78.6%; advanced: 96.1%; recurrent: 45.3%). The median TTNT and OS from first-line therapy were 19.9 months (95% confidence interval [CI]: 17.5-23.5) and 35.9 months (95% CI: 31.5-53.5), respectively. Following first-line PBCT, the median OS from second-line chemotherapy (N = 187) was 10.4 months (95% CI: 8.9-13.3) and higher for those rechallenged with PBCT (N = 72; 38.5%) versus no rechallenge (N = 115; 61.5%) (13.3 months [95% CI: 11.2-20.9] vs. 6.4 months [95% CI: 4.6-10.4; p < 0.001]). The findings highlight poor outcomes in A/R EC, particularly following first-line therapy, and that additional tolerable therapeutic options are needed to improve patient outcomes.

Selection Bias in Real-World Data Studies Used to Support Health Technology Assessments: A Case Study in Metastatic Cancer.

Real-world evidence has been increasingly used to support evaluations of emerging therapies. These investigations are often conducted in settings that may not be representative of the underlying population. The purpose of this investigation was to empirically quantify the magnitude of this selection bias. Individuals diagnosed with solid metastatic cancer in Alberta, Canada, between 2010-2019 were identified using the provincial cancer registry for 13 common metastatic sites. Two outcomes used to support oncology reimbursement decisions were examined: the proportion of individuals who initiated systemic therapy and median overall survival (OS). These outcomes were assessed in the entire population and in a subset of individuals who were referred to a medical oncologist. Among the 23,152 individuals in the entire population, 40.8% (95% CI: 40.2-41.4) initiated systemic therapy, and the median OS from diagnosis was 5.4 months (95% CI: 5.3-5.6). Among those who were referred to a medical oncologist (n = 13,372; 57.8%), 67.4% (95% CI: 66.6-68.2) initiated systemic therapy, and the median OS from diagnosis was 11.2 months (95% CI: 10.9-11.5). The magnitude of bias varied by cancer site where lower referral rates were associated with greater bias. Non-referral is an important source of selection bias in real-world investigations. Studies that rely on limited-catchment real-world data should be interpreted with caution, particularly in metastatic cancer settings.

Patient-Reported Symptom Complexity and Acute Care Utilization Among Patients With Cancer: A Population-Based Study Using a Novel Symptom Complexity Algorithm and Observational Data

Patients with cancer in Canada are often effectively managed in ambulatory settings; however, patients with unmanaged or complex symptoms may turn to the emergency department (ED) for additional support. These unplanned visits can be costly to the healthcare system and distressing for patients. This study used a novel patient-reported outcomes (PROs)-derived symptom complexity algorithm to understand characteristics of patients who use acute care, which may help clinicians identify patients who would benefit from additional support. This retrospective observational cohort study used population-based linked administrative healthcare data. All patients with cancer in Alberta, Canada, who completed at least one PRO symptom-reporting questionnaire between October 1, 2019, and April 1, 2020, were included. The algorithm used ratings of 9 symptoms to assign a complexity score of low, medium, or high. Multivariable binary logistic regressions were used to evaluate factors associated with a higher likelihood of having an ED visit or hospital admission (HA) within 7 days of completing a PRO questionnaire. Of the 29,133 patients in the cohort, 738 had an ED visit and 452 had an HA within 7 days of completing the PRO questionnaire. Patients with high symptom complexity had significantly higher odds of having an ED visit (OR, 3.10; 95% CI, 2.59-3.70) or HA (OR, 4.20; 95% CI, 3.36-5.26) compared with low complexity patients, controlling for demographic covariates. Given that patients with higher symptom complexity scores were more likely to use acute care, clinicians should monitor these more complex patients closely, because they may benefit from additional support or symptom management in ambulatory settings. A symptom complexity algorithm can help clinicians easily identify patients who may require additional support. Using an algorithm to guide care can enhance patient experiences, while reducing use of acute care services and the accompanying cost and burden.

