Tom Baker Cancer Centre Research Articles

SU‐E‐T‐242: Quality Assurance for a Novel Translating Bed Total Body Irradiation Technique

Purpose: To establish a method of quality assurance for a novel aperture modulated translating bed total body irradiation technique currently under development at the Tom Baker Cancer Centre. Methods: This TBI technique uses the MLC on a conventional linear accelerator to dynamically shape the radiation beam as the patient is translated through with 0° gantry angle. The dynamically shaped field allows for the compensation of varying patient composition as the patient translates through the beam, resulting in improved dose homogeneity. This technique requires a high degree of accuracy in the positioning of the translating bed and MLC leaves throughout treatment, as the bed position must be properly correlated with the field shape being delivered. The QA method developed in the present work makes use of the linacˈs EPID to verify the location of the individual leaves of the collimating system throughout treatment delivery. The EPID operates in cine mode, and acquires images of the MLC defined field throughout plan delivery. The MLC defined field edges of each acquired image are found using a simple edge detection algorithm, and the locations of the detected edges are compared to the prescribed MLC positions for the specified number of MUs delivered. The position of the translating bed is also monitored throughout the delivery to ensure proper correlation between MLC leaf positions and bed position. Results: The EPID allows for the accurate detection of bed and MLC leaf positions throughout the delivery of aperture modulated translating bed TBI plans. Quantitative data comparing prescribed and detected positions of the bed and MLC leaves are supplied for the entire duration of plan delivery. Conclusions: The method developed allows for pre‐treatment verification of the novel TBI treatment plans, and has the potential to be extended in order to verify MLC and bed positions during actual patient treatment.

Validating the Selection of Quality Indicators for Venipuncture Procedures Performed in a Radiation Therapy Department

Purpose An extensive literature review was completed to validate the selection of quality indicators for venipuncture procedures performed in a radiation therapy department. Methods A retrospective quantitative study (2007-2010) was conducted at the Tom Baker Cancer Center (TBCC) to review the data captured on a quality control log/statistical template for 900 venipuncture procedures performed in the radiation treatment program (RTP). The quality indicators for the venipuncture program had previously been identified to include the collection and monitoring of: the frequency/occurrence of adverse events, identifying the type of adverse events, and the number of attempts required to obtain venous access. There were no patient identifiers recorded on the department log/statistical template. Results Data extracted from the TBCC RTP quality control log in 2007-2010 revealed an incidence of five extravasations events and one air embolism event. Comparison of the published adverse events and rates in the literature to the TBCC RTP venipuncture program rates show that its recorded quality control log/statistical template is targeting the appropriate categories. The literature reported, on average, rates for extravasations to be between 0.04% and 1.3% compared with the TBCC RT department’s 0.56%. The occurrence of air embolism rates in the literature was reported to be between 11.7% and 23% compared with 0.11% occurrence in the TBCC RTP department. Based on the evidence reported in the literature, other quality control indicators have been incorporated into the TBCC RTP venipuncture program. The TBCC RTP expanded the venipuncture program quality control log/statistical template to collect and monitor the occurrence rates of phlebitis, hematoma/bruising, nerve, tendon and/or ligament damage, and infection. Conclusion The creation of standardized quality indicators for radiation treatment programs performing venipuncture in all health care facilities performing venipuncture would 1) be a step in maximizing patient safety and improving quality of care and 2) provide an opportunity for institutions to gauge and compare the quality of care provided using the same quality indicators for health care institutes performing venipuncture procedures. Collaboration with other facilities to identify, monitor, and report the data collected from standardized quality indicators would result in an increase of knowledge concerning the occurrence of rates of adverse events during and after venipuncture procedures performed in a radiation therapy department. Such efforts can only lead to increased quality of care provided across the health care system.

Returning research results to clinical trial participants: A survey of patients with cancer.

