Survival In Canada Research Articles

EP04.02-001 Sex as a Potential Independent Prognostic Factor in Non-Small Cell Lung Cancer Survival

This is an update of an abstract entitled “The impact of sex on non-small cell lung cancer survival in Canada” that was presented at WCLC 2021. The leading cause of cancer-related death in Canada is lung cancer, with non-small cell lung cancer (NSCLC) accounting for the majority of lung cancer cases. Studies from other countries have demonstrated differences in NSCLC survival by sex, even after accounting for other factors. There has yet to be a robust analysis of the role of sex in NSCLC survival in the Canadian context.

Changes in exposure to ambient fine particulate matter after relocating and long term survival in Canada: quasi-experimental study

ObjectiveTo investigate the association between changes in long term residential exposure to ambient fine particulate matter (PM2.5) and premature mortality in Canada.DesignPopulation based quasi-experimental study.SettingCanada.Participants663 100 respondents to the 1996,...

FP02.02 The Impact of Sex on Non-Small Cell Lung Cancer Survival in Canada

Lung cancer is the leading cause of cancer-related death in Canada. Non-small cell lung cancer (NSCLC) accounts for the majority of lung cancer cases, and while new treatments have been developed, survival outcomes remain poor. Literature from outside Canada indicates differences in NSCLC survival by sex. These differences cannot be explained by differences in stage, NSCLC subtype, age, or smoking history, indicating that sex may be an independent prognostic factor. The impact of sex on NSCLC survival has yet to be thoroughly examined in the Canadian context. Here we evaluate the impact of sex on survival outcomes among a population-based Canadian cohort of lung cancer patients. A retrospective cohort study was completed using real-world data from the Glans-Look Lung Cancer Database (GLD). The GLD contains demographic, clinical, pathological, treatment, and outcome data for all individuals diagnosed with NSCLC in Alberta, Canada, between 2010 and 2017. Descriptive statistics were used to characterize the cohort. To analyze the impact of sex on NSCLC survival, Kaplan-Meier estimators with log rank tests were used for comparisons between cohorts grouped by sex, stage, and subtype. Overall survival was defined as time from diagnosis to death from any cause. 8193 patients with complete data were included in analyses. Median age was 69.30 years (IQR 61.85-76.19), with 49.35% of the cohort being female. Median overall survival was 12.73 months (IQR 4.83–28.07), with 6277 (76.61%) patients deceased at end of follow-up. The highest proportion of cases (49.04%) were stage IV at diagnosis, and the most common histological subtypes were adenocarcinoma (55.35%), squamous cell carcinoma (SCC) (24.68%), and pathologically not otherwise specified (NOS) (9.79%). Survival analyses by stage indicated females had longer survival than males at every stage of diagnosis (p<0.01) (Figure). Analyses by subtype indicated that amongst those with adenocarcinoma, SCC, or pathological NOS, females had longer survival than males (p<0.01). Analyses by stage and subtype showed longer female survival for all stages of adenocarcinoma (p<0.01), and stage IV SCC (p<0.01) and pathological NOS (p=0.02) compared to males. These preliminary analyses suggest that females with NSCLC have longer survival than males with NSCLC at all stages of disease, and within the most common histological subtypes. These analyses suggest that survival trends among Canadian NSCLC patients are similar to those seen in other western countries, and that further research is needed to elucidate the consideration of sex as an independent prognostic factor for NSCLC.

The cancer survival index: Measuring progress in cancer survival to help evaluate cancer control efforts in Canada.

A comprehensive evaluation of progress in cancer survival for all cancer types combined has not previously been conducted for Canada. The cancer survival index (CSI) is superior to age standardization in measuring such progress. Data are from the population-based Canadian Cancer Registry, record-linked to the Canadian Vital Statistics Death database. CSI estimates for both sexes combined were calculated as the weighted sum of the sex- and cancer-specific age-standardized net survival estimates. Sex-specific CSI estimates were calculated separately using sex-specific cancer type weights. From the 1992-to-1994 period to the 2015-to-2017 period, the five-year CSI increased 8.6 percentage points to 63.7%. It increased by 8.9 percentage points to 61.8% among males, and by 8.2 percentage points to 65.8% among females. The contribution of a cancer and sex combination to change in the CSI over time is a function of its assigned weight and changes in its age-standardized net survival. Female breast was the most influential cancer and sex combination, contributing 10.1% to the overall increase, followed by prostate (8.2%) and female lung (7.3%). The increase in the index since the 2005-to-2007 period was most impacted by lung cancer among both females (11.1%) and males (9.4%). While prostate cancer survival increased over the entire study period, it has recently decreased, resulting in a counterproductive 8.1% contribution since the 2005-to-2007 period. Steady progress has been made in overall cancer survival in Canada since the early 1990s. Female breast cancer has contributed the most to this progress overall, but more recently female lung cancer has been the most influential.