The impact of population-based EGFR testing in non-squamous metastatic non-small cell lung cancer in Alberta, Canada

ObjectivesWhile Epidermal Growth Factor Receptor (EGFR) Tyrosine Kinase Inhibitors have been shown to be effective in phase III randomized trials, the value of targeted therapies has been challenging to evaluate at the population-level. We examined the impact of population-level EGFR testing and treatment on survival outcomes among non-squamous metastatic Non-Small Cell Lung Cancer (NSCLC) patients. Materials and methodsReal-world, population-level data were collected from all de novo non-squamous metastatic NSCLC patients in Alberta, Canada from 2004 to 2020. EGFR testing data were collected through Alberta Precision Laboratories. Differences in survival rates and overall survival (OS) pre (2004–2012) and post initiation (post) (2013–2019) testing periods were evaluated using interrupted time series analyses. The impact of testing and subsequent treatment was evaluated using multivariable Cox Proportional Hazards models. ResultsIn total, 4,578 non-squamous metastatic NSCLC patients were diagnosed pre-EGFR testing and 4,457 patients were diagnosed post-EGFR testing (2013–2019). Among patients diagnosed in the pre-EGFR testing period, the 6-month, 1-year, and 2-year survival probabilities were 0.39 (95 % CI: 0.38–0.41), 0.22 (95 % CI: 0.21–0.23), and 0.09 (95 % CI: 0.08–0.10), while the survival probabilities for patients diagnosed in the post-EGFR testing period were 0.45 (95 % CI: 0.43–0.46), 0.29 (95 % CI: 0.27–0.30), and 0.16 (95 % CI: 0.15–0.17), respectively. After adjusting for baseline patient and clinical characteristics, OS in the post-EGFR period was significantly improved compared to the pre-EGFR period (HR: 0.81; 95 % CI: 0.78–0.85). Among patients who were treated with systemic therapy, those tested for an EGFR mutation had significantly greater survival than patients who were not tested HR of 0.81 (95 % CI: 0.70–0.95). ConclusionThese results show the considerable impact of population-based molecular testing and subsequent targeted therapies on survival among metastatic NSCLC patients. The estimates here can be used in future studies to evaluate the population-level cost-effectiveness of testing and treatment.

Understanding the Symptoms and Concerns of Adolescents and Young Adults with Cancer in Alberta: A Comparative Cohort Study Using Patient-Reported Outcomes.

Purpose: Adolescents and young adults (AYAs) with cancer are in a unique situation due to their age and developmental stage in life and may have different symptoms and concerns than older patients. Patient-Reported Outcomes (PROs) questionnaires, routinely used in Alberta, can help identify the distinct needs of AYAs. We aimed to compare PROs data for AYAs and older adults (OAs) to better understand how the concerns of AYAs differ, which is key to providing individualized care and creating targeted programming and system-level change. Methods: Retrospective data were collected for two patient cohorts who completed at least one PROs questionnaire between October 1, 2019 and April 1, 2020. The AYA cohort was aged 18-39, and the OA cohort was aged 40 and older. Symptoms were compared using mean scores and multiple linear regression, and concerns were compared using counts and multivariate negative binomial regression. Results: AYAs had significantly higher mean scores on depression and anxiety, compared to OAs, and lower mean scores for most physical symptoms. They indicated significantly more concerns in the Emotional and Social/Family/Spiritual domains, and were over three times more likely to indicate Work/School as a concern. Conclusion: AYAs with cancer have distinct concerns that should be addressed to ensure comprehensive, quality cancer care for this population. PROs data are useful in identifying needs and facilitating evidence-based, data-driven change at all levels of the health care system.

A Review of Trastuzumab Biosimilars in Early Breast Cancer and Real World Outcomes of Neoadjuvant MYL-1401O versus Reference Trastuzumab.