2611 Background: The disclosure of trial results (TR) in early stage breast cancer patients (pts) is not well characterized and there is a paucity of information regarding the attitudes of adult cancer pts with tumors in other sites. The purpose of this study was to determine the preferred method of sharing TR with clinical trial participants. Methods: A survey was given to cancer pts who participated in clinical trials at the Tom Baker Cancer Centre via mail (250) or during a clinic visit. Clinical trial participants provided demographic information and indicated their preferred mode of communication of TR, timing and attitudes regarding return of TR, and whether there is a difference of opinion if the clinical trial findings were positive or negative. Results: 146 clinical trial participants completed the survey (median age 59; 68% female; 94% Caucasian; 70% postsecondary education; type of cancer: breast n=84, prostate n=26, other n=36). The majority of patients were treated with adjuvant intent (82%) and had home internet access (92%). Most pts (92%) felt they had a right to receive results of the research they took part in. The preferred method of notification of positive TR was a letter (53%); internet website/email was acceptable in 22%. For negative TR, internet website/email and letter were acceptable in 10% and 31% respectively. Significantly more pts preferred a personal visit for negative TR (43%) compared to positive TR (18.4%) (p<0.0001). 43% of patients preferred a personal visit to a clinic or research lab to get negative results compared to only 18% of patients that receive positive results (p<0.0001). 86% of clinical trial participants would like to receive TR as soon as the study is accepted to be published or sooner. 66% of pts wanted their next of kin to be notified of TR in the event of the pt’s death. 51% of pts would be more likely to participate in a clinical trial if investigators provided TR. Conclusions: The vast majority of clinical trial participants felt that they had a right to receive TR and many viewed receipt of TR as an incentive to participate in clinical trials. Although most pts had internet access, the preferred notification mode was letter for positive TR and in person for negative TR.

The prognostic significance of uncoupled proliferation and EGFR expression in oral cancer treated with surgery and radiation.

e21146 Background: Oral squamous cell cancer (OSCC) is characterized by poor prognosis, high morbidity and mortality. The epidermal growth factor receptor (EGFR) is overexpressed in most OSCCs; however, the association between EGFR and survival is inconsistent. Despite being linked to proliferation in normal tissue, few studies have examined the relationship between proliferation and EGFR expression, and OSCC outcomes. Methods: This retrospective study evaluated OSCC patients treated with surgery (n=17) or surgery and post-operative RT (n=47) between 1998-2005 at the Tom Baker Cancer Centre, Calgary, AB, Canada (median follow-up: 43 months). Tissue microarrays were assembled from pre-treatment formalin-fixed paraffin embedded tumor tissue. Clinico-pathologic data were obtained from chart review. EGFR and Ki67 expression were quantified using fluorescent IHC and AQUA technology. Regions of high and low EGFR expression were defined for each tumor core. We measured the ratio of Ki67 levels between high versus low EGFR expressing regions (Ki67EGFR-hi/Ki67EGFR-lo) to evaluate the relationship between proliferation and EGFR expression. Continuous variables were dichotomized using Xtile. Biomarker association with recurrence free survival (RFS) 5-year disease-specific survival (DSS) was analyzed using the Cox model. Results: In OSCC RFS and DSS associated with pathologic T-stage [RFS HR 2.8 (1.3-6.3), p=0.01; DSS HR 3.6 (1.5-8.4), p=0.004], and lymph node status [RFS HR 3.5 (1.6-7.7), p=0.002; DSS HR 6.4 (2.5-16.2), p<0.001]. Neither Ki67 nor EGFR alone significantly correlated with RFS or DSS. We observed a high Ki67EGFR-hi/Ki67EGFR-lo ratio in normal oral epithelium. In OSCC, a high Ki67EGFR-hi/Ki67EGFR-lo ratio (similar to normal epithelium) associated with improved survival [RFS HR 0.50 (0.23-1.08), p=0.076; DSS HR 0.46 (0.20-1.06), p=0.07]. The association with survival outcomes was more pronounced in patients who received RT [RFS HR 0.31 (0.12-0.83), p=0.02; DSS HR 0.40 (0.14-1.13), p=0.08]. Conclusions: Our results suggest that the uncoupling of proliferation and EGFR expression in OSCC represents a more aggressive and RT resistant tumor phenotype.

Cost of care for prostate cancer patients: An observational cohort study comparing clinical trials to standard care.