Changes in residential exposure to ambient fine particulate matter due to relocation and long-term survival in Canada: a quasi-experimental study

BACKGROUND AND AIM: Despite significant advances in understanding the health burden of hypothetical changes in ambient fine particulate matter (PM2.5), less is known how actual changes in PM2.5 levels may influence its long-term adverse effects, especially on mortality. We aimed to conduct a quasi-experiment to evaluate the association between mortality and changes in PM2.5 in Canada. METHODS: We identified movers from a national cohort of Canadian census respondents (10 million) who were aged 25-89 years, had a history of either high or low exposure to PM2.5 before census day, and moved within the following five years, yielding two cohorts. Exposures were ascertained using satellite-derived PM2.5 measurements based on movers’ postal-code addresses since five years before the census day. To assess the relationship between changes in PM2.5 and mortality, we conducted a propensity score matching analysis with Cox proportional hazards model including various covariates. We did various sensitivity analyses, such as considering multiple imputation. RESULTS:Residential mobility yielded a decline in annual PM2.5 exposure from ~10 μg/m3 to 7.4 μg/m3 and to 5.0 μg/m3 in the high to intermediate (or low) movers. Conversely, annual PM2.5 increased from ~4.6 μg/m3 to 6.7 μg/m3 and to 9.2 μg/m3 in the low to intermediate (or high) movers. Over five years after the move, we observed a 6.8% reduction in mortality among individuals whose PM2.5 exposures decreased from high to intermediate levels (95% confidence interval: 1.7%-11.7%). A greater decline in mortality was observed among individuals with a larger reduction in exposures. These results were consistent in sensitivity analyses. Additionally, we found an increase in mortality with elevated PM2.5 exposure. CONCLUSIONS:Decreases in PM2.5 were associated with lowered mortality whereas increases in PM2.5 were associated with elevated mortality in Canada. These results were found at the PM2.5 levels considerably lower than many other countries, providing support for continuously improving air quality. KEYWORDS: quasi-experiment, fine particulate matter, mortality

307 Melanoma survival in Canada: A national population-based study elucidating healthcare and socioeconomic barriers affecting patient care

Background: Cutaneous melanoma (CM) accounts for the majority of skin cancer deaths. While morbidity due to this cancer can be largely prevented, disparities in melanoma survival persists. The mortality to incidence ratio (MIR) is a method to approximate case-based survival and is a useful tool to compare CM survival between geographic areas. We aim to investigate CM survival through MIR analysis in Canada over a 25-year period and determine healthcare and socioeconomic factors associated with poor survival.Methods: Data was obtained from the Canadian Cancer Registry and Canadian Vitals Statistics patient databases from 1992-2016 for all Canadian provinces. Age-standardized incidence and mortality rates, and MIR were calculated per province, per year. Healthcare and socioeconomic factors associated to MIR were determined using a generalized linear mixed model while adjusting for province and year. Results: Our analysis identified 106,015 CM cases and 20,570 CM deaths between 1992 to 2016. Plotted annual national MIR from 1992 to 2016 demonstrated a significant linear increase (p-value <0.0001). Saskatchewan (0.187), Ontario (0.185) and Manitoba (0.183), were among the provinces with the highest overall MIR, while New Brunswick had the lowest (0.152). Increased median household income, percentage of individuals with tertiary education, density of dermatologists and family physicians per 100,000 individuals, were factors negatively associated to MIR (i.e. better disease outcome) (p-value <0.05). Interestingly, healthcare spending per capita and number of visible minorities were not significantly associated with MIR. Conclusions: Public health resources should be oriented towards providing adequate primary and specialty healthcare services in high-risk provinces to improve CM survival.