The reduced cost of trastuzumab biosimilars has led to increased adoption for HER2-positive breast cancer. This review of trastuzumab biosimilars encompasses this development and real world clinical data in early breast cancer. In addition, we present a retrospective study evaluating the total pathological complete response (tpCR) rates (lack of residual invasive cancer in resected breast tissue and axillary nodes), of MYL-1401O to reference trastuzumab (TRZ) in the neoadjuvant setting for HER2+ early breast cancer (EBC) in Alberta, Canada. Neoadjuvant patients with HER2+ EBC treated with TRZ from November 2018–October 2019 and MYL-1401O from December 2019–September 2020 were identified. Logistic regression was used to control for variables potentially associated with tpCR: trastuzumab product, age, pre-operative T- and N-stage, grade, hormone receptor (HR)-status, HER2-status, chemotherapy regimen, and chemotherapy completion. tpCR was 35.6% in the MYL-1401O group (n = 59) and 40.3% in the TRZ (n = 77) group, p = 0.598. After controlling for clinically relevant variables, there was no significant difference in the odds of achieving tpCR in patients treated with TRZ versus MYL-1401O (OR 1.1, 95% CI 0.5–2.4, p = 0.850). tpCR rates were similar for patients treated with MYL-1401O compared to trastuzumab in our real world study of HER2+ neoadjuvant EBC and comparable to pivotal phase 3 trials.

Expected Cost Savings From Low-Dose Computed Tomography Scan Screening for Lung Cancer in Alberta, Canada

IntroductionThe expensive modern therapeutic regimens for advanced lung cancer (LC) stages have been recently approved. We evaluated whether low-dose computed tomography (LDCT) LC screening of high-risk Albertans is cost saving. MethodsWe used a decision analytical modeling technique with a health system perspective and a time horizon of 3 years to compare benefits associated with reduced health service utilization (HSU) from earlier diagnosis to the costs of screening. Using patient-level data, HSU costs by stage of disease were estimated for patients with LC, including inpatient, outpatient, and physician services, and costs for prescription drugs and cancer treatments. ResultsOf 101,000 people aged 55 to 74 years eligible for screening, an estimated 88,476 scans would be performed in Alberta in 3 years. Given LDCT sensitivity and specificity of 90.5% and 93.1%, respectively, we estimated that a stage shift toward earlier diagnosis would be expected whereby 43% more patients would be identified at stage 1 or 2 as compared with without screening. The estimated cost of screening is $35.6 million (M), whereas the stage shift associated with screening would avoid $42M in HSU costs. The net cost avoidance associated with screening is therefore $6.65M. The probability for the screening to be cost saving is estimated at 72%. ConclusionsThis study has revealed that LDCT LC screening is likely to be cost saving in Alberta. Adoption of this program into the provincial health care system is worth considering provided constraints in the system related to surgical capacity and CT wait times could be addressed.

Understanding patient characteristics, treatment patterns, and clinical outcomes for advanced and recurrent endometrial cancer in Alberta, Canada.

