Main Cancer Sites Research Articles

Safety and effectiveness of sodium-glucose co-transporter 2 inhibitors in active cancer patients with heart failure: results of the observational TOSCA trial

Abstract Background Sodium-glucose co-transporter 2 inhibitors (SGLT2i) currently represent a pillar of heart failure (HF) treatment. However, cancer patients have not been included in landmark randomized controlled trials (RCTs), and data on safety and effectiveness in this population are lacking. Purpose Purpose of present study was to evaluate safety and effectiveness of SGLT2i in active cancer patients with HF. Methods TOSCA is a multi-centre observational trial including patients (≥ 18 years) with active cancer (diagnosis < 3 years) receiving SGLT2i for HF treatment. Patients were enrolled in two (prospective and retrospective) cohorts. The primary endpoint was safety (incidence of known and unexpected side effects). The secondary endpoint was effectiveness (ejection fraction (EF) increase, New York Heart Association (NYHA) class change, HF-related events). Exploratory endpoints included drug-drug interactions with anticancer and supportive care drugs, treatment of cancer therapy-related cardiac dysfunction (CTRCD), and changes in NT-proBNP. Results Eighty-three pts were enrolled (59 prospective - 24 retrospective). Median age was 71 (range 44-92) yrs, M/F 48/52%. The main cancer sites were breast, gastrointestinal tract, and hematological malignancies. Most cases (62%) received an active treatment (mainly chemotherapy) while on SGLT2i. Prevalent aetiology was drug-induced HF (37%) with reduced EF as the prevalent clinical presentation (39%). Prescribed agents were dapagliflozin in 60% and empagliflozin in 40% of cases on top of conventional guideline-directed medical therapy, with a median treatment duration of 3 (range 3-25) months. The incidence of urinary tract infection was 2.5%. No cases of genital infection, hypoglycemia, diabetic ketoacidosis, acute renal injury, thrombosis, and bone fractures were reported. Mean overall EF slightly increased (44.1% vs. 46.6%), and NYHA class improved (class improvement in 16%). Unplanned cardiology visits (1.2%), i.v. diuretics (1.2%), coronary angiography (5%), emergency access (2.5%), and new HF episodes (3.7%) rates were low. SGLT2i appeared effective in 31 cases of CTRCD. A relative reduction in mean NT-proBNP levels (2748 vs 1125pg/mL) was observed. No drug-drug interactions were reported. Conclusions SGLT2i appear to be safe and effective in active cancer patients with HF, with potential cardioprotective effect. No new safety warnings were recorded.

Serious Health-Related Suffering Impairs Treatments and Survival in Older Patients With Cancer

ContextMore than half of new cancer cases occurred in older adults. Older patients with cancer are particularly at risk of physical, psycho-existential or socio-familial suffering as defined by the concept of Serious Health-related Suffering (SHS). ObjectivesTo assess the direct and indirect effects of physical, psycho-existential and socio-familial dimensions of suffering on cancer treatability, supportive care needs and 12-month mortality in older patients with cancer. MethodsWe included patients with cancer aged 70 years and over from the Elderly Cancer Patients cohort (ELCAPA, Ile-de-France), referred for geriatric assessment between 2007 and 2019 before cancer treatment. Structural equation modelling examined the direct and indirect relationships between SHS dimensions (latent variables), patients’ characteristics (age, sex, tumor location and metastatic status, comorbidity, period of care), and outcomes. ResultsThe analysis included 4,824 patients (mean age: 82.2 ± 4 years; women: 56%; main cancer sites: breast [22.3%], colorectal [15.2%], prostate [8.5%], and lung [6.8%]; metastatic cancer: 46%). Physical suffering had direct pejorative effects on cancer treatability, and mortality (standardized coefficient [SC] = 0.12 [P < 0.001], SC = 0.27 [P < 0.001], respectively). Psycho-existential and socio-familial sufferings had indirect pejorative effects on survival through decreased cancer treatability (SC = 0.08 [P < 0.001], SC = 0.03 [P < 0.001], respectively). Psycho-existential dimension had the main direct effect size on supportive care needs (SC = 0.35 [P < 0.001]) and was interrelated with physical suffering. ConclusionPhysical suffering has direct pejorative effect on survival. All dimensions indirectly decrease survival due to poorer cancer treatability. Our findings support concomitant management of physical and psycho-existential suffering.