Trends in paediatric cancer survival in Canada, 1992 to 2017.

While impressive gains in childhood cancer survival have been reported both in Canada and internationally, it has been almost 15 years since the last comprehensive evaluation of Canadian data. Data are from the population-based Canadian Cancer Registry, record-linked to the Canadian Vital Statistics Death database. Children aged 0 to 14 diagnosed with new primary malignant cancers from 1992 to 2017 in Canada except Quebec were included. Overall survival was measured using observed survival proportions (OSPs). Estimates for the 2013-to-2017 period were predicted using the period method; otherwise, the cohort method was used. For the 2013-to-2017 period, five-year OSPs were at least 90% for 10 of 24 individual cancer groups or subgroups reported. Survival was highest for thyroid carcinomas (100%) and Hodgkin lymphomas (99%) and lowest for other gliomas (42%). A significant increase in the five-year OSP from the 1992-to-1996 period (77%) to the 2013-to-2017 period (84%) was observed for all childhood cancers combined, but not since the 2003-to-2007 period. The greatest increase was for chronic myeloproliferative diseases (35.4 percentage points); for lymphoid leukemias, survival increased from 85% to 93%. Survival was relatively poor at baseline for hepatic tumours, malignant bone tumours, and soft tissue and other extraosseous sarcomas, and it remained virtually unchanged. Once children survived five years, the probability of surviving another five years exceeded 95% across most diagnoses. Significant improvements in both short- and long-term paediatric cancer survival have been made in Canada since the early to mid-1990s. These findings are clinically meaningful and are likely to be reassuring to families.

An international evaluation of trends and outcomes of living donor liver transplantation: United States, United Kingdom, and Canada

Presenter: Tommy Ivanics MD | University Health Network, Toronto General Hospital Background: Living donor liver transplantation (LDLT) offers an opportunity to decrease the liver transplant waitlist and reduce waitlist mortality. We sought to compare donor and recipient characteristics and post-transplant outcomes after LDLT in the United States (US), United Kingdom (UK), and Canada, where deceased donors provide the majority of organs available for transplantation. Methods: We studied adults (≥18-years) who underwent primary LDLT between Jan-2008 and Dec-2018 from three national liver transplantation registries: United Network for Organ Sharing (UNOS;US), National Health Service Blood and Transplantation (NHSBT;UK), and the Canadian Organ Replacement Registry (CORR;Canada). Patients undergoing re-transplantation, multi-visceral transplantation, or had waitlist drop-out were excluded. Recipient and donor characteristics were compared across countries. A non-parametric Cox-Stuart trend test for LDLT was performed in each country. Post-transplant survival was evaluated using the Kaplan-Meier method, and multivariable adjustments were performed using Cox Proportional Hazard models. Results: A total of 3,086 LDLTs were performed (US:n = 2,433; UK:n = 97; Canada:n = 556). A trend toward increased LDLT over time was present in the US (Cox-Stuart trend test: US: p = 0.08; UK:p = 0.73; Canada: p = 0.49). Overall, the proportion of LDLTs compared to other grafts has remained stable (Figure 1) with Canada maintaining the highest proportion over time (proportion of LDLT 2008: US 3.4%; UK:1.7%; Canada: 20.1%; p<0.001; 2018: US: 5.0%; UK: 0.4%; Canada: 13.8%; p<0.001). The US and Canadian recipients had the highest body mass index (median [IQR]], US 26 [23-30]; UK 24 [22-28]; Canada 26 [23-29]; overall p<0.001) and the highest donor age (years, median [IQR]: US 36 [28-45]; UK 33 [25-40]; Canada 35 [27-46]; overall p = 0.010). The laboratory Model for End-Stage Liver disease (MELD) score was highest in Canada (median [IQR]: US 15 [11-19]; UK 11 [8-18]; Canada 17 [13-21]; p<0.001). UK had a higher proportion of hepatitis C virus as disease etiology (US 2%; UK 21%; Canada 12%;p<0.001) whereas the US had a higher proportion of non-alcoholic steatohepatitis (US 17%; UK 11%; Canada 7%;p<0.001). Time on the waitlist was longest in the US (days, median [IQR]; US 151 [79-308]; UK 92 [7-202]; Canada 122 [64-230];overall p<0.001). At 1-year there was a non-statistically significant superior survival in Canada (1-year%[95%CI]]; US 93.0% [(92.0-94.1]; UK 91.4% [85.8-97.3]; Canada 95.8% [94.1-97.5];p = 0.06]. The 3-, 5-, 10-year survival rate was superior in Canada (3-year% [95%CI]; US 88.1% [86.8-89.5]; UK 90.0% [84.0-96.5]; Canada 92.1% [89.8-94.5];p = 0.04), (5-year%[95%CI]; US 83.5% [81.8-85.3]; UK 85.4% [77.1-94.5]; Canada 89.9% [87.1-92.7];p = 0.005), and (10-year%; US 71.1% [67.6-74.8]; UK 66.7% [45.0-98.8]; Canada 82.7% [78.2-87.5];p = 0.001). The median survival was not reached in any of the registries. After adjustment for characteristics of donors, recipients, annual center volume, and year of transplantation, all countries had an equivalent hazard of mortality post-LT ([HR] for mortality, US Reference, UK HR:1.26, 95%CI 0.67-2.39;p = 0.47; Canada HR:0.61,95%CI 0.30-1.26;p = 0.18). Stratification by hepatocellular carcinoma status did not alter the patterns observed in the data. Conclusion: LDLT use has remained stably low in western countries. Despite this, long-term survival is excellent. Continued efforts to increase LDLT in these countries is thus warranted due to the growing waitlist and differences in allocation that may disadvantage patients currently awaiting liver transplantation.

