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A 2011 updated systematic review and clinical practice guideline for the management of malignant extradural spinal cord compression.

https://arctichealth.org/en/permalink/ahliterature126132
Source
Int J Radiat Oncol Biol Phys. 2012 Oct 1;84(2):312-7
Publication Type
Article
Date
Oct-1-2012
Author
D Andrew Loblaw
Gunita Mitera
Michael Ford
Normand J Laperriere
Author Affiliation
Department of Radiation Oncology, Sunnybrook Health Science Centre, University of Toronto, Toronto, Canada. andrew.loblaw@sunnybrook.ca
Source
Int J Radiat Oncol Biol Phys. 2012 Oct 1;84(2):312-7
Date
Oct-1-2012
Language
English
Publication Type
Article
Keywords
Adult
Decompression, Surgical - methods
Dose Fractionation
Humans
Meta-Analysis as Topic
Multicenter Studies as Topic
Neoplasm Recurrence, Local - radiotherapy
Ontario
Randomized Controlled Trials as Topic
Retrospective Studies
Spinal Cord Compression - diagnosis - therapy
Spinal Cord Neoplasms - secondary - therapy
Steroids - therapeutic use
Walking
Abstract
To update the 2005 Cancer Care Ontario practice guidelines for the diagnosis and treatment of adult patients with a suspected or confirmed diagnosis of extradural malignant spinal cord compression (MESCC).
A review and analysis of data published from January 2004 to May 2011. The systematic literature review included published randomized control trials (RCTs), systematic reviews, meta-analyses, and prospective/retrospective studies.
An RCT of radiation therapy (RT) with or without decompressive surgery showed improvements in pain, ambulatory ability, urinary continence, duration of continence, functional status, and overall survival. Two RCTs of RT (30 Gy in eight fractions vs. 16 Gy in two fractions; 16 Gy in two fractions vs. 8 Gy in one fraction) in patients with a poor prognosis showed no difference in ambulation, duration of ambulation, bladder function, pain response, in-field failure, and overall survival. Retrospective multicenter studies reported that protracted RT schedules in nonsurgical patients with a good prognosis improved local control but had no effect on functional or survival outcomes.
If not medically contraindicated, steroids are recommended for any patient with neurologic deficits suspected or confirmed to have MESCC. Surgery should be considered for patients with a good prognosis who are medically and surgically operable. RT should be given to nonsurgical patients. For those with a poor prognosis, a single fraction of 8 Gy should be given; for those with a good prognosis, 30 Gy in 10 fractions could be considered. Patients should be followed up clinically and/or radiographically to determine whether a local relapse develops. Salvage therapies should be introduced before significant neurologic deficits occur.
PubMed ID
22420969 View in PubMed
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Association between germline HOXB13 G84E mutation and risk of prostate cancer.

https://arctichealth.org/en/permalink/ahliterature122735
Source
J Natl Cancer Inst. 2012 Aug 22;104(16):1260-2
Publication Type
Article
Date
Aug-22-2012
Author
Mohammad R Akbari
John Trachtenberg
Justin Lee
Stephanie Tam
Robert Bristow
Andrew Loblaw
Steven A Narod
Robert K Nam
Author Affiliation
Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada.
Source
J Natl Cancer Inst. 2012 Aug 22;104(16):1260-2
Date
Aug-22-2012
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Biopsy
Canada
Case-Control Studies
European Continental Ancestry Group - genetics
Genetic Predisposition to Disease
Germ-Line Mutation
Homeodomain Proteins - genetics
Humans
Male
Middle Aged
Odds Ratio
Prostatic Neoplasms - genetics
Research Design
Risk assessment
Risk factors
Abstract
Recently, a G84E mutation in HOXB13, a gene involved in prostate development, was shown to be strongly associated with an increased risk of prostate cancer. To confirm this association in a screening setting, we conducted a case-control study and sequenced germline DNA from peripheral leukocytes of 1843 men diagnosed with prostate cancer (case subjects) and 2225 men without prostate cancer (control subjects) for mutations in HOXB13. Subjects (aged 40-94 years) were prescreened and underwent a prostate biopsy at two tertiary care centers in Canada. The frequency of HOXB13 variants was determined in case subjects and control subjects by race, and odds ratios and 95% confidence intervals were based on 2×2 table analysis. All statistical tests were two-sided. Twelve men of white race were identified to be carriers of the G84E mutation. The G84E mutation was more frequent among white case subjects than among white control subjects (10 of 1525 [0.7%] vs 2 of 1757 [0.1%], P = .01) and was associated with an increased risk of prostate cancer (unadjusted odds ratio = 5.8, 95% confidence interval = 1.3 to 26.5, P = .01).