The impact of rurality on patient experience and diagnostic pathway intervals in Scotland’s cancer patients: Further results from a national cancer diagnosis audit

BackgroundIn Scotland 17 % of the population reside rurally and previous research has demonstrated worse cancer outcomes in this group. The underlying reason for this is unclear. This study aims to determine whether patient presenting factors, GP consultation factors or the diagnostic pathways differ between urban and rural patients within Scotland. MethodsThis study combined two Scottish National Cancer Diagnosis Audits. Participating GPs collected data on the diagnostic pathway from primary to secondary care for cancer patients diagnosed during the audit period. Using the Scottish Government Urban Rural Classification, patients were designated as rural or urban dwellers and compared in descriptive analyses. Key cancer intervals (primary, diagnostic, secondary and treatment interval) were compared between urban and rural dwellers with an additional adjusted analysis for the main cancer sites. ResultsA total of 4309 cancer diagnoses were included in the study; 22 % were in patients from rural locations. Rural patients had significantly more consultations and investigations prior to referral than their urban counterparts. There was no difference in prolonged cancer pathways between the two groups except in lung cancer patients where rural patients had a significantly increased odds of a diagnostic interval of >90 days. ConclusionOur findings suggest differences in the interaction between patients and GPs prior to referral in urban and rural settings. However, this does not appear to lead to prolonged patient pathways, except in lung cancer. Further research is needed to determine whether this delay is clinically significant and contributing to poorer outcomes in Scottish rural dwellers with lung cancer.

Geriatric impairments were directly and indirectly associated with mortality in older patients with cancer: a structural equation analysis

ObjectivesWe assessed the direct and indirect effects between six geriatric domains and 6- and 12-month mortality in older cancer patients. Study Design and SettingWe included cancer patients aged ≥70 years from the Elderly Cancer Patients cohort, referred for geriatric assessment between 2007 and 2016. We used structural equation modelling to examine the interrelationships between six geriatric domains (function and mobility, nutrition, cognition, mood, comorbidities and polypharmacy, and social support) and the direct and indirect relationships between these domains, the cancer stage, site, and treatment on the one hand and mortality on the other. ResultsThe analysis included 1,434 patients (mean age: 80 ± 5.6 years; women: 48%; main cancer sites: digestive tract [36.2%], urinary tract and prostate [26.6%], and breast [16.5%]; metastatic cancer: 48%). Direct relationships to 6- and 12-month mortality were identified for functional impairment (standardized coefficient [SC]: 0.37 [P < 0.001] and 0.32 [P < 0.001], respectively), poor nutritional status (SC: 0.11 [P = 0.005] and 0.14 [P = 0.001]), poor social support (SC = 0.07 [P = 0.08] and 0.09 [P = 0.02]), cancer site, stage, and treatment. The effects of comorbidities, cognitive impairment, and depression on mortality were mediated by functional and nutritional status. ConclusionIn older cancer patients, functional and nutritional impairments were the strongest direct prognostic geriatric factors for mortality.

Abstract P3-12-35: Industrial and ruminant trans fatty acid intakes and cancer risk: Results from the NutriNet-Santé cohort

Abstract Background Dietary trans fatty acids (TFAs) are either natural (from ruminant sources) or generated through industrial processes by partial hydrogenation of vegetable oils. Extended evidence demonstrated their role as cardiovascular risk factors. In contrast, their involvement in cancer etiology is suspected, but epidemiological evidence remains limited. Objectives Our objective was to investigate associations between TFA intake of different types (total, rumninant [rTFAs], industrial [iTFAs], and corresponding specific isomers) and the risk of cancer (overall and main cancer sites) in the NutriNet-Santé prospective cohort (2009-2020). Methods Overall, 104,909 participants were included. Usual TFA intake was estimated from validated repeated 24-h dietary records matched with detailed composition table. Associations between sex-specific quartiles of TFA intake and cancer risk were assessed using multi-adjusted Cox proportional hazard models. Results A total of 3,374 incident cancer cases occured during follow-up (among which 982 breast and 405 prostate cancers). Dietary intake of total TFAs was associated with higher prostate cancer risk (HRfor quartile 4 versus 1: 1.27, 1.11-1.77 Ptrend=0.005). rTFAs were associated with increased overall cancer risk (1.16, 1.02-1.32 Ptrend=0.07), in particular the conjugated linoleic acid isomers (CLA) (1.19, 1.04-1.36 Ptrend=0.04). These associations were specifically observed for breast cancer (rTFAs: 1.35, 1.06-1.72 Ptrend=0.01; CLA: 1.29, 1.00-1.66 Ptrend=0.048), in particular before menopause (rTFAs: 1.68, 1.06-2.67 Ptrend=0.02; CLA: 2.013, 1.25-3.23 Ptrend=0.003). Several iTFAs were associated with overall (1.18, 1.06-1.31 Ptrend=0.02 for transdocosenoic acid), breast (isomer 18:2t: 1.30, 1.06-1.58 Ptrend=0.01; hexadecenoic acid: 1.28, 1.05-1.56 Ptrend=0.02) and prostate (transdocosenoic acid: 1.52, 1.09-2.12 Ptrend=0.07) cancer risks. Conclusion In this large prospective study, several types of TFAs were associated with increased overall, breast and prostate cancer risks. Although further studies are needed to better understand underlying mechanisms, these results support the WHO's goal of achieving industrially produced TFAs elimination from food supplies. Meanwhile, the consumption of food products containing partially-hydrogenated oils should be avoided. Citation Format: Gaëlle Wendeu-Foyet, Véronique Chajes, Inge Huybrechts, Jean-Marie Bard, Charlotte Debras, Eloi Chazelas, Bernard Srour, Laurent Zelek, Chantal Julia, Emmanuelle Kesse-Guyot, Cédric Agaësse, Nathalie Druesne-Pecollo, Pilar Galan, Serge Hercberg, Mélanie Deschasaux-Tanguy, Mathilde Touvier. Industrial and ruminant trans fatty acid intakes and cancer risk: Results from the NutriNet-Santé cohort [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P3-12-35.