Home Hemodialysis and Peritoneal Dialysis Patient and Technique Survival in Canada

IntroductionAs interest for home dialysis is growing, knowledge of comparative clinical outcomes between peritoneal dialysis (PD) and home hemodialysis (HHD) would help to better inform shared decision making with patients and caregivers during modality discussion. This study aimed to assess differences in risk of mortality and technique failure in an incident home dialysis cohort and, specifically, to assess change in this association through eras.MethodsAll adults patients initiating PD or HHD, in Canada (excluding Quebec), within 365 days after kidney replacement therapy (KRT) initiation between 2000 and 2013 were included (administrative censoring 31 December 2014). Mortality and treatment failure (transfer to another modality for >90 days or death) were assessed in a multivariable Cox proportional hazard model, with prespecified stratification based on the year of KRT initiation.ResultsThe study included 959 HHD and 15,469 PD patients. Compared with incident PD, incident HHD was associated with a lower risk of mortality (adjusted hazard ratio [aHR] = 0.64, 95% confidence interval [CI] = 0.53−0.78), and treatment failure (aHR = 0.52, 95% CI = 0.45−0.60). These lower risks of mortality with HHD were more pronounced for older cohorts (2000−2005: aHR = 0.47, 95% CI = 0.31−0.70; 2006−2010: aHR = 0.70, 95% CI = 0.54−0.89) and not significantly different in the most recent era (2011−2013: aHR = 0.86, 95% CI = 0.51−1.47).ConclusionIn Canadian incident KRT patients, HHD was associated with appreciably lower risks of mortality and treatment failure compared to PD, although this association appeared to be attenuated in the most contemporary era.

Feministic Analysis of Shauna Singh Baldwin’s selected stories in English Lessons and Other Stories

The present paper aims at exploration of Shauna Singh Baldwin’s specific technique implemented to present women predicament in selected stories from feministic point of view. The feministic point of view has developed out of a movement for equal rights and chances for women society. The present search is based on analytical and interpretative methods. Shauna Singh Baldwin is a writer of short fiction, poetry, novels and essays. Her ‘English Lessons and Other Stories’ explores the predicament of earlier neglected women of Sikh community by putting them in the context of globalization, immigration to West and consumerism at Indian modern society. “Montreal 1962” presents a Sikh wife’s attachment, love, determination, struggles and readiness to do anything for survival in Canada where her husband is threatened to remove his turban and cut his hair short to get the job. “Simran” presents the story of sacrifice of individual desire by a young Sikh girl because of her mother’s fundamentalist attitude. The title of story “English Lessons” presents injustice to an Indian woman who has married to an American, who compels her to become a prostitute and a source of his earnings in the States. The fourth selected story “Jassie” tells us about the timely need of religious tolerance in the file of an Indian immigrant old woman. Being a feminist writer, though Baldwin has never claimed directly to be, she has very skillfully presented the issues of feminism through her own technique of presentation. She has used technique of presenting absence or opposite to highlight it indirectly. Thus, true to her technique, though not explicitly declared, Baldwin is one of the feminist writers who skillfully deals with feminine concerns.