Notes
Comment In: J Urol. 2013 Feb;189(2):52823312158
PubMed ID
22781434 View in PubMed
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Communication with referring physicians in a palliative radiotherapy clinic.

https://arctichealth.org/en/permalink/ahliterature180150
Source
Support Care Cancer. 2004 Sep;12(9):669-73
Publication Type
Article
Date
Sep-2004
Author
Elizabeth A Barnes
Edward Chow
Lou Andersson
Charles Hayter
Andrew Loblaw
David Lee
Lori Holden
Grace Chan
Cyril Danjoux
Author Affiliation
Rapid Response Radiotherapy Program, Department of Radiation Oncology, Toronto-Sunnybrook Regional Cancer Centre, University of Toronto, 2075 Bayview Avenue, Toronto, Ontario, M4 N 3M5, Canada. toni.barnes@tsrcc.on.ca
Source
Support Care Cancer. 2004 Sep;12(9):669-73
Date
Sep-2004
Language
English
Publication Type
Article
Keywords
Cancer Care Facilities
Health Care Surveys
Humans
Interdisciplinary Communication
Medical Records
Neoplasms - radiotherapy
Ontario
Palliative Care
Physician-Patient Relations
Questionnaires
Radiation Oncology
Referral and Consultation
Abstract
The rapid response radiotherapy program (RRRP) at Toronto-Sunnybrook Regional Cancer Center (TSRCC) provides quick access to palliative radiotherapy for patients with a life expectancy of less than 12 months. Patients then return to their referring physician for continued oncologic management. After the initial RRRP consultation, we fax an interim consultation report to the referring physician. The purpose of this study was to assess how useful referring physicians perceive this interim report and whether this report needs to be modified to meet their information needs.
Physicians who referred patients to the RRRP and who were faxed an interim consultation report were identified over a 4-month period. These physicians were then faxed a questionnaire that asked how useful the interim report was in patient management, about their satisfaction with the information provided, to critique the report format, and whether the RRRP physician and nurse were easily accessible by telephone.
Forty physicians referred patients to the RRRP clinic over the 4-month study period. The response rate to our survey was 58% (23/40). The vast majority of physicians (95%) stated that the interim consultation report was useful in patient management. They felt that treatment details were adequately discussed in the report. The report format was perceived to be clear and concise. Referring physicians wished to be informed about any medication changes. RRRP physicians and nurse were perceived to be easily accessible by telephone if needed.
Results showed that referring physicians found the faxed interim consultation report useful in patient management. Suggestions were made on how to improve the report, and they will be used to further enhance physician communication and ultimately patient care.
PubMed ID
15138865 View in PubMed
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Cost-effectiveness of surgery plus radiotherapy versus radiotherapy alone for metastatic epidural spinal cord compression.

https://arctichealth.org/en/permalink/ahliterature166260
Source
Int J Radiat Oncol Biol Phys. 2006 Nov 15;66(4):1212-8
Publication Type
Article
Date
Nov-15-2006
Author
Kenneth C Thomas
Bohdan Nosyk
Charles G Fisher
Marcel Dvorak
Roy A Patchell
William F Regine
Andrew Loblaw
Nick Bansback
Daphne Guh
Huiying Sun
Aslam Anis
Author Affiliation
Department of Surgery (Orthopedics), University of Calgary, Calgary, AB, Canada.