Abstract P1-09-01: Breast and prostate cancer risk associated with nitrites and nitrates from food additives: Results from the NutriNet-Santé cohort

Abstract Background Nitrates and nitrites occur naturally in water and soil and are commonly ingested from drinking water and dietary sources. They are also used as food additives in processed meats to increase shelf life and to avoid bacterial growth. These compounds could have a role in the carcinogenicity of processed meat. Objective To investigate the relationship between nitrate and nitrite intakes (distinguishing between natural food, water and food additive sources) and the risk of cancer in a large prospective cohort with detailed and up to date dietary assessment. Design Population based prospective cohort study. Setting Overall, 101,056 adults from the French NutriNet-Santé cohort study (2009-ongoing) were included. Consumption of nitrites and nitrates was evaluated using repeated 24h dietary records, linked to a comprehensive food composition database and accounting for details of commercial names/brands of industrial products. Main outcome measures Associations between nitrite and nitrate exposures and the risk of cancer (overall and by main cancer sites) were assessed by Cox hazard models adjusted for known risk factors. Results During follow-up, 3311 first incident cancer cases were diagnosed (among which 966 breast and 400 prostate cancers). Compared with non-consumers, higher consumers of nitrates from food additives had higher risk of breast cancer (HR=1.24 (1.03-1.48), P=0.02); this was more specifically observed for potassium nitrate (e252, HR=1.25 (1.04-1.50), P=0.01). Higher consumers of nitrites from food additives had higher risk of prostate cancer (HR=1.58 (1.14-2.18), P=0.008), specifically for sodium nitrite (e250, HR=1.62 (1.17-2.25), P=0.004). No significant association was observed for nitrates and nitrites from natural sources. Conclusions In this large prospective cohort, food additive nitrates were positively associated with breast cancer risk and food additive nitrites were positively associated with prostate cancer risk. While these results need confirmation in other large-scale prospective studies, they provide new insights in a context of lively debate around the ban of nitrite additives in the food industry. Study registration The NutriNet-Santé cohort is registered at clinicaltrials.gov (NCT03335644). Citation Format: Eloi Chazelas, Fabrice Pierre, Nathalie Druesne-Pecollo, Younes Esseddik, Fabien Szabo de Edelenyi, Cédric Agaesse, Alexandre De Sa, Rebecca Lutchia, Stéphane Gigandet, Bernard Srour, Charlotte Debras, Inge Huybrechts, Chantal Julia, Emmanuelle Kesse-Guyot, Benjamin Allès, Laurent Zelek, Pilar Galan, Serge Hercberg, Mélanie Deschasaux-Tanguy, Mathilde Touvier. Breast and prostate cancer risk associated with nitrites and nitrates from food additives: Results from the NutriNet-Santé cohort [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P1-09-01.

Occupational cancers: essentials for the general practioners

Given the frequency of cancers, prevention is based on knowledge of the causes. Experts estimate the proportion of cancers attributable to work at around 5 %. If it is shown that exposure at work is involved, the patient can claim compensation for an occupational disease. In order for the occupational origin to be identified, it is important to know which jobs/sectors of activity are possibly at risk. The aim of this article is to present the six main cancer sites for which a link with occupational exposure has been documented, to specify the causes of the under-reporting of occupational cancers, the role of the treating physician working in a multidisciplinary network, and the tools and practical advice for optimizing the support to patients/their relatives.