Brain cancer survival in Canada 1996-2008: effects of sociodemographic characteristics.

Literature suggests that factors such as rural residence and low socioeconomic status (ses) might contribute to disparities in survival for Canadian cancer patients because of inequities in access to care. However, evidence specific to brain cancer is limited. The present research estimates the effects of rural or urban residence and ses on survival for Canadian patients diagnosed with brain cancer. Adults diagnosed with primary malignant brain tumours during 1996-2008 were identified through the Canadian Cancer Registry. Brain tumours were classified using International Classification of Diseases for Oncology (3rd edition) site and histology codes. Hazard ratios (hrs) and 95% confidence intervals (cis) were estimated using Cox proportional hazards models. Events were restricted to individuals whose underlying cause of death was cancer-related. Postal codes were used to match patient records with Statistics Canada data for rural or urban residence and neighbourhood income as a surrogate measure of ses. Of 25,700 patients included in the analysis, 78% died during the study period, 21% lived in rural areas, and 19% were in the lowest income group. A modest variation in survival by rural compared with urban residence was observed for patients with glioblastoma (first 5 weeks after diagnosis hr: 0.86; 95% ci: 0.79 to 0.99) and oligoastrocytoma (first 3 years after diagnosis hr: 1.41; 95% ci: 1.03 to 1.93). Small effects of low compared with high income were seen for patients with glioblastoma (first 1.5 years after diagnosis hr: 1.15; 95% ci: 1.08 to 1.22) and diffuse astrocytoma (first 6 months after diagnosis hr: 1.17; 95% ci: 1.00 to 1.36). Our analysis did not yield evidence of strong effects of rural compared with urban residence or ses strata on survival in brain cancer. However, some variation in survival for patients with specific histologies warrants further research into the mechanisms by which rural or urban residence and income stratum influences survival.

Counselling and management for anticipated extremely preterm birth.

Counselling couples facing the birth of an extremely preterm infant is a complex and delicate task, entailing both challenges and opportunities. This revised position statement proposes using a prognosis-based approach that takes the best estimate of gestational age into account, along with additional factors, including estimated fetal weight, receipt of antenatal corticosteroids, singleton versus multiple pregnancy, fetal status and anomalies on ultrasound and place of birth. This statement updates data on survival in Canada, long-term neurodevelopmental disability at school age and quality of life, with focus on strategies to communicate effectively with parents. It also proposes a framework for determining the prognosis-based management option(s) to present to parents when initiating the decision-making process. This statement replaces the 2012 position statement.

Temporal Trends and Factors Associated with Home Hemodialysis Technique Survival in Canada.

The last 15 years has seen growth in home hemodialysis (HD) utilization in Canada owing to reports of improved outcomes relative to patients on conventional in-center HD. What effect growth has had on home HD technique and patient survival during this period is not known. We compared the risk of home HD technique failure, mortality, and the composite outcome among three incident cohorts of patients on home HD in Canada: 1996-2002, 2003-2007, and 2008-2012. A multivariable piece-wise exponential model was used to evaluate all outcomes using inverse probability of treatment and censoring weights. A total of 1869 incident patients on home HD were identified from the Canadian Organ Replacement Register. Relative to those treated between 2003 and 2007 (n=568), the risk of home HD technique failure was similar between patients treated between 1996 and 2002 (n=233; adjusted hazard ratio [AHR], 1.39; 95% confidence interval [95% CI], 0.78 to 2.46) but higher among incident patients on home HD treated between 2008 and 2012 (n=1068; AHR, 1.51; 95% CI, 1.06 to 2.15). Relative to patients treated between 2003 and 2007, adjusted mortality was similar among those treated between 2008 and 2012 (AHR, 0.83; 95% CI, 0.58 to 1.19) and those treated between 1996 and 2002 (AHR, 0.67; 95% CI, 0.38 to 1.21). The risk of the composite outcome of death and technique failure was similar across cohorts, as was the risk of receiving a kidney transplant. Increasing age, diabetes as a comorbidity, and smoking status were associated with an increased risk of death as well as the composite outcome. Medium-sized facilities had a lower risk of death, technique failure, and the composite outcome compared with larger facilities. A higher risk of technique failure was seen in the most contemporary era. Further characterization of the risk factors for, and causes of technique failure is needed to develop strategies to improve patient retention on home HD.