184 Background: Monetary support of clinical trials is a fundamental necessity for improving treatment and prevention methods; however, current economic data pertaining to the per-patient costs of treating prostate cancer are limited. A concurrent lack of certainty regarding the cost requirements of standard care patients makes it difficult for healthcare professionals and policy makers to generate informed decisions regarding budgets and funding needs. Prostate cancer clinical trials are facing a national funding crisis due to the perception that patients enrolled in clinical trials consume more resources than patients receiving standard care. Methods: A retrospective observational cohort study was conducted to examine the costs incurred by prostate cancer patients at the Tom Baker Cancer Center over one year. Costs for 36 patients enrolled in one of nine cancer trials were compared with costs for 36 matched control subjects who received standard care. Resource utilization was tracked using medical charts and quantified by prices listed in the TBCC's 2009 Clinical Trials Budget template. Results: No evidence was found to support a difference in overall resource utilization between clinical trial patients and standard of care patients (Paired two-tailed t- test, N= 36, p =0.90). There was, however, variability in the types of resources used by each patient population, indicating that, while trial patients may take up significantly more clinic time (p =0.04), undergo more tests and procedures (p &lt; 0.001) and require more diagnostic imaging (p = 0.01), standard care patients are more likely to receive costly interventions such as radiation therapy (p =0.06). Pharmaceutical costs have not yet been included in the analysis and could drastically alter the final results. Conclusions: This study revealed differences in the cost distribution of clinical trials patients versus standard of care patients, which could be used by administrators to improve budgeting and time allocation. The lack of difference in overall cost may be helpful to research advocates attempting to encourage centers to take on more trials. Further analysis is required before definitive conclusions can be drawn. No significant financial relationships to disclose.

The significance of HPV status in patients with anal cancer: A comparative technical analysis.

425 Background: HPV status is an important prognostic factor for outcome in head and neck cancers, with improved survival noted in HPV-positive vs -negative tumors. However, this effect has not been studied in anal cancer. Challenges exist in defining reliable and methods of detecting the presence of high-risk HPV virus or the expression of HPV-related proteins. Purpose: To determine p16 expression and HPV16 status, in association with HPV subtyping, in pre-treatment anal cancers, and to correlate marker status with clinical outcome. Methods: This retrospective study evaluated anal cancer patients treated between 1992-2005 with definitive RT or CRT at a single institution (Tom Baker Cancer Centre, Calgary, Canada). HPV subtyping, p16 protein expression via conventional immunohistochemistry (IHC) and automated quantitative IHC (AQUA), and HPV16 in-situ hybridization (CISH) was performed in a subset of patient tumors with sufficient pretreatment tumor specimen. The correlation between results using these different techniques and association of HPV markers with clinical outcome was evaluated. Results: 89 patients were identified; M:F 1:2; median age 57 years. Median tumor size was 3.5 cm. All patients were treated with radical external beam RT with curative intent; 81% received concurrent chemotherapy. Clinical CR was observed in 73% of patients at 3 months post-treatment. Median OS was 82 months. Of tumor specimens analyzed for HPV subtype, 78% (28/36) were HPV16. Using conventional IHC (DAB), 80% (28/35) of tumors over-expressed p16 (score 3). HPV16 CISH was positive in 81% (34/42). P16 AQUA™ score correlated with HPV16 subtyping, CISH for HPV16, and p16 DAB. With HPV16 subtyping as the gold standard for HPV16 infection, false positive and false negative rates were 8% and 4% with DAB, and 10% and 13% with CISH. In univariate analysis only p16 AQUA score &gt; 244 (upper 15%) was associated with PFS (p= 0.006-95% CI 8.4 [1.8-38.6]) and OS (p= 0.013-95% CI 4.5 [1.4-15]). Conclusions: p16 expression via quantitative IHC correlates with other methods, including HPV16 subtyping, and appears more reliable for defining HPV16 status than CISH. Only quantitative IHC identified a subset of patients with worse outcome. No significant financial relationships to disclose.