Prevalence and prognostic impact of cachexia among older patients with cancer: a nationwide cross-sectional survey (NutriAgeCancer).

Background Nutritional impairment is common in cancer patients and is associated with poor outcomes. Only few studies focused on cachexia. We assessed the prevalence of cachexia in older cancer patients, identified associated risk factors, and evaluated its impact on 6 month overall mortality.MethodsA French nationwide cross‐sectional survey (performed in 55 geriatric oncology clinics) of older cancer patients aged ≥70 referred for geriatric assessment prior to treatment choice and initiation. Demographic, clinical, and nutritional data were collected. The first outcome was cachexia, defined as loss of more than 5% of bodyweight over the previous 6 months, or a body mass index below 20 kg/m2 with weight loss of more than 2%, or sarcopenia (an impaired Strength, Assistance with walking, Rise from chair, Climb stairs and Falls score) with weight loss of more than 2%. The second outcome was 6 month overall mortality.ResultsOf the 1030 patients included in the analysis [median age (interquartile range): 83 (79–87); males: 48%; metastatic cancer: 42%; main cancer sites: digestive tract (29%) and breast (16%)], 534 [52% (95% confidence interval: 49–55%)] had cachexia. In the multivariate analysis, patients with breast (P < 0.001), gynaecologic (P < 0.001), urinary (P < 0.001), skin (P < 0.001), and haematological cancers (P = 0.006) were less likely to have cachexia than patients with colorectal cancer. Patients with upper gastrointestinal tract cancers (including liver and pancreatic cancers; P = 0.052), with previous surgery for cancer (P = 0.001), with metastases (P = 0.047), poor performance status (≥2; P < 0.001), low food intake (P < 0.001), unfeasible timed up‐and‐go test (P = 0.002), cognitive disorders (P = 0.03) or risk of depression (P = 0.005), were more likely to have cachexia. At 6 months, 194 (20.5%) deaths were observed. Cachexia was associated with 6 month mortality risk (adjusted hazard ratio = 1.49; 95% confidence interval: 1.05–2.11) independently of age, in/outpatient status, cancer site, metastatic status, cancer treatment, dependency, cognition, and number of daily medications.ConclusionsMore than half of older patients with cancer managed in geriatric oncology clinics had cachexia. The factors associated with cachexia were upper gastrointestinal tract cancer, metastases, poor performance status, poor mobility, previous surgery for cancer, cognitive disorders, a risk of depression, and low food intake. Cachexia was independently associated with 6 month mortality.

MO507ROCK STUDY: RESEARCH STUDY OF CANCER ASSOCIATED KIDNEY DISEASES

Abstract Background and Aims The improvement in the survival rates of cancer patients due to the new oncological and biological agents has led to an increase in those who develop kidney diseases. It is now well known that chronic kidney disease (CKD) and cancer are connected in several ways. Nevertheless, although emerging evidence suggests that the risk of renal impairment in cancer patients is high and increasing, the overall incidence and prevalence of CKD in this population are still uncertain. The purpose of the study is to provide data on the prevalence and incidence of CKD in patients included in the Cancer Registry of the province of Reggio Emilia, Italy, since January, 1st to December, 31st 2016. Method single-center, observational and retrospective study. For all patients included, data on sex, age, ethnicity, serum creatinine and related eGFR, type and number of tumors, diagnosis of diabetes mellitus were collected. The main cancer sites considered were breast, colorectal, lung, pancreas, stomach, prostate, lymphomas and leukemias. An eGFR ≥ 60 ml/min1.73m2 was indicative of a normal kidney function, while an eGFR &amp;lt;60 ml/min/1.73m2 as kidney impairment. All the eGFR data were calculated not only with the CKD-EPI formula, now recognized as the reference formula for estimating eGFR in the general population, but also with the Wright formula which seems to provide the best estimate in cancer patients. Results 4254 patients with a cancer diagnosis were identified between January 1st and December 31st 2016; of these, 171 patients were excluded due to lack of data. Of the remaining 4083 patients, 776 (19%) had at least an eGFR value &amp;lt;60 mL/min/1.73m2 prior to cancer diagnosis and 497 patients (11.7%) were identified as affected by CKD. The incidence of new-onset CKD in the following 24 months since cancer diagnosis was 4.4% (186 patients) [95% CI 3.9-5.3] using CKD-EPI formula; using Wright formula, we identified 140 (3.4%) [95% CI 2.9-4.0] new cases of CKD in the same period. For both cohorts of patients (pre-existing CKD and CKD diagnosed after cancer diagnosis), descriptive analyzes were conducted related to demographic and clinical data. Referring to the CKD-EPI formula, in patients with pre-existing CKD (497 patients, 11.7%), the mean age was 81 years (SD ± 8.4), 53.7% were men, 18.3% had a known diagnosis of type 2 diabetes mellitus, 3.6% of these patients had 2 or more cancer diagnosis in the study period. 44.3% were alive at the end of the follow-up (December 31st, 2018). Using Wright formula, 504 (11.8%) patients with CKD already present at the time of cancer diagnosis were identified; these patients had an average age of 82 years (SD ± 8.4) and in 55.4% of cases were men; 18.8% had type 2 diabetes mellitus and 3.8% had 2 or more cancer diagnosis. Conclusion The ROCK study is the first large cohort study that allows a clearer estimation of the frequency of CKD in Italian cancer patients. Knowledge of the prevalence of CKD in cancer patients is essential for proper clinical and therapeutic management and implementation of preventive strategies.