The Canadian National Breast Screening Studies are compromised and their results are unreliable. They should not factor into decisions about breast cancer screening

The Canadian National Breast Screening Studies were compromised by an unblinded allocation process and poor quality mammography. Contrary to the requirement that allocation in a randomized controlled trial (RCT) be blinded to avoid any possible intentional or unintentional subversion of a random allocation, all women in the CNBSS trials underwent a clinical breast examination prior to assignment to the study arm or the usual care arm. Women with abnormal clinical breast examinations were identified, and this information was available to the coordinators who then assigned the women on open lists. It was, therefore, possible to assign women to whichever arm the coordinator chose. Although subversion was likely unintended, a significant number of women with four or more positive axillary lymph nodes were assigned to the screening arm of CNBSS1. This explains why there were more breast cancer deaths among the screened women in the first ten years of the trial and why the 5 year survival of the control women was better than 90% when the background survival in Canada at the time was only 75%. The trials were further compromised by the poor quality of the mammography which was confirmed by a review conducted by the trials' organizers. These fundamental problems compromise the CNBSS and make their results, which are major outliers in the RCT's of breast cancer screening, unreliable. Consequently, they should not be used to establish guidelines for breast cancer screening.

LO70: Do automatic external defibrillators improve rates of return of spontaneous circulation, survival to hospital discharge and favourable neurological survival in Canada?

Introduction: Survival for victims of out-of-hospital cardiac arrest (OHCA) is typically 8-12%. Recent evidence has shown that public access automatic external defibrillators (AED) may improve survival. The objectives of this study were to determine whether AEDs improve rates of return of spontaneous circulation (ROSC), overall survival, and favourable neurological survival (FNS) in Canada. Methods: The BC Resuscitation Outcomes Consortium prospectively collected detailed prehospital and hospital data on consecutive non-traumatic OHCAs from 2011-2015 within BC’s four metropolitan areas. We included all EMS-treated adult patients. Data were collected in accordance with recognized Utstein criteria. We described frequencies with counts, means and medians where appropriate, and the Z-test was used to compare population proportions. Results: We examined 7577 OHCAs from 2011-2015. AEDs were deployed on 223 patients in this period (mean age 60.4 yrs [95% CI 45.7-75.1] and 83.9% male; non-AED OHCAs mean age 66.2 yrs [48.4-83.8] and 67.3% male). Seventy seven percent of AED deployments occurred in public locations, 69.1% were witnessed by bystanders and CPR was initiated in 98.7% of these cases. Fifteen percent of non-AED OHCAs occurred in public locations, 38.3% were bystander witnessed, and 45.4% received bystander CPR. AEDs delivered shocks to 61.4% of patients, and EMS crews found an initial shockable rhythm upon scene arrival in 60.5% of AED deployments (22.9% for non-AED cases). AED OHCA patients had higher rates of ROSC at any time (67.2% vs 47.6%; difference of 19.6% [12.9-26.2 p&amp;lt;0.01]), and ROSC at ED arrival (61% vs 35.4%; difference of 25.6% [19.2-32.0 p&amp;lt;0.01]). AED OHCA patients had higher rates of survival to hospital discharge (23.8% vs 8.5%; difference 15.3% [11.5-19.1 p&amp;lt;0.01]). Detailed neurologic outcome data was not available for all patients, yet for those which it was available AED OHCA patients had improved outcomes (modified Rankin score&amp;lt;2) compared to non-AED OHCA patients (9.0% vs 5.4%; difference 3.6% [0.6-6.6 p&amp;lt;0.02]. Conclusion: Automatic external defibrillators markedly improve rates of ROSC at any time, sustained ROSC at ED arrival, survival to hospital discharge, and FNS in Canada. Continued support for public access AED programs is essential to improve patient outcomes.