e17624 Background: Endometrial cancer (EC) incidence in Canada is steadily increasing and a paucity of real-world data exists. This study aimed to examine treatment (tx) patterns and clinical outcomes for patients (pts) with advanced and recurrent (A/R) EC in Canada. Methods: A retrospective observational cohort study was conducted among pts with primary advanced EC (de novo stage IIIB, IIIC, IV) or recurrent EC (progression from de novo stage I, II, IIIA) between 2010 and 2018 in Alberta, Canada. Health administrative data were used to describe baseline characteristics, time to next tx (TTNT), and overall survival (OS). Using Kaplan-Meier methods, TTNT was defined from tx initiation to initiation of subsequent tx or death from any cause, and OS was examined from tx initiation until death from any cause. Outcomes were stratified by pt type (A/R) and tx. Results: 1,053 pts were included: 620 (58.9%) advanced and 433 (41.1%) recurrent pts. 713 (67.7%) pts received first-line (1L) systemic therapy; this differed by pt type (75.2% of advanced and 57.0% of recurrent pts). Advanced pts who received chemotherapy were more likely to have prior surgery (p &lt; 0.001), radiotherapy (p = 0.01), were younger (p &lt; 0.001), and had fewer comorbidities (p &lt; 0.001) than those without chemotherapy. Platinum-based chemotherapy (PBCT) was the most common 1L regimen (78.6%), differing by pt type (96.1% for advanced and 45.4% for recurrent pts). Hormone therapy in 1L was higher for recurrent compared to advanced pts (27.9% vs 3.2%). Median TTNT and OS from 1L systemic therapy was 19.9 months (95% confidence interval [CI]: 17.5–23.5) and 35.9 months (95% CI: 31.5–53.5), differing by therapy (p &lt; 0.05). Median OS from 1L ranged from 8.5 months (95% CI: 6.2–20.0; platinum monotherapy) to 62.5 months (95% CI: 59.2–NA; hormone therapy). 257 pts received second-line (2L) chemotherapy, with a median TTNT of 7.0 months (95% CI: 6.1–8.2) and median OS of 12.6 months (95% CI: 10.0–14.6). Outcomes differed by tx (p &lt; 0.05), with median OS ranging from 8.0 months (95% CI: 5.9–13.2; non-platinum monotherapy) to 17.1 months (95% CI: 12.7–NA; non-platinum combination). Among pts who received a 1L PBCT, median OS from 2L chemotherapy (N = 187) was 10.4 months (95% CI: 8.9–13.3) and was significantly higher for those rechallenged with PBCT compared to no rechallenge (13.3 months [95% CI: 11.2–20.9] vs 6.4 months [95% CI: 4.6–10.4]). Median OS in third-line (N = 71) and fourth-line (N = 26) chemotherapy was 11.0 months (95% CI: 8.2–13.5) and 12.0 months (95% CI: 7.5–NA), respectively. Outcomes did not differ significantly by pt type (A/R; p≥0.05). Conclusions: Outcomes for pts with A/R EC in Alberta, Canada are poor, particularly following 1L therapy where tx options are limited. Novel therapies with proven efficacy could address this unmet need and improve pt outcomes. Funding: GSK (216962; diana.d.martins@gsk.com).

The impact of population-based EGFR testing in metastatic non-small cell lung cancer in Alberta.

e21139 Background: While Epidermal Growth Factor Receptor (EGFR) Tyrosine Kinase Inhibitors have been shown to be effective in phase III randomized trials, the value of targeted therapies have been challenging to evaluate at the population level. We examined the impact of population-level EGFR testing and treatment on survival outcomes among metastatic Non-Small Cell Lung Cancer (NSCLC) patients. Methods: Real-world, population-level data were collected from all de novo metastatic non-squamous NSCLC patients in Alberta, Canada from 2004 to 2020. EGFR testing data were collected through Alberta Precision Laboratories using various text mining approaches. Differences in survival rates and overall survival (OS) pre (2004-2012) and post-initiation (post) (2013-2019) testing periods were evaluated using interrupted time series analyses. The impact of testing and subsequent treatment weas evaluated using multivariable Cox Proportional Hazards models. Results: In total, 4,578 metastatic NSCLC patients with a confirmed non-squamous cell carcinoma histology were diagnosed pre- EGFR testing and 4,457 patients were diagnosed post- EGFR testing (2013-2019). Among patients diagnosed in the pre- EGFR testing period, the 6-month, 1-year, and 2-year survival probabilities were 0.39 (95% CI: 0.38-0.41), 0.22 (95% CI: 0.21-0.23), and 0.09 (95% CI: 0.08-0.10), while the survival probabilities for patients diagnosed in the post- EGFR testing period were 0.45 (95% CI: 0.43-0.46), 0.29 (95% CI: 0.27-0.30), and 0.16 (95% CI: 0.15-0.1 7), respectively. After adjusting for baseline patient and clinical characteristics, OS in the post- EGFR period was significantly improved compared to the pre- EGFR period (HR: 0.81; 95% CI: 0.78-0.85). In the post-EGFR period, among patients who were treated with systemic therapy, those tested for an EGFR mutation had significantly greater survival than patients who were not tested HR of 0.81 (95% CI: 0.70-0.95). Conclusions: These results show the considerable impact of population-based molecular testing and subsequent targeted therapies on survival among advanced NSCLC patients. The estimates here can be used in future studies to evaluate the population-level cost-effectiveness of testing and treatment.