Ten years experience in the management of borderline ovarian tumors at Tom Baker Cancer Centre

The aim of this study was to review the clinical outcomes of patients with borderline ovarian tumors (BOTs) at Tom Baker Cancer Centre (TBCC) and to assess the value of surgical staging. This retrospective study included 138 patients treated for BOTs at TBCC between January 1994 and December 2005. Patients were divided into two groups: group I with complete surgical staging (n = 89) and group II with incomplete surgical staging (n = 49). This population-based study identified patients using the Alberta Cancer Registry. Charts were reviewed by a single person. Data extracted included demographic information and prognostic factors such as age, histological type, laterality of the cyst, presence of microinvasion, and the type of surgical procedure. Data were extracted and entered into a study database for analysis. Overall survival and overall recurrence-free survival of both groups were calculated using the Kaplan-Meier method. Risk factors for recurrence were analyzed using Cox regression analysis. A total of 138 patients were enrolled, with a mean age of 46 years. The median follow-up time was 37 months. The most common histological type of BOT was the serous type found in 70 (50.7%) patients. Microinvasion was identified in four (2.9%) patients. Twelve patients were found to have implants as result of the staging procedure; two of them were invasive implants and both required chemotherapy. Forty-three (31%) patients had conservative surgery and 95 (68.8%) patients had non-conservative surgery. Nine (6.5%) patients experienced recurrence: five (5.6%) patients in group I versus four (8.2%) patients in group II. The presence of microinvasion is the risk factor for recurrence (P = 0.013). The indications for restaging surgery remain controversial, as there was no difference in recurrence rates observed between the study groups. However, surgical staging is important for identifying invasive extraovarian implants that need to be treated with chemotherapy. For patients who have conservative surgery, close- and long-term follow-up is required.

Drug cost avoidance resulting from cancer clinical trials

The purpose of the study was to determine if economic benefits result when cancer clinical trial patients receive sponsor-provided drug, thereby avoiding standard care drug costs for which institutions are financially responsible. All open, closed and terminated oncology trial protocols and drug dispensing data from 1992–2007 were reviewed for the lung, hematology, neurology, genitourinary and gynecology tumor groups at the Tom Baker Cancer Centre. Actual and projected, potential drug cost avoidance per patient and per drug from the trials was determined. Forty-two percent of the 101 reviewed studies offered drug cost avoidance. Drug specific cost avoidance ranged from $11.74 to $249,731.70 per patient, while potential drug specific cost avoidance ranged from $14.14 to $286,650.70 per patient. Actual drug cost avoidances, according to tumor group, were calculated showing a median range of $1377.00 to $23,751.00 per patient between tumor groups. The median range for potential drug cost avoidance was substantially higher, from $9868.00 to $46,640.00 per patient.Economic benefits result for the institution when patients participating in clinical trials receive drug provided by an external source. Drug cost avoidance varies due to type and cost of standard of care drug used and due to the design of individual trials. The existence of drug cost avoidance is an additional benefit that clinical trials can bring to an institution (in our case, Alberta Health Services).

The Prognostic Value of Hemoglobin in Patients With Anal Cancer Treated With Chemoradiotherapy

This study aimed to evaluate the impact of hemoglobin level on clinical outcome (local response, progression-free survival, and overall survival) in patients with carcinoma of the anal canal treated with definitive chemoradiotherapy. This is a retrospective study of patients with anal cancer treated between 1992 and 2005 with definitive chemoradiotherapy at Tom Baker Cancer Centre. Patient treatment, laboratory, and outcome data were extracted from the chart. Seventy-two patients treated with definitive chemoradiotherapy were identified. The median age was 56 years, the male-to-female ratio was 1:2, and the median tumor size was 3.5 cm. At 6 weeks after the completion of chemoradiotherapy, 62% of patients (38/61) had complete clinical response, and 34% (21/61) had achieved a partial clinical response. At 3 months after treatment, complete clinical response was observed in 78% (49/63) and a partial response in 16% (10/63). The median pretreatment hemoglobin level was 138.5 g/L, and the median on-treatment hemoglobin level was 129 g/L. Distant relapse was associated with hemoglobin levels in the lowest quartiles, pretreatment and on-treatment (P = .007 and P = .008, respectively). Hemoglobin levels were not associated with response at 6 weeks or 3 months. A pretreatment hemoglobin level of <130 g/L was associated with worse progression-free and overall survival (P < .0001, both). A hemoglobin on-treatment level of <121 g/L was associated with progression-free and overall survival (P < .0001 and P = .019, respectively), when stratified by gender. Hemoglobin status was correlated with progression-free and overall survival, and distant relapse, but not clinical response, in patients with carcinoma of the anal canal treated with chemoradiotherapy. The clinically relevant cut point, and the value of correcting hemoglobin levels before or during treatment, remains to be elucidated.