Ignatian Radicalism: The Influence of Jesuit Spirituality on Dorothy Day

In December 1951 issue of Catholic Worker newspaper, Dorothy Day (1897-1980) included an obituary for French-Canadian Jesuit named Onesimus Lacouture (1881-1951), originator of the retreaf that she had enthusiastically embraced decade earlier and which she would later memorialize in her autobiography, The Long Loneliness. Noting that Lacouture had been of twenty-one children in his family-his father had married twice-Day wrote,Doesn't that sound like beginning of life of saint? Peter Maurin was of twenty-three children. These two men who had most on my life (and so in way on life of Catholic Worker) were both French peasants, of France and French Canada. They both knew life of land and of city. Both were men of poor.1For Day, Lacouture and his theology had deeply profound effect and- along with Maurin-she saw French-Canadian Jesuit as having had the most influence on her life and Catholic Worker. I am completely sold on this retreat business, she wrote in 1941, I think it will cure all ills, settle all problems, bind up all wounds, strengthen us, enlighten us, and in other words make us happy.2 And indeed, others would later credit retreat-which Day called bread for strong-as having brought about second conversion in her life.3Despite such high praise from Day, theology operative in Lacouture's retreat has often been portrayed by contemporary scholars in much more negative terms. For instance, J. Leon Hooper, S.J., has suggested that retreat was filled with Jansenistic suspicion of body and that its wholesale rejection of natural could be understood only as a flirting with of which Lacouture was (accurately) accused.4 Not to be outdone, James T. Fisher described retreat theology as being imbued with bitterly mystical, 'gloomy Catholicism' which wedded of Port Royal to harsh struggle for Catholic survival in Canada.5 And he described Lacouture's ethnic Jansenism as having blended potently with Day's more aesthetic Jansenism to help form what Fisher declared to be one of most abject brands of self-abnegation in American religious history.6Such characterizations of theology that deeply shaped Dorothy Day are not insignificant. This study argues that depictions like those made by Hooper and Fisher have greatly contributed to way in which Day and others associated with Catholic Worker have been characterized as sectarian and out of step with traditional Catholic theology.7 In fact, Fisher's depiction of Lacouture's theology goes long way in shaping Eugene McCarraher's argument that, because of their rejection of middle-class materialist aspirations of their fellow Catholics, Day and others associated with Catholic Worker movement are ultimately irrelevant to American Catholicism.8But while descriptions of retreat as Jansenist seem to prevail in American Catholic scholarship-influencing way Day and others have been perceived-it is certainly not only way that Lacouture's theological vision can be or has been interpreted. In fact, quite different depiction of Lacouture's retreat was offered by Fr. John J. Hugo (1911-85) two generations ago. Hugo, Pittsburgh priest, was Dorothy Day's spiritual director for much of 1940s and '50s, and was perhaps greatest promulgator of retreat in English-speaking countries (Figure 1).9 Throughout 1940s-during period in which he himself was prevented from preaching retreat by his bishop-Hugo wrote several works defending retreat theology in response to criticisms of it made by some of most prominent U.S. Catholic theologians of day. These critics had accused retreat of promoting an exaggerated supernaturalism with Jansenist tendencies- charges not all that unlike those made more recently by Fisher and Hooper. Central to Hugo's defense was his claim that Onesimus Lacouture, S. …

PC3 - 164 Urban-Rural Residence and Brain Cancer Survival in Canada (1996-2008)

Disparities in cancer survival rates have been identified for rural patients in Canada and are thought to be due to inequities in access to care. The objective was to perform the first examination of urban and rural brain cancer survival in Canada. Methods: A population-based retrospective cohort study was performed using Canadian Cancer Registry data for patients diagnosed with a primary brain cancer from 1996-2008. Seven major brain cancer histology groups used were glioblastoma, diffuse astrocytoma, glioma (not otherwise specified), oligodendroglioma, anaplastic astrocytoma, oligoastrocytic tumours, and anaplastic oligodendroglioma as categorized by the Central Brain Tumor Registry of the United States (CBTRUS). Kaplan-Meier (KM) survival estimates and Cox Proportional Hazards Regression were performed, adjusting for sex, histology, age group, region, and urban-rural residence. Rural residence was defined using Statistics Canada’s “Rural and Small Town” definition of living in a region with a population of less than 10,000 people. Results: No significant difference between urban and rural residence was identified in crude KM survival estimates. Though not significant, 5-year survival was generally better among rural residents than urban residents, except for rural residents with anaplastic astrocytoma. There remained no significant difference for Cox hazard ratios after adjustment for age, sex, or region. Conclusions: This is the first study to examine the effect of urban-rural residence on brain cancer survival. No significant differences for any histology were found, indicating equitable access to care for brain cancer patients in Canada, regardless of their location of residence.