Impact of Open-Label Design on Patient-Reported Outcomes (PROs) Data in Randomized Clinical Trials of Immuno-Oncology (IO) Agents in Patients with Advanced or Metastatic Cancer: A 10-year systematic literature review (SLR)

Abstract Background The unblinded nature of open-label clinical trials may bias patient assessments of treatment efficacy and PRO measures. In this context, we conducted a SLR of IO trials across indications, to assess and quantify the potential impact of open-label vs. double-blind designs on treatment effects of PROs. Methods Independent reviewers conducted a systematic search of indexed literature published from January 2009 to May 2019, using PubMed/MEDLINE, Cochrane Library, EMBASE databases and manual search. A detailed search algorithm identified all randomized clinical trials of IO therapies focused on advanced or metastatic cancer patients reporting PRO data. We conducted descriptive analyses quantifying differences at baseline and over time according to the type of studies (open vs. blinded) in terms of PRO questionnaire completion rates and on obtained PRO measures. We determined frequencies, percentages and 95% confidence intervals of the estimated differences when comparing open-label vs. blinded trials. Complementary analyses also assessed the concordance between PRO results and efficacy. Results Overall, we identified 8,285 references. After duplicates were removed, 5,888 papers were screened and finally 28 papers were identified according to our predefined criteria, corresponding to a total of 24 studies. Among them, 15 (62.5%) were open-label studies. The main cancer sites were melanoma (N = 10, 41.7%) and non-small cell lung cancer (N = 7, 29.2%). The principal IO-drugs investigated, alone or as part of a combination therapy regimen, were nivolumab (N = 12, 50.0%), ipilimumab (N = 8, 33.3%), and pembrolizumab (N = 5, 20.8%). Descriptive analyses are ongoing and will be presented at the conference. Conclusion To our knowledge, this SLR is the first one to focus on the impact of open-label design on PROs in randomized clinical trials of IO agents using a large search algorithm in the 3 most relevant scientific literature databases. Future research should use patient-level data to investigate potential differences in PROs between open-label and blinded trials. Legal entity responsible for the study Bristol-Myers Squibb. Funding Bristol-Myers Squibb. Disclosure A. Anota: Honoraria (self), Research grant / Funding (institution), Travel / Accommodation / Expenses: Bristol-Myers Squibb. C. Lefevre: Full / Part-time employment: Bristol-Myers Squibb. H. Lemasson: Full / Part-time employment: Bristol-Myers Squibb. F-E. Cotte: Full / Part-time employment: Bristol-Myers Squibb. G. Mouillet: Honoraria (self): Bristol-Myers Squibb. All other authors have declared no conflicts of interest.

Cancer incidence trend in northern tunisia: 1994-2009

Abstract Background Cancer is a major public health problem in Tunisia. The objectives of this study were to describe the epidemiological pattern of cancer for all and main cancer sites in Northern Tunisia during the period 2007-2009 and to analyze it’s incidence trend between 1994 and 2009. Methods Cancer registry of Northern Tunisia was the source of data for the identification of patients for this study. This registry notify, since 1994, all cases of malignant tumor in people living in the District of Tunis, Nabeul, Zaghouan, Bizerte (North East) Beja, Jendouba, Kef and Siliana (North West). Cases were codified using the third version of International Classification of Diseases for Oncology. Demographic data were provided by the National Statistical Institute. Incidence trend analysis was achieved by using JoinPoint Software. Results During the period 2007-2009, the age-standardised incidence rate of all sites combined was 149.2/100 000 person-years and 112.3/100 000 person-years respectively among males and females. The sex ratio was 1.26. The mean age at diagnosis was 58.28±16.77 years. The most common sites for males were: lung, bladder, prostate and colorectal; while for females, they were breast, colorectal, thyroid and cervix uteri. Local stage at diagnosis was observed in 37.7% of cases. The highest incidence rates were observed in the District of Tunis and in the governorates of North East. The trend incidence cancer of all sites combined during the period from 1994 to 2009 was significantly risen except for stomach cancer among males and cervix uteri among females with annual percent changes of -2.5% and of -4.1% respectively. Conclusions Despite the existence of a national cancer strategy in Tunisia, many barriers affect the implementation of interventions; while the trend cancer incidence continues to rise particularly in males. Strengthening prevention strategy of this scourge is strongly recommended. Key messages Cancer is a major public health in world and in Tunisia. Prevention must be applied to reduce the incidence of cancer.