Feasibility study of a telehealth delivered, psychoeducational support group for allogeneic hematopoietic stem cell transplant patients

This study investigates the feasibility and efficacy of a telehealth delivered psychoeducational support group for allogeneic hematopoietic stem cell transplant (AHSCT) survivors. All AHSCT survivors 0-3 years post-transplant from the Tom Baker Cancer Centre, Calgary, Alta., Canada were contacted over a 4-year period and invited to participate. Groups were led by trained facilitators and the didactic content included many of the concerns commonly reported by AHSCT survivors. Participants met with facilitators and other group members via videoconferencing equipment located at various community health centres across Alberta, British Columbia, and Saskatchewan. Of the 19 AHSCT survivors who chose to participate, 74% attended five or more of the six sessions and 100% stated that they were satisfied with the program. The groups were found to be feasible and well liked by all participants. While participants appeared to have gained a greater appreciation of life, they did not demonstrate any significant improvements in quality of life, spirituality and meaning making, distress, or positive growth as measured by the questionnaires in the pre/post-package. Attendance and satisfaction ratings suggest that participants gleaned some benefit from participation. Psychoeducational support groups via videoconferencing may provide a viable alternative for those with limited access to psychosocial support. Clearly, more rigorous research is required to determine the utility of these psychoeducational support groups.

Abstract 1742: Evaluating the prognostic value of EGFR by p16/HPV status in patients with squamous cell carcinoma of the head and neck treated with concurrent chemoradiation

Abstract Background: Overexpression of the epidermal growth factor receptor (EGFR) has been correlated with a worse prognosis in patients with squamous cell carcinoma of the head and neck (SCCHN), however the prognostic value of EGFR has not been fully evaluated in the context of human papillomavirus (HPV) status. Methods: Records from 91 consecutive SCCHN patients treated with concurrent chemoradiation at the Tom Baker Cancer Centre between August 2000 and March 2005 were reviewed. Triplicate 0.6 mm cores from available pre-treatment formalin-fixed paraffin-embedded (FFPE) biopsies were assembled into a tissue microarray. Immunofluorescence combined with automated quantitative analysis (AQUA™) was used to evaluate EGFR and p16 protein expression. Phosphorylated EGFR (pEGFR) was assessed by proximity ligation assay. HPV infection status was determined by colorimetric in-situ hybridization using the INFORM HPV Family 16 Probe (CISH). PCR was used to detect HPV DNA. EGFR and pEGFR were correlated with clinical outcomes according to p16-status and HPV-status. Results: FFPE biopsies were available from 49 patients (54%). Patient characteristics were as follows: mean age 55 years, 82% male, 49% oropharyngeal primaries. The complete response rate was 88%. With a median follow-up of 42 months (range 3 to 60), the 5 year overall survival (OS) was 54%. EGFR and pEGFR protein expression were classified as high in 14 (29%) and 13 (27%) tumours respectively. 27 tumours were p16 positive; 30 were HPV positive by either PCR or CISH. p16 was strongly correlated with HPV status (Spearman r=0.80). In univariate analyses, tumours with high EGFR, low p16, and HPV negative were associated with significant 3-, 7-, and 5-fold increases, respectively, in locoregional recurrence, recurrence at any site, disease-specific mortality and worse OS. pEGFR did not predict outcome. Neither EGFR nor pEGFR predicted response. After adjusting for age, smoking status, T- and N-stage, p16, and HPV there was no relationship between EGFR and outcome. p16 and EGFR were inversely related (Spearman r=-0.3). Conclusions: In our small cohort of patients, EGFR did not have prognostic value after correction for p16 / HPV status. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 1742.