Source
Int J Radiat Oncol Biol Phys. 2006 Nov 15;66(4):1212-8
Date
Nov-15-2006
Language
English
Publication Type
Article
Keywords
Canada - epidemiology
Cost-Benefit Analysis
Epidural Neoplasms - economics - epidemiology - secondary - therapy
Health Care Costs - statistics & numerical data
Humans
Neurosurgical Procedures - economics - statistics & numerical data
Radiotherapy - economics - statistics & numerical data
Randomized Controlled Trials as Topic
Spinal Cord Compression - economics - epidemiology - therapy
Abstract
A recent randomized clinical trial has demonstrated that direct decompressive surgery plus radiotherapy was superior to radiotherapy alone for the treatment of metastatic epidural spinal cord compression. The current study compared the cost-effectiveness of the two approaches.
In the original clinical trial, clinical effectiveness was measured by ambulation and survival time until death. In this study, an incremental cost-effectiveness analysis was performed from a societal perspective. Costs related to treatment and posttreatment care were estimated and extended to the lifetime of the cohort. Weibull regression was applied to extrapolate outcomes in the presence of censored clinical effectiveness data.
From a societal perspective, the baseline incremental cost-effectiveness ratio (ICER) was found to be $60 per additional day of ambulation (all costs in 2003 Canadian dollars). Using probabilistic sensitivity analysis, 50% of all generated ICERs were lower than $57, and 95% were lower than $242 per additional day of ambulation. This analysis had a 95% CI of -$72.74 to 309.44, meaning that this intervention ranged from a financial savings of $72.74 to a cost of $309.44 per additional day of ambulation. Using survival as the measure of effectiveness resulted in an ICER of $30,940 per life-year gained.
We found strong evidence that treatment of metastatic epidural spinal cord compression with surgery in addition to radiotherapy is cost-effective both in terms of cost per additional day of ambulation, and cost per life-year gained.
Notes
Comment In: Int J Radiat Oncol Biol Phys. 2007 May 1;68(1):314; author reply 314-517448887
PubMed ID
17145536 View in PubMed
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Determining the incidence of pain flare following palliative radiotherapy for symptomatic bone metastases: results from three canadian cancer centers.

https://arctichealth.org/en/permalink/ahliterature152980
Source
Int J Radiat Oncol Biol Phys. 2009 Sep 1;75(1):193-7
Publication Type
Article
Date
Sep-1-2009
Author
Amanda Hird
Edward Chow
Liying Zhang
Rebecca Wong
Jackson Wu
Emily Sinclair
Cyril Danjoux
May Tsao
Elizabeth Barnes
Andrew Loblaw
Author Affiliation
Department of Radiation Oncology, Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada.
Source
Int J Radiat Oncol Biol Phys. 2009 Sep 1;75(1):193-7
Date
Sep-1-2009
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Alberta
Analgesics - therapeutic use
Bone Diseases - diagnosis - epidemiology - etiology
Bone Neoplasms - radiotherapy - secondary
Breast Neoplasms - pathology
Female
Humans
Incidence
Lung Neoplasms - pathology
Male
Middle Aged
Ontario
Pain - diagnosis - epidemiology - etiology
Pain Measurement
Prostatic Neoplasms - pathology
Radiotherapy Dosage
Abstract
To determine the incidence of pain flare following radiotherapy (RT) for painful bone metastases.
Patients with bone metastases treated with RT were eligible. Worst pain scores and analgesic consumption were collected before, daily during, and for 10 days after treatment. Pain flare was defined as a 2-point increase in the worst pain score (0-10) compared to baseline with no decrease in analgesic intake, or a 25% increase in analgesic intake with no decrease in worst pain score. Pain flare was distinguished from progression of pain by requiring the worst pain score and analgesic intake return to baseline levels after the increase/flare (within the 10-day follow-up period).