Cancer mortality among indigenous people in western amazon

TPS 723: Low and middle income countries: sanitation infections and other health effects, Exhibition Hall, Ground floor, August 26, 2019, 3:00 PM - 4:30 PM Aim: to estimate the cancer mortality and cancer Standardized Mortality Ratio (SMR) in western Amazon indigenous population. Methods: A cancer mortality descriptive study was accomplished among indigenous people in the state of Acre, Brazil, located in the western Amazon region. Cancer deaths diagnosed from January 1, 2000 to December 31, 2012 were obtained from Death Certificate Information System. Population at risk was obtained from the Brazilian Institute of Geography and Statistics. Cancer deaths distributions stratified by sex, age, and ethnic group were proceeded according to anatomic sites. The SMR, with 95% confidence intervals, were estimated using the cancer-mortality rates of Goiania, Acre state, and Brazilian North region as references. Results: A total of 81 cancer-deaths among indigenous people were recorded from 2000-2012, mostly among men (59.3%), those aged 70+ (37%), and Huni Kuin/Kaxinawá ethnic group (38.8%). Among men, the main cancer sites were stomach(27.1%), liver(18.7%), colorectal(8.3%), leukemia(8.3%), and prostate(8.3%); while among women were cervix(36.4%), stomach(12.1%), liver(6.1%), leukemia(6.1%), and uterus(6.1%). In men, cancer deaths excess were observed for stomach as compared to men from Goiânia(SMR=2.72;95%CI:2.58-2.87), Acre state(SMR=2.05;95%CI:1.94-2.16), and North region(SMR=3.10;95%CI:2.93-3.27); and also for liver comparing to Goiânia(SMR=3.89;95%CI:3.66-4.14), Acre state(SMR=1.79;95%CI:1.68-1.91), and North region(SMR=4.04;95%CI:3.77-4.30). In women, cancer deaths excess were observed for cervix as compared to cervical cancer rates from Goiânia(SMR=4.67;95%CI:4.41-4.93), Acre state(SMR=2.12;95%CI:2.00-2.24), and North region(SMR=2.60;95%CI:2.45-2.75). Conclusion: Cancer mortality among indigenous people from western Amazon affected mainly men, elderly people (aged 70+), and Huni Kuin/Kaxinawá ethnic group. In men, stomach and liver cancer-deaths excess were observed among indigenous people comparing to non-indigenous population from Goiania, Acre state, and North region. In women, a cervical cancer-death excess were observed among indigenous people comparing to non-indigenous population from the same areas. It suggests that indigenous people in western Amazon have lack of cancer prevention, diagnosis and treatment access, as compared to non-indigenous population in the same area.

The Dietary Inflammatory Index Is Associated with Prostate Cancer Risk in French Middle-Aged Adults in a Prospective Study

Background: Chronic inflammation is one of the mechanisms involved in carcinogenesis. Diet is a major source of pro- and anti-inflammatory compounds. The Dietary Inflammatory Index (DII) was designed to estimate its overall inflammatory potential.Objective: Our objective was to investigate the associations between the DII and overall, breast, and prostate cancer risks.Methods: This prospective study included 6542 participants [3771 women and 2771 men with a mean ± SD age of 49.2 ± 6.4 y and a BMI (in kg/m2) of 24.0 ± 3.6 at baseline] from the Supplémentation en VItamines et Minéraux AntioXydants (SU.VI.MAX) cohort who completed at least six 24-h dietary records during the first 2 y of follow-up. The DII was based on 36 food variables. Higher scores corresponded to more proinflammatory diets. A total of 559 incident cancers were diagnosed (median follow-up, 12.6 y), including 158 female breast and 123 prostate cancers (the 2 main cancer sites in this cohort). Associations were characterized by multivariable Cox proportional hazards models. Stratified analyses were performed according to the median of usual daily alcohol intake.Results: Sex-specific quartiles of the DII were positively associated with prostate cancer risk [quartile (Q) 4 compared with Q1, HR: 2.08; 95% CI: 1.06, 4.09] but not with overall or breast cancer risks. There was an interaction between the DII and alcohol intake (grams per day) on overall cancer risk (P-interaction = 0.02): the DII was positively associated with overall cancer risk in low-to-moderate alcohol drinkers (Q4 compared with Q1 HR: 1.75; 95% CI: 1.15, 2.68; P-trend = 0.02), whereas no association was detected in higher consumers of alcohol (P-trend = 0.8). This interaction was also observed for breast cancer (P-interaction = 0.001).Conclusion: Consistent with mechanistic data, findings from this study indicated that proinflammatory diets are associated with increased prostate cancer risk and, in low-to-moderate alcohol drinkers, with increased overall and breast cancer risk. The SU.VI.MAX trial was registered at clinicaltrials.gov as NCT00272428.