Conservation genetics of Magnolia acuminata, an endangered species in Canada: Can genetic diversity be maintained in fragmented, peripheral populations?

The genetic diversity of peripheral populations is potentially important to the future adaptive capacity of species, although may be difficult to predict. A large number of species-at-risk in Canada are at the northern edge of their distribution, and many of these live in fragmented habitat. We used nuclear and chloroplast markers to assess patterns of genetic diversity and differentiation within and among populations of Canadian Magnolia acuminata (Cucumber tree), an endangered species in Canada that extends as far north as the fragmented Carolinian forest in southern Ontario. We also compared the genetic composition of Canadian M. acuminata to populations sampled throughout its central distribution in the USA. We found a high proportion of shared microsatellite alleles, plus a single cpDNA haplotype, distributed throughout the entire M. acuminata range. We also found that despite occupying fragmented habitat at their range periphery, Canadian populations showed little reduction in genetic diversity relative to the USA populations, and we attribute this to effective historical dispersal in a long-lived, polyploid species. However, a combination of private alleles, genetic substructuring, and lower levels of genetic diversity in seedlings compared to mature trees, suggests that current levels of gene flow are relatively low among Canadian populations. Therefore, despite high levels of genetic diversity in Canadian M. acuminata, managers should be aware that without intervention, populations will likely become increasingly isolated and experience a reduction in genetic diversity which in turn may threaten their long-term survival in Canada.

Breast cancer survival in Canada and the USA: meta-analytic evidence of a Canadian advantage in low-income areas

This study tested the hypothesis that relatively poor Canadian women with breast cancer have a survival advantage over their counterparts in the USA. Seventy-eight independent retrospective cohort (incidence between 1984 and 2000, followed until 2006) outcomes were synthesized. Fixed effects meta-regression models compared women with breast cancer in low-income areas of Canada and the USA. Low-income Canadian women were advantaged on survival [rate ratio (RR) = 1.14; 95% confidence interval (CI) 1.13-1.15] and their advantage was even larger among women <65 years of age who are not yet eligible for Medicare coverage in the USA (RR = 1.21, 95% CI 1.18-1.24). Canadian advantages were also larger for node positive breast cancer, which may present with greater clinical and managerial discretion (RR = 1.40, 95% CI 1.30-1.50), and smaller when Hawaii, the state providing the most Canadian-like access, was the US comparator (RR = 1.12, 95% CI 1.01-1.20). More inclusive health care insurance coverage in Canada vs the USA, particularly among each country's relatively poor people, seems the most plausible explanation for such Canadian advantages. Provision of health care for all Americans would likely prevent countless early deaths, particularly among the relatively poor.

Childhood and adolescent cancer survival: A period analysis of data from the Canadian Cancer Registry

This study provides up-to-date estimates of childhood and adolescent (ages 0–19) cancer survival in Canada using data from the Canadian Cancer Registry (CCR). Cases were classified according to the third edition of the International Classification of Childhood Cancer classification scheme. Follow-up for vital status was determined through record linkage to the Canadian Mortality Data Base, and from information reported by provincial/territorial cancer registries. Observed survival proportions (OSPs) were based on period analysis (1999–2003). The 1-, 3- and 5-year OSPs for all cancers combined were 92%, 85% and 82%, respectively. Among diagnostic groups, five-year survival estimates were highest for retinoblastoma (99%), carcinomas and other malignant epithelial neoplasms and malignant melanomas (91%) and for renal tumours (91%); they were poorest for hepatic tumours (68%) and for malignant bone tumours (68%). Survival for childhood and adolescent cancer in Canada has improved substantially since last reported.