A total of 111 patients from three cancer centers were evaluable. There were 50 male and 61 female patients with a median age of 62 years (range, 40-89 years). The primary cancers were mainly breast, lung, and prostate. Most patients received a single 8 Gy (64%) or 20 Gy in five fractions (25%). The overall pain flare incidence was 44/111 (40%) during RT and within 10 days following the completion of RT. Patients treated with a single 8 Gy reported a pain flare incidence of 39% (27/70) and, with multiple fractions, 41% (17/41).
More than one third of the enrolled patients experienced a pain flare. Identifying at-risk individuals and managing potential pain flares is crucial to achieve an optimal level of care.
Notes
Comment In: Int J Radiat Oncol Biol Phys. 2010 Oct 1;78(2):637; author reply 63720832666
PubMed ID
19167840 View in PubMed
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Dramatic increase in prostate cancer cases by 2021.

https://arctichealth.org/en/permalink/ahliterature135138
Source
BJU Int. 2011 Dec;108(11):1734-8
Publication Type
Article
Date
Dec-2011
Author
Harvey Quon
Andrew Loblaw
Robert Nam
Author Affiliation
Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, ONT, Canada.
Source
BJU Int. 2011 Dec;108(11):1734-8
Date
Dec-2011
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Age Distribution
Aged
Aged, 80 and over
Canada - epidemiology
Child
Child, Preschool
Forecasting
Humans
Incidence
Infant
Male
Mass Screening - statistics & numerical data
Middle Aged
Prevalence
Prostate-Specific Antigen - blood
Prostatic Neoplasms - diagnosis - epidemiology
Young Adult
Abstract
What's known on the subject? and What does the study add? Estimates of prostate cancer cases are often based solely on changes in the age distribution of the population or on historical trends. This study also incorporates changes in screening prevalence, sensitivity screening maneuvers and lowering threshold for biopsies.
• To estimate the magnitude of increase in prostate cancer cases diagnosed in Canada by the year 2021.
• Using available evidence, the number of new prostate cancer cases expected in 2021 was estimated based on the effects of four major factors: aging population, increased prevalence of PSA screening, lowered PSA cutoff to recommend biopsy, and improved sensitivity of prostate biopsy. • These effects were combined with population data from Statistics Canada and the Canadian Cancer Statistics to estimate new prostate cancer cases.
• The two factors with the largest effect on estimated new prostate cancers in 2021 compared with 2009 were: aging population (increase of 39%), and lowering the PSA threshold to 2.6 ng/mL before prostate biopsy (increase of 200%). • In the 'best-case' scenario, the number of new prostate cancers will only be affected by the aging population and will increase by 39% to 35,121 new cases. • In the 'most-likely' scenario, all four factors will have a combined effect to increase new cases by 201% to 76,379.
• The aging population and lowering PSA threshold to 2.6 ng/mL have the most significant impact on estimated new prostate cancer cases in 2021. At that time, the number of new cases may triple to 76,379 cases in Canada. • Significant planning will be required to manage this considerable increase in new prostate cancers. .
PubMed ID
21507185 View in PubMed
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Multidisciplinary radiation oncology palliative care rounds as a continuing educational activity implementing the rapid response radiotherapy program at the toronto sunnybrook regional cancer centre.

https://arctichealth.org/en/permalink/ahliterature184259
Source
J Cancer Educ. 2003;18(2):86-90
Publication Type
Article
Date
2003
Author
Ewa Szumacher
Edmee Franssen
Charles Hayter
Cyril Danjoux
Edward Chow
Lourdes Andersson
Rebecca Wong
Andrew Loblaw
Author Affiliation
Department of Radiation Oncology, University of Toronto, Ontario, Canada. ewa.szumacher@tsrcc.on.ca
Source
J Cancer Educ. 2003;18(2):86-90
Date
2003
Language
English
Publication Type
Article
Keywords
Attitude of Health Personnel
Cancer Care Facilities
Education, Medical, Continuing - methods
Humans
Neoplasms - radiotherapy
Ontario
Palliative Care
Patient care team
Physicians
Program Evaluation
Radiation Oncology - education - methods
Abstract
This paper describes the development of the Rapid Response Radiotherapy Program and evaluates the continuing medical education (CME) series, in the form of multidisciplinary monthly Radiation Oncology Palliative Care Rounds at the Toronto Sunnybrook Regional Cancer Centre.