Cancer screening: global debates and Cuban experience.

A review was conducted of screening strategies for detecting the main cancer sites for which screening has been recommended, assessing WHO and other international organizations' positions, as well as the requirements of Cuba's cancer control strategy. Universally, screening is recommended for cervical, breast and colorectal cancer, all included in the Cuban strategy. Additionally, in Cuba, PSA testing is indicated for men considered at risk (aged >45 years with family history) and those aged >50 years who request it; annual oral exams and teaching of oral self-examination are recommended for the entire population; and for adults aged >35 years, active annual oral cancer case finding. Screening for skin cancer is performed by physical examination of individuals at risk. To maximize benefits of early cancer detection, greater coverage is needed as well as studies of how well screening is performing under current Cuban conditions.

Cohort studies on cancer mortality of digestive system among workers exposed to asbestos: a meta-analysis

To determine if there are excessive risks of malignant tumors or not among workers exposed to asbestos by applying a meta-analysis technique. All data meeting the criteria of cohort studies on cancer mortality of digestive system among workers exposed to asbestos would be incorporated into the meta-analysis. The pooled standardized mortality ratios (SMR) and their corresponding 95% confidence intervals (CIs) for main cancer sites of digestive system were calculated by using two approaches of un-weighted ratio and random effects model. The heterogeneity and its sources of the results were examined with a Q-statistic and Z-score test. 69 asbestos-exposed cohorts were summarized. The significantly elevated meta-SMR for all deaths (1.16), all cancers (1.42), cancer of digestive system (1.15) and cancer of stomach (1.20) among workers exposed to chrysotile alone or mixed asbestos were observed (P < 0.01). The stomach cancer SMR was significantly increased in the asbestos cement workers, the screening mine workers and the insulators, (1.27, 1.21 and 2.13 respectively) (P < 0.05). meta-SMR for cancers at other sites of digestive system including esophagus, colon, rectum and liver were not significant. There are likely excessive risks of cancer of stomach among workers exposed to asbestos. However, there is likely no convincing indication of an etiological association between asbestos exposure and cancers at other sites of digestive system.

Symptom clusters in patients with advanced cancers

9566 Background: It has been observed that certain cancer symptoms such as pain, depression and fatigue frequently occur together. Prior research on symptom patterns has focused on inpatients, early stage cancers, or a single cancer type or metastatic site. Our aim was to explore symptom clusters among outpatients with various types of advanced cancers. Methods: Symptom scores measured by Edmonton Symptom Assessment Scale (ESAS) were routinely collected for patients attending Oncology Palliative Care Clinics at Princess Margaret Hospital from January 2004 to October 2007. Principal component analysis (PCA) was performed for the entire patient cohort and within specific disease sites to determine interrelationships of the 9 ESAS symptoms. Regression analyses were used to identify patient characteristics that were associated with symptom clusters and severity of symptom distress. Results: A total of 1,366 patients were included: 50% were male and median age was 64 years (range 18 to 74). The 3 most prevalent symptoms were fatigue, poor general well-being and decreased appetite. PCA of symptoms for the entire patient cohort revealed 2 major symptom clusters: cluster 1 (fatigue, drowsiness, nausea and decreased appetite) and cluster 2 (anxiety, depression and poor general well-being). There was high internal reliability in the clusters (Cronbach’s alpha coefficient 0.80 and total variance 10–47%). Neither patient gender nor age predicted for symptom clusters (all p>0.05). Results from PCA of symptoms within the main cancer sites were tabulated (see table). Conclusions: In patients with advanced cancers, cancer site is associated with distinct symptom clusters which are not influenced by patient demographics. Further prospective studies are warranted in order to develop cancer-specific palliative interventions for this patient population. ESAS Symptom CNS H&N Breast Lung GI GU Gyne Pain 0.70* 0.23 0.87* 0.74* 0.73* 0.71* 0.55* Fatigue 0.77* 0.64* 0.43 0.60 0.56* 0.73* 0.60* Nausea 0.22 0.10 0.28 0.41* 0.78* 0.15 0.21 Depression 0.33 0.83* 0.47 0.31 0.79* 0.17 0.14 Anxiety 0.25 0.79* 0.20 0.17 0.84* 0.20 0.16 Drowsiness 0.80* 0.24 0.57* 0.33 0.73* 0.45 0.12 Appetite 0.10 0.19 0.28 0.81* 0.03 0.77* 0.76* Well-being 0.33 0.68* 0.32 0.68* 0.39 0.73* 0.78* Dyspnea 0.65* 0.77* 0.24 0.01 0.27 0.44 0.59* Values listed represent factor loading in principal component analysis where * indicates possible symptom clustering within the disease site. CNS: central nervous system; H&N: head and neck; GI: gastrointestinal; GU: genitourinary; Gyne: gynecological. No significant financial relationships to disclose.