Retrospective study of factors associated with late detection of oral cancer in alberta: A qualitative study.

Oral cancer continues to be diagnosed in advanced stages, giving patients lower chances of survival. The objective of this study was to explore reasons for delayed diagnosis of oral cancer in Alberta. A retrospective qualitative design was implemented through seven steps suggested for conducting a narrative clinical document. Data was retrieved from the Alberta Cancer Registry database between 2005 and 2017. A sample of initial consultation notes (ICN) of oral and oropharyngeal cancer patients were identified through a purposeful sampling method and added to the study until saturation was achieved. A deductive analysis approach inspired by the model pathways to treatment health care provider (HCP) was employed. From the 34 ICN included in our analysis, five main categories were identified: appraisal interval, help-seeking interval, diagnosis interval, pre-treatment interval, and other contributing factors such as health-related behaviours, system delay, and tumor characteristics. These factors negatively contributed to early detection of oral and oropharyngeal cancers and affect treatment wait time with patients, providers, and the healthcare system. Patient’s lack of awareness, provider’s oversight and prolonged access to care were the main reasons of delay in cancer diagnosis and management in our study. A sustainable plan for public awareness interventions and implementation of a solid curriculum for medical and dental students is needed to enhance their related knowledge, competence in clinical judgement, and treatment managements.

Demographic, tumor and treatment factors of oral/oropharyngeal cancer in Alberta, Canada

<h3>Introduction</h3> Oral and oropharyngeal cancers have high morbidity and mortality worldwide. Distinct differ- ences exist between oropharyngeal and oral cancers; the former increasing in incidence and the later decreas- ing. The aim of this study was to determine demographic profiles, tumor characteristics and treatment factors of oral/oropharyngeal cancer in the adult population of Alberta, Canada. <h3>Methods/materials</h3> Information regarding oral/oropharyngeal cancer incidence in Alberta residents older than 18 years from 2005-2017 was extracted from the Alberta Cancer Registry database. Demographic factors included gen- der, diagnosis age, diagnosis date, age at death, vital status, death cause and geographic zone diagnosis. Tumor factors included location/site, morphology, histologic grade and clinical stage. Treatment modality was examined. Descriptive statistics was done using SPSS. <h3>Results</h3> 4069 oral/oropharyngeal cancer cases were identified. The mean (SD) age at diagnosis was 62.1 (13.3) years. 53.5% of diagnoses were made between 46-65 years of age, and 68.5% of patients were male. The number of reported oral cancer cases increased from 231 in 2005 to 398 in 2017. Most common cancer sites were tonsil (20%), tongue (19.1%), and base of tongue (15.8%). 78.6% of tumors were squamous cell carcinoma and variants and 39.1% of tumors were moderately-differentiated. 55.7% of cases were diagnosed at stage IV. Most common initial treatments were surgery (63.1%) and radiation (57.6%). As of 2017, 54.3% of patients in the study were reported alive. The main oral cancer-related deaths occurred in patients with tongue (13.9%), base of tongue (9.2%) and tonsil (9.1%) cancers. <h3>Conclusions</h3> There was a higher incidence of oral cancer in older males. Diagnoses were made at advanced stages. Higher mortality was associated with locations/sites that are difficult to examine. These findings are similar to other jurisdictions and support the need for early detection through screening examinations, increased awareness of oral/oropharyngeal cancer and earlier access to care.