Palliative care rounds were initiated by the multidisciplinary committee in September, 1998. From January, 2000, to June, 2002, attendees used a standard 5- point Likert rating scale to conduct formal evaluations.
A total of 203 evaluation forms examining 20 rounds have been collected. Findings indicated that 86.8, 96.0, 87.1, and 90.8% of participants thought the material of the presentation was relevant to their practice, interesting, and instructional. Overall 90.1% of the respondents highly rated the grand rounds (rating of 4 or 5).
The grand rounds are an effective CME activity at our hospital.
PubMed ID
12888382 View in PubMed
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Patient costs associated with external beam radiotherapy treatment for localized prostate cancer: the benefits of hypofractionated over conventionally fractionated radiotherapy.

https://arctichealth.org/en/permalink/ahliterature125131
Source
Can J Urol. 2012 Apr;19(2):6165-9
Publication Type
Article
Date
Apr-2012
Author
Perakaa Sethukavalan
Patrick Cheung
Colin I Tang
Harvey Quon
Gerard Morton
Robert Nam
Andrew Loblaw
Author Affiliation
Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
Source
Can J Urol. 2012 Apr;19(2):6165-9
Date
Apr-2012
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Canada
Cost of Illness
Costs and Cost Analysis
Dose Fractionation
Health Services Accessibility - economics
Humans
Male
Middle Aged
Prostatic Neoplasms - economics - radiotherapy
Transportation - economics
Abstract
To estimate the out-of-pocket costs for patients undergoing external beam radiotherapy (EBRT) for prostate cancer and calculate the patient-related savings of being treated with a 5-fraction versus a standard 39-fraction approach.
Seventy patients accrued to the pHART3 (n = 84) study were analyzed for out-of-pocket patient costs as a result of undergoing treatment. All costs are in Canadian dollars. Using the postal code of the patient's residence, the distance between the hospital and patient home was found using Google Maps. The Canada Revenue Agency automobile allowance rate was then applied to determine the cost per kilometer driven.
The average cost of travel from the hospital and pHART3 patient's residence was $246 per person after five trips. In a standard fractionation regimen, pHART3 patients would have incurred an average cost of $1921 after 39 visits. The patients receiving hypofractionated radiotherapy would have paid an average of $38 in parking while those receiving conventional treatment would have paid $293. The difference in out-of-pocket costs for the patients receiving a standard versus hypofractionated treatment was $1930.
Medium term prospective data shows that hypofractionated radiotherapy is an effective treatment method for localized prostate cancer. Compared to standard EBRT, hypofractionated radiotherapy requires significantly fewer visits. Due to the long distance patients may have to travel to the cancer center and the expense of parking, the short course treatment saves each patient an average of $1900. A randomized study of standard versus hypofractionated accelerated radiotherapy should be conducted to confirm a favorable efficacy and tolerability profile of the shorter fractionation scheme.
PubMed ID
22512958 View in PubMed
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Population based study of long-term rates of surgery for urinary incontinence after radical prostatectomy for prostate cancer.