Intraperitoneal Chemotherapy for Advanced Ovarian and Peritoneal Cancers in Patients Following Interval Debulking Surgery or Primary Cytoreductive Surgery: Tom Baker Cancer Centre Experience From 2006 to 2009

ObjectiveTo describe our experience with cisplatin- and paclitaxel-based IP chemotherapy in patients treated initially with either neoadjuvant chemotherapy and interval debulking surgery (IDS) or primary cytoreductive surgery (PCRS). MethodsWe performed a retrospective review of the records of 67 patients (38 IDS, 29 PCRS) enrolled in the intraperitoneal (IP) chemotherapy program at the Tom Baker Cancer Centre between 2006 and 2009. Information pertaining to patient demographics, IP chemotherapy toxicity, and catheter complications was extracted, and the median time to recurrence was calculated. ResultsMost patients in the study were aged 50 to 70 years and had a diagnosis of stage III serous ovarian cancer. Overall, 295/393 IP cycles (75%) were successfully administered. The proportion of patients completing six cycles of chemotherapy in the IDS and PCRS groups was 53% and 59%, respectively. Frequent (>25%) Grade 1 to 2 chemotherapy toxicities included fatigue, peripheral neuropathy, and nausea. Catheter complications were observed in 34% of patients (23/67). The recurrence rates for patients completing four or more cycles of IP chemotherapy in the IDS and PCRS groups were 58% and 35%, respectively, with the median time to recurrence approximately one year. ConclusionAlthough IP chemotherapy is well tolerated in both IDS and PCRS patients, the median time to recurrence is shorter than expected.

Foreword

Journal of Surgical OncologyVolume 99, Issue 8 p. 461-461 Guest Editorial Foreword Walley J. Temple MD FRCSC FACS, Corresponding Author Walley J. Temple MD FRCSC FACS [email protected] Department of Surgery and Oncology, Tom Baker Cancer Centre, Calgary, Alberta, CanadaDepartment of Surgery and Oncology, Tom Baker Cancer Centre, 1331 29th St NW, Calgary, Alberta, Canada T2N 4N2; Fax: 403 283 3744.Search for more papers by this author Walley J. Temple MD FRCSC FACS, Corresponding Author Walley J. Temple MD FRCSC FACS [email protected] Department of Surgery and Oncology, Tom Baker Cancer Centre, Calgary, Alberta, CanadaDepartment of Surgery and Oncology, Tom Baker Cancer Centre, 1331 29th St NW, Calgary, Alberta, Canada T2N 4N2; Fax: 403 283 3744.Search for more papers by this author First published: 22 May 2009 https://doi.org/10.1002/jso.21320AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article. Volume99, Issue8Special Issue: Seminars in Surgical Oncology: Outcomes15 June 2009Pages 461-461 RelatedInformation

Tribute to Marija Auersperg

Journal of Surgical OncologyVolume 99, Issue 8 p. 459-460 Editorial Tribute to Marija Auersperg Walley J. Temple MD, FRCSC, FACS, Corresponding Author Walley J. Temple MD, FRCSC, FACS [email protected] Department of Surgery and Oncology, Tom Baker Cancer Centre, Calgary, Alberta, Canada1331 29th St NW, Calgary, Alberta, Canada T2N 4N2. Fax: 403-283-3744.Search for more papers by this author Walley J. Temple MD, FRCSC, FACS, Corresponding Author Walley J. Temple MD, FRCSC, FACS [email protected] Department of Surgery and Oncology, Tom Baker Cancer Centre, Calgary, Alberta, Canada1331 29th St NW, Calgary, Alberta, Canada T2N 4N2. Fax: 403-283-3744.Search for more papers by this author First published: 22 May 2009 https://doi.org/10.1002/jso.21314AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article. Volume99, Issue8Special Issue: Seminars in Surgical Oncology: Outcomes15 June 2009Pages 459-460 RelatedInformation