Yield of routine staging laparoscopy in patients with gastric cancer in Alberta, Canada.

Background:Despite guidelines recommending diagnostic laparoscopy in patients with gastric cancer, implementation is low. We aimed to explore trends in the use of laparoscopy for staging of gastric cancer in Alberta, Canada, determine the rate of positive findings and identify factors predictive of positive staging laparoscopy (SL) findings in this patient population.Methods:In August 2018, we sent a survey to all general surgeons in Alberta who were members of the Alberta Association of General Surgeons to identify those treating gastric cancer. The survey inquired about type of practice (academic or community), gastric cancer case volume, routine versus selective use of SL and, if selective use of SL, criteria used to select cases. Participants were also asked to provide data from their SL cases from July 2007 to February 2019. We double-checked surgeon records with chart review. The primary outcome was evidence of metastatic disease on SL or cytologic examination or both. We performed logistic regression analysis to identify factors predictive of positive laparoscopy findings.Results:The survey was completed by 41 of 127 surgeons (response rate 32.3%). We reviewed 116 cases from 5 surgeons at 4 centres. Gross metastatic disease or positive findings on cytologic examination or both were identified in 37 patients (31.9%). On univariate analysis, the following were associated with an increased risk of identification of metastatic disease at laparoscopy: visualization of the primary tumour on computed tomography (CT) (odds ratio [OR] 9.8, 95% confidence interval [CI] 1.2–76.5), presence of abdominal lymphadenopathy greater than 1 cm (OR 2.4, 95% CI 1.1–5.4) and presence of ascites (OR 19.1, 95% CI 2.2–161.8). Visualization of the primary tumour on CT (OR 8.4, 95% CI 1.0–68.3) and the presence of ascites (OR 15.9, 95% CI 1.8–137.0) remained statistically significant predictors on multivariate analysis.Conclusion:Metastatic disease was identified at SL in almost one-third of cases, which suggests that SL should still be used routinely in gastric cancer staging in Canadian centres. Our study identified several preoperative imaging findings associated with evidence of metastatic disease on laparoscopy; however, further studies are needed to establish robust predictors of positive findings before advocating for a selective SL approach.

A138 TEMPORAL CHANGES IN SURVIVAL OF METASTATIC COLORECTAL CANCER PATIENTS: A POPULATION BASED STUDY

BackgroundColorectal cancer (CRC) remains a significant cause of morbidity and mortality in Canada. While early screening programs and improvements in surgical and oncologic therapies have led to a steady decline in the mortality rate of CRC, survival in metastatic stage IV disease remains low. Furthermore, it is unclear which factors have the largest impact on survival leading to a wide range in quoted survival times between studies.AimsThis study examines the impact of various disease, patient, and treatment factors on the outcomes and survival of stage IV CRC patients in Alberta, Canada from 2004–2014 and compares the survival data of this population to the most current statistics from clinical trials. It is hypothesized that survival should increase over the past decade and factors such as age, presence of comorbidities, number of metastases, and chemmotherapy regimen chosen will have significant impacts on overall survival.MethodsA registry-based analysis was conducted identifying patients diagnosed with advanced colorectal cancer in Alberta. Specifically, we collected demographic information for patients in 3 time intervals: 2004–2006, 2008–2010, and 2012–2014. Data collected included year of diagnosis, age, sex, number of metastatic sites at diagnosis (single vs multiple), area of residence (rural vs urban), Charlson comorbidity index, and primary site of disease. The survival data from the three timeframes were compared.ResultsA total of 1476 patients were studied across the 3 time intervals. Over the three time periods examined in this study, there was essentially no clinically significant difference in the survival curves. Median survival from 2004–2006 was 22.3 months, from 2008–2010 was 24.4 months, and from 2012–2014 was 24.0 months. While median survival did increase over the 3 time periods, the improvement was not statistically significant (p=0.196). Overall survival in this cohort was 23.9 months. Patients who were >68 years old or those who had multiple sites of metastases and multiple comorbidities had a worse overall survival (p<0.05).ConclusionsDespite a decade of advances in both the surgical and medical management of Stage IV CRC, the overall survival remains low. Furthermore, there remains a wide range in the quoted survival for studies performed with this cohort. This variation is almost certainly due to the heterogeneity of the study population in stage IV disease. Future studies should employ broad inclusion criteria in order to address these important gaps in the external validity of oncology trials. Survival of Stage IV Colorectal Cancer Over One Decade (2004–2014)Funding AgenciesNone