https://arctichealth.org/en/permalink/ahliterature123394
Source
J Urol. 2012 Aug;188(2):502-6
Publication Type
Article
Date
Aug-2012
Author
Robert K Nam
Sender Herschorn
D Andrew Loblaw
Ying Liu
Laurence H Klotz
Lesley K Carr
Ronald T Kodama
Aleksandra Stanimirovic
Vasundara Venkateswaran
Refik Saskin
Calvin H L Law
David R Urbach
Steven A Narod
Author Affiliation
Division of Urology, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, Ontario, Canada. Robert.nam@utoronto.ca
Source
J Urol. 2012 Aug;188(2):502-6
Date
Aug-2012
Language
English
Publication Type
Article
Keywords
Adult
Aged
Follow-Up Studies
Health Surveys
Humans
Male
Middle Aged
Ontario
Postoperative Complications - epidemiology - surgery
Prospective Studies
Prostatectomy
Prostatic Neoplasms - epidemiology - surgery
Reoperation - statistics & numerical data
Suburethral Slings
Urinary Incontinence - epidemiology - surgery
Urinary Sphincter, Artificial
Abstract
Urinary incontinence can be a significant complication of radical prostatectomy. It can be treated with post-prostatectomy surgical procedures. The long-term rate of patients who undergo these surgeries, including artificial urinary sphincter or urethral sling insertion, is not well described. We examined the long-term rate of post-prostatectomy incontinence surgery and factors influencing it.
We performed a population based study of 25,346 men who underwent radical prostatectomy for prostate cancer in Ontario, Canada between 1993 and 2006. We used hospital and cancer registry administrative data to identify patients from this cohort who were later treated with surgery for urinary incontinence.
Of the 25,346 patients 703 (2.8%) underwent artificial urinary sphincter insertion and 282 (1.1%) underwent urethral sling placement a median of 2.9 years after prostatectomy. The probability of an artificial urinary sphincter/sling procedure increased with time from prostatectomy. Cumulative 5, 10 and 15-year Kaplan-Meier rates of an artificial urinary sphincter/sling procedure were 2.6% (95% CI 2.4-2.8), 3.8% (95% CI 3.6-4.1) and 4.8% (95% CI 4.4-5.3), respectively. Factors predicting surgery for incontinence were patient age at radical prostatectomy (HR 1.24 per decade, 95% CI 1.11-1.38, p = 0.0002), radiotherapy after surgery (HR 1.61, 95% CI 1.36-1.90, p
Notes
Comment In: Eur Urol. 2013 May;63(5):962-323541255
PubMed ID
22704098 View in PubMed
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Psychometric refinement of an outpatient, visit-specific satisfaction with doctor questionnaire.

https://arctichealth.org/en/permalink/ahliterature180862
Source
Psychooncology. 2004 Apr;13(4):223-34
Publication Type
Article
Date
Apr-2004
Author
D Andrew Loblaw
Andrea Bezjak
P Mony Singh
Andrew Gotowiec
David Joubert
Kenneth Mah
Gerald M Devins
Author Affiliation
Department of Radiation Oncology, Princess Margaret Hospital, University Health Network, University of Toronto, Canada.
Source
Psychooncology. 2004 Apr;13(4):223-34
Date
Apr-2004
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Ambulatory Care
Canada
Factor Analysis, Statistical
Female
Humans
Male
Medical Oncology
Middle Aged
Neoplasms - therapy
Office Visits
Patient satisfaction
Physician-Patient Relations
Psychometrics - methods - standards
Quality of Health Care
Questionnaires
Reproducibility of Results
Abstract
Measuring patient's satisfaction with their physician is gaining interest but requires a questionnaire that is valid, reliable and acceptable to patients. We previously published a self-administered visit-specific satisfaction with physician questionnaire for cancer patients. Eighty outpatients at a Canadian Cancer Center completed the Princess Margaret Hospital Patient Satisfaction with Doctor Questionnaire and the FACT-G questionnaires along with demographic information just after clinic visit and again 3-5 days later. Exploratory factor analysis extracted two factors, labeled 'physician disengagement' and 'perceived support,' with average coefficient alpha values of 0.93 and 0.90. Test-retest reliability was 0.83 and 0.73, respectively, for the two factors. Confirmatory factor analysis applied to the data from 174 patients in the original study indicated excellent goodness of fit. PMH/PSQ-MD correlated moderately with FACT-G (average r=0.37, p
PubMed ID
15054727 View in PubMed
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11 records – page 1 of 2.