Racial differences in acute toxicities of FEC 100 chemotherapy in patients with breast cancer

e11515 Background: Racial disparities in breast cancer outcomes are attributed to differences in baseline tumor characteristics, stage, and socioeconomic factors. However, little is known about racial differences in treatment-related toxicities. We hypothesized that racial and ethnic differences result in differential tolerance to chemotherapy and possibly compromise to the dose intensity of adjuvant/neoadjuvant chemotherapy. Methods: Data was collected from 4 international collaborating centers (University of Miami, JBCRG (Japan Breast Cancer Research Group), University of Hong Kong, and Tom Baker Cancer Center) at which patients of different ethnic background have been treated for non metastatic breast cancer with same adjuvant or neoadjuvant chemotherapy of FEC 100: fluorouracil 500 mg/m2, epirubicin 100 mg/m2, and cyclophosphamide 100 mg/m2). Racial/ethnic differences in toxicities were assessed by first episode of grade 2 or higher toxicity. Analysis of data was performed at the University of Miami. Results: Treatment-related toxicities are compared according to four race/ethnicity groups (120 Caucasian from USA and Canada (C), 16 African American (AA) from USA and Canada, 141 Japanese Asian (JA), and 23 Asian from Hong Kong (HKA)) (Table). JA and HKA had a significant higher rate of grade 3 or higher toxicity compared with C or AA women; 65%, 61%, 28%, and 31% respectively. However, there were no significant differences in chemotherapy dose intensity or density across the 4 race/ethnicity groups. Conclusions: This unique study noted racial differences in acute toxicity in women with breast cancer who were treated with FEC 100 chemotherapy. However, there are several limitations including the retrospective nature of our study, differences in practice across four countries, and different number of patients available for comparison. This study is ongoing and further statistical analyses are planned when a larger sample size is reached. [Table: see text] No significant financial relationships to disclose.

Complementary therapies for cancer patients: assessing information use and needs

Many cancer patients seek complementary therapies (CTs) for cancer management; however, relatively little is known about patients' CT information seeking behaviour. Therefore, we assessed: 1) cancer patients' use of the types and sources of CT information; 2) their information preferences; and 3) their understanding of the phrase "scientific evidence or proof that a therapy works." We collected data from 404 patients attending the Tom Baker Cancer Centre (TBCC) in Calgary and 303 patients calling the Cancer Information Service (CIS) helpline. In most cases, patients wanted information on the safety of CTs, how CTs work and their potential side effects. Physicians and conventional cancer centres were the most desired sources of CT information, but relatively few patients obtained information via these sources. Although patients were aware of the meaning of scientific evidence, they often used information based on non-scientific evidence, such as patient testimonials. The creation of a supportive care environment in conventional cancer treatment centres, by providing CT information, may help address cancer patients' concerns and alleviate some of the stress that may have been caused by the cancer diagnosis.

A Radiation Therapy Venipuncture Certification Education Program

The Tom Baker Cancer Center (TBCC) is located in Calgary, Alberta, and employs 80 radiation therapists. The province of Alberta currently has two facilities that offer radiation therapy services. In 2006–2007, approximately 2,800 new and repeat patients received care at the TBCC. The Radiation Treatment Program (RTP) annually performs between 220 and 240 intravenous procedures using contrast media. Radiation therapists are licensed to practice through the Alberta College of Medical Diagnostic and Therapeutic Technologists (ACMDTT). In 2007, a radiation therapy venipuncture certification process was developed to implement an extended role for radiation therapists, allowing them to perform venipuncture. Using an algorithm as a design tool, the RTP radiation therapist educators created a locally based education and experiential learning certification program for radiation therapists endorsed by the RTP administration and the ACMDTT. Included in this article is a description and explanation of the algorithm design, an outline of the RTP radiation therapy venipuncture certification process, and a discussion on possible future research areas to further support the validity of an algorithm as a design tool.