Developing a Prediction Model for Pathologic Complete Response Following Neoadjuvant Chemotherapy in Breast Cancer: A Comparison of Model Building Approaches.

PURPOSEThe optimal characteristics among patients with breast cancer to recommend neoadjuvant chemotherapy is an active area of clinical research. We developed and compared several approaches to developing prediction models for pathologic complete response (pCR) among patients with breast cancer in Alberta.METHODSThe study included all patients with breast cancer who received neoadjuvant chemotherapy in Alberta between 2012 and 2014 identified from the Alberta Cancer Registry. Patient, tumor, and treatment data were obtained through primary chart review. pCR was defined as no residual invasive tumor at surgical excision in breast or axilla. Two types of prediction models for pCR were built: (1) expert model: variables selected on the basis of oncologists' opinions and (2) data-driven model: variables selected by trained machine. These model types were fit using logistic regression (LR), random forests (RF), and gradient-boosted trees (GBT). We compared the models using area under the receiver operating characteristic curve and integrated calibration index, and internally validated using bootstrap resampling.RESULTSA total of 363 cases were included in the analyses, of which 86 experienced pCR. The RF and GBT fits yielded higher optimism-corrected area under the receiver operating characteristic curves compared with LR for the expert (RF: 0.70; GBT: 0.69; LR: 0.65) and data-driven models (RF: 0.71; GBT: 0.68; LR: 0.64). The LR fit yielded the lowest integrated calibration indices for the expert (LR: 0.037; GBT: 0.05; RF: 0.10) and data-driven models (LR: 0.026; GBT: 0.06; RF: 0.099).CONCLUSIONOur models demonstrated predictive ability for pCR using routinely collected clinical and demographic variables. We show that machine learning fit methods can be used to optimize models for pCR prediction. We also show that additional variables beyond clinical expertise do not considerably improve predictive ability and may not be of value on the basis of the burden of data collection.

Mortality and Resource Use Among Individuals With Chronic Kidney Disease or Cancer in Alberta, Canada, 2004-2015