Incidencia del cáncer en Guipúzcoa (1998-2002) y tendencias desde 1986

ObjectivesTo determine the cancer incidence in Gipuzkoa (Spain) from 1998 to 2002 and describe time trends since 1986. MethodsThe annual incidence of cancer in Gipuzkoa from 1998 to 2002 was estimated as a rate per 100,000 inhabitants. Incidence trends for the period 1986-2002 were studied for all cancers and for the main cancer sites using Poisson regression and joinpoint regression for prostate tumours. ResultsOn average, one in 3 men and one in 5 women would probably be diagnosed with cancer at some time during their life (0-74 years). Among men, prostate surpassed lung as the most frequent cancer site. Among women, breast cancer represented approximately 30% of all cases of cancer (excluding non-melanoma skin cancers). There was an annual increase in the incidence of cancer of 1.5% (95% CI, 1.1-1.8) in men and 0.9% (95% CI, 0.5-1.3) in women. The incidence of prostate cancer in men increased over the study period, and especially between 1996 and 1999, with an annual increase of 34.7% (95% CI, 5.9-71.5). The incidence of lung cancer in women presented an annual increase of 5.2% (95% CI, 3.4- 7.1). In contrast, the incidence of stomach cancer decreased during the study period. ConclusionsCancer incidence in Gipuzkoa increased during the study period. This increase was particularly marked in lung cancer and skin melanoma, for which preventive strategies are fundamental.

Cancer incidence in Gipuzkoa, Spain (1998-2002), and time trends from 1986

Objectives: To determine the cancer incidence in Gipuzkoa (Spain) from 1998 to 2002 and describe time trends since 1986. Methods: The annual incidence of cancer in Gipuzkoa from 1998 to 2002 was estimated as a rate per 100,000 inhabitants. Incidence trends for the period 1986-2002 were studied for all cancers and for the main cancer sites using Poisson regression and Joinpoint regression for prostate tumours. Results: On average, one in 3 men and one in 5 women would probably be diagnosed with cancer at some time during their life (0-74 years). Among men, prostate surpassed lung as the most frequent cancer site. Among women, breast cancer represented approximately 30% of all cases of cancer (excluding non-melanoma skin cancers). There was an annual increase in the incidence of cancer of 1.5% (95% CI, 1.1-1.8) in men and 0.9% (95% CI, 0.5-1.3) in women. The incidence of prostate cancer in men increased over the study period, and especially between 1996 and 1999, with an annual increase of 34.7% (95% CI, 5.9-71.5). The incidence of lung cancer in women presented an annual increase of 5.2% (95% CI, 3.4-7.1). In contrast, the incidence of stomach cancer decreased during the study period. Conclusions: Cancer incidence in Gipuzkoa increased during the study period. This increase was particularly marked in lung cancer and skin melanoma, for which preventive strategies are fundamental.

Risk factors of main cancer sites

Cancer prevention is a system of various measures devoted to avoid this disease. Primary cancer prevention means the identification, avoidance, or destruction of known risk factors. The main risk factors are smoking, diet, alcohol consumption, occupational factors, environmental pollution, electromagnetic radiation, infection, medicines, reproductive hormones, and lack of physical activity. Approximately one-third of cancers can be avoided by implementing various preventive measures. The aim of this article was to acquaint medical students, family doctors with risk factors of main cancer sites (lung, breast, colorectal, and prostate).

External radiation exposure and mortality in a cohort of French nuclear workers

Objective:To analyse the effect of external radiation exposure on the mortality of French nuclear workers.Methods:A cohort of 29 204 workers employed between 1950 and 1994 at the French Atomic Energy...