Psychosocial Characteristics of Cancer Patients Who Choose to Attend an Educational Session on Cancer-Related Fatigue

Little is known about cancer patients who seek specific educational interventions on cancer-related fatigue (CRF). The objectives of this study were (1) to describe the level of CRF, and emotional distress; social support; coping styles; and quality of life of patients who chose to attend a 1-hour educational session on CRF and (2) to examine the relationship between the selected demographic, psychosocial, and treatment-related variables and CRF. A questionnaire-based survey of 41 cancer patients who volunteered after a 1-hour education session on CRF at the Tom Baker Cancer Centre was conducted. The sample consisted mostly of married white women who lived in an urban environment. The average age was 56 years, and participants had an average of 14 years of education; 78% of the sample reported moderate to severe fatigue, 27% had significant levels of emotional distress, and 63% had a problematic coping style. Higher fatigue was associated with emotional distress, poorer quality of life, hopelessness, and reduced social support. To conclude, patients who self-refer to an educational session on CRF present a wide range of emotional difficulties and problematic coping styles. Therefore, educational sessions with patients with CRF should emphasize coping with emotional distress and building a support system.

New look at the old management of unknown primary

Journal of Surgical OncologyVolume 98, Issue 2 p. 71-72 Guest Editorial New look at the old management of unknown primary Scot Dowden MD, Corresponding Author Scot Dowden MD [email protected] Tom Baker Cancer Centre, University of Calgary, Alberta, Canada Medical Oncologist; Clinical Assistant Professor, Medicine and Oncology; Assistant Chair, Gastrointestinal Tumour Group; Director, Medical Oncology Training Program.1331—29th Street NW, Calgary, Alberta, Canada T2N 4N2; Fax: 403-283-1651.===Search for more papers by this authorWalter Miller D.O., Walter Miller D.O. Department of Surgical Oncology, Tom Baker Cancer Centre, Alberta, Canada Surgery Oncology Fellow.Search for more papers by this author Scot Dowden MD, Corresponding Author Scot Dowden MD [email protected] Tom Baker Cancer Centre, University of Calgary, Alberta, Canada Medical Oncologist; Clinical Assistant Professor, Medicine and Oncology; Assistant Chair, Gastrointestinal Tumour Group; Director, Medical Oncology Training Program.1331—29th Street NW, Calgary, Alberta, Canada T2N 4N2; Fax: 403-283-1651.===Search for more papers by this authorWalter Miller D.O., Walter Miller D.O. Department of Surgical Oncology, Tom Baker Cancer Centre, Alberta, Canada Surgery Oncology Fellow.Search for more papers by this author First published: 11 July 2008 https://doi.org/10.1002/jso.20995Citations: 1 AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume98, Issue21 August 2008Pages 71-72 RelatedInformation

Salvage Prostate Cryoablation: Initial Results From the Cryo On-Line Data Registry

We report contemporary outcomes of salvage cryoablation at a large number of centers which have participated in the COLD (Cryo On-Line Data) Registry. A secure online database was developed to collect data for patients undergoing prostate cryoablation. Kaplan-Meier analysis was performed with biochemical failure defined using the American Society of Therapeutic Radiology and Oncology, and the Phoenix definitions. Data from 279 patients who had undergone salvage cryoablation were entered. Average patient age was 70.0 +/- 7.1 years. Pretreatment prostate specific antigen was 7.6 +/- 8.2 ng/ml and Gleason score was 7.5 +/- 1.1 (median 7). Patients were followed for 21.6 +/- 24.9 months and 47 were followed longer than 5 years. The 5-year actuarial biochemical disease-free rates were 58.9% +/- 5.7% (American Society of Therapeutic Radiology and Oncology) and 54.5% +/- 4.9% (Phoenix). As predicted based on the preservation of some prostatic tissue, 83% +/- 3.5% of patients had a detectable prostate specific antigen 0.2 ng/ml or greater at 5 years. Positive biopsies were observed in 15 of the 46 patients (32.6%) who underwent prostate biopsy after salvage cryotherapy. The incontinence rate (requiring pad use) was 4.4%. The rectal fistula rate was 1.2% and 3.2% of patients underwent transurethral prostate resection to remove sloughed tissue. Biochemical and local control rates support the use of salvage cryoablation for localized recurrence following failed radiation therapy. Efforts to continue to minimize these complications and to improve disease control in patients with persistent cancer following definitive radiotherapy should continue.