Although the public is aware that cancer is associated with excess mortality and adverse outcomes, the clinical consequences of chronic kidney disease (CKD) are not well understood. To compare the clinical consequences of incident severe CKD and the first diagnosis with a malignant tumor, focusing on the 10 leading causes of cancer in men and women residing in Canada. This population-based cohort study enrolled individuals aged 19 years and older with severe CKD or certain types of cancer between 2004 and 2015 in Alberta, Canada. Data were analyzed in November 2021. Individuals were categorized as having severe CKD (based on estimated glomerular filtration rate <30 mL/min/1.73 m2 or nephrotic albuminuria without dialysis or kidney transplantation) or nonmetastatic or metastatic cancer (defined by a diagnosis of lung, breast, colorectal, prostate, bladder, thyroid, kidney or renal pelvis, uterus, pancreas, or oral cancer). All-cause mortality, number of hospitalizations, total number of hospital days, and placement into long-term care were calculated after diagnosis. Of 200 494 individuals in the cohort (104 559 women [52.2%]; median [IQR] age, 66.8 [55.9-77.7] years), 51 159 (25.5%) had incident severe CKD, 115 504 (57.6%) had nonmetastatic cancer, and 33 831 (16.9%) had metastatic cancer. Kaplan-Meier 1-year survival was 83.3% (95% CI, 83.0%-83.6%) for patients with CKD, 91.2% (95% CI, 91.0%-91.4%) for patients with nonmetastatic cancer, and 52.8% (95% CI, 52.2%-53.3%) for patients with metastatic cancer. Kaplan-Meier 5-year survival was 54.6% (95% CI, 54.2%-55.1%) for patients with CKD, 76.6% (95% CI, 76.3%-76.8%) for patients with nonmetastatic cancer, and 33.9% (95% CI, 33.3%-34.4%) for patients with metastatic cancer. Compared with nonmetastatic cancer, the age-, sex-, and comorbidity-adjusted relative rate of death was similar for CKD (adjusted relative rate, 1.00; 95% CI, 0.97-1.03; P = .92) during the first year of follow-up and was higher for CKD at years 1 to 5 (adjusted relative rate 1.23; 95% CI, 1.19-1.26). During the first year of follow-up, for patients with CKD, adjusted rates of placement in long-term care (adjusted relative rate, 0.88; 95% CI, 0.82-0.94) and hospitalization (adjusted relative rate, 0.65; 95% CI, 0.64-0.66) were lower than rates for patients with nonmetastatic cancer; however, those rates were higher for the CKD group than for the nonmetastatic cancer group during years 1 to 5 (long-term care placement, adjusted relative rate, 1.36; 95% CI, 1.29-1.43; hospitalization, adjusted relative rate, 1.55; 95% CI, 1.52-1.58). As expected, adjusted rates of long-term care placement and hospitalization were higher for patients with metastatic cancer than for the other 2 groups. In this study, mortality, hospitalization, and likelihood of placement into long-term care were similar for CKD and nonmetastatic cancer. These data highlight the importance of CKD as a public health problem.

Chronic disease surveillance in Alberta's tomorrow project using administrative health data.

IntroductionAlberta’s Tomorrow Project (ATP) is the largest population-based prospective cohort study of cancer and chronic diseases in Alberta, Canada. The ATP cohort data were primarily self-reported by participants on lifestyle behaviors and disease risk factors at the enrollment, which lacks sufficient and accurate data on chronic disease diagnosis for longer-term follow-up.ObjectivesTo characterize the occurrence rate and trend of chronic diseases in the ATP cohort by linking with administrative healthcare data.MethodsA set of validated algorithms using ICD codes were applied to Alberta Health (AH) administrative data (October 2000-March 2018) linked to the ATP cohort to determine the prevalence and incidence of common chronic diseases.ResultsThere were 52,770 ATP participants (51.2±9.4 years old at enrollment and 63.7% females) linked to the AH data with average follow-up of 10.1±4.4 years. In the ATP cohort, hypertension (18.5%), depression (18.1%), chronic pain (12.8%), osteoarthritis (10.1%) and cardiovascular diseases (8.7%) were the most prevalent chronic conditions. The incidence rates varied across diseases, with the highest rates for hypertension (22.1 per 1000 person-year), osteoarthritis (16.2 per 1000 person-year) and ischemic heart diseases (13.0 per 1000 person-year). All chronic conditions had increased prevalence over time (p < for trend tests), while incidence rates were relatively stable. The proportion of participants with two or more of these conditions (multi-morbidity) increased from 3.9% in 2001 to 40.3% in 2017.ConclusionsThis study shows an increasing trend of chronic diseases in the ATP cohort, particularly related to cardiovascular diseases and multi-morbidity. Using administrative health data to monitor chronic diseases for large population-based prospective cohort studies is feasible in Alberta, and our approach could be further applied in a broader research area, including health services research, to enhance research capacity of these population-based studies in Canada.