Adenocarcinoma of the appendix is less than 0.5% of all gastrointestinal cancers. The aim of this study was to analyse the incidence, symptoms, pathology and treatment of appendiceal adenocarcinoma in a well defined cohort as well as the prognosis of the patients.
This is a retrospective study on all patients diagnosed with adenocarcinoma of the appendix in Iceland from 1990-2009. Information on epidemiological factors, survival and treatment was collected. All histological material was reviewed. Overall survival was estimated with median follow up of 15 months (range, 0-158).
A total of 22 patients were diagnosed with appendiceal adenocarinoma in the study period (median age 63 yrs, range: 30-88, 50% males). Age-standardized incidence was 0.4/100,000/year. The most common symptom was abdominal pain (n=10). Eight patients had clinical signs of appendicitis. Most patients were diagnosed at operation or at pathological examination but one patient was diagnosed at autopsy. Five patients had an appendectomy and 11 a right hemicolectomy. One patient was not operated on and in three patients only a biopsy was taken. Twelve patients had chemotherapy and seven of them for metastatic disease. Eight patients had adenocarcinoma, seven mucinous adenocarcinoma, three signet ring adenocarcinoma, one mixed goblet cell carcinoid and mucinous adenocarcinoma,one mixed adenocarcinoma and signet ring adenocarcinoma and two a mucinous tumour of unknown malignant potential. In eight cases the tumor originated in adenoma. Most of the patients had a stage IV disease (n=13), three stage III, three stage II and three stage I. Operative mortality was 4.8% (n=1). Disease specific five year survival was 54% but overall five year survival was 44% respectively.
Adenocarcinoma of the appendix is a rare disease. No patients were diagnosed pre-operatively. Over half of the patients presented with stage IV disease.
Adherence to long-term pharmacological treatment for chronic conditions is often less than optimal. Till date, a limited number of population-based studies have assessed adherence to adjuvant hormonal therapy in breast cancer, a therapy with proven benefits in terms of reductions of recurrence and mortality. We aimed to examine rates of adherence and early discontinuation in Sweden where prescribed medications are subsidized for all residents and made available at reduced out-of-pocket costs. Individual-level data were obtained from Regional Clinical Quality Breast Cancer Registers, the Swedish Prescribed Drug Register, and several other population-based registers. Multivariate logistic regression was used to analyze factors associated with adherence to prescribed medication for a period of 3 years. Between January 1 and December 31, 2005, 1,741 patients in central Sweden were identified with estrogen receptor positive breast cancer, and at least one prescription dispensation of either tamoxifen or an aromatase inhibitor. Of these women, 1,193 (69%) were fully adherent to therapy for 3 years (medication possession ratio of 80% or higher and a maximum of 180 days between refills). During the 3-year follow-up, 215 women (12%) had prematurely discontinued therapy. Adherence was positively associated with younger age, large tumor size, being married, and being born in the Nordic countries, while no clear association was observed with education or income. During the 3 years of follow-up, 31% of women were non-adherent to therapy. Further efforts must be undertaken to promote adherence over the entire recommended treatment period.
Patient adherence is critical in evaluating the effectiveness of an oral therapy. We sought to measure adherence among women randomly assigned to capecitabine in a preplanned substudy of a multicenter clinical trial.
Cancer and Leukemia Group B study CALGB 49907 was a randomly assigned trial comparing standard chemotherapy versus oral chemotherapy with capecitabine in patients age 65 years or older with early-stage breast cancer. We used microelectronic monitoring system (MEMS) caps on participants' capecitabine bottles to record pill bottle openings. Capecitabine was given in two divided daily doses for 14 consecutive days of a 21-day cycle for six cycles. Adherence was calculated as the number of doses taken divided by doses expected, taking into account toxicity-related dosing changes. A participant was defined as adherent if 80% or more of expected doses were recorded by MEMS.
Overall, 161 patients were enrolled. Median age was 71 years (range, 65 to 89 years); 124 patients (83%) persisted with capecitabine to completion of planned protocol therapy. Adherence was 78% across all cycles, and adherence did not vary by cycle (P = .32). Twenty-five percent of participants took fewer than 80% of expected doses and were nonadherent. In a logistic regression model, participants with node-negative disease (P = .01) and mastectomy (P = .01) were more likely to be nonadherent. Adherence was not related to age, tumor stage, or hormone receptor status. Adherence was not significantly associated with relapse-free survival or grade 3 or 4 toxicity.
Most older women with early-stage breast cancer were adherent to short-term oral chemotherapy in a randomized clinical trial. Age was not associated with adherence.
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Clinical practice guidelines (CPGs) recommend adjuvant chemotherapy after curative-intent surgery for colorectal cancer (CRC). Studies have shown variable rates of adherence to adjuvant therapy CPGs. This study sought to determine the proportion of patients in Nova Scotia receiving CPG-concordant adjuvant chemotherapy within 12 weeks of surgery for CRC in 2001 to 2005, and to identify factors associated with chemotherapy receipt beyond 12 weeks from surgery or chemotherapy nonreceipt.
Patients with stages IIB or III colon or stages II or III rectal cancer who underwent curative-intent surgery in Nova Scotia were identified through the provincial cancer registry and anonymously linked to 14 administrative health databases. Chart review was conducted to obtain chemotherapy data and reasons for chemotherapy nonreceipt. Logistic regression was used to identify factors independently associated with receipt of chemotherapy and meeting the 12-week benchmark (P
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Evidence suggests that pre- and/or postoperative treatment benefits patients with stage II/III rectal cancer. This study aimed to quantify treatment patterns and adherence to treatment guidelines, and to identify barriers to having a consultation with an oncologist and barriers to receiving treatment in stage II/III rectal cancer, in a publicly funded medical care system.
Patients with surgically treated stage II/III rectal adenocarcinoma, diagnosed from 2002 to 2005 in Alberta, a Canadian province with a population of 3 million, were included. Demographic and treatment information from the Alberta Cancer Registry were linked to data from electronic medical records, hospital discharge data and the 2001 Canadian Census. The study outcomes were 'not having an oncologist consultation' and 'not receiving guideline-based treatment'. The relative risks of the two outcomes in association with patient characteristics were estimated using multivariable log-binomial regression.
Of a total of 910 surgically treated stage II/III rectal adenocarcinoma patients, 748 (82%) had a consultation with an oncologist and 414 (45.5%) received treatment. Pre-/post-surgical treatment modalities and timing varied; 96 (10.5%) received neoadjuvant treatment only, 389 (42.7%) received adjuvant treatment only, 119 (13.1%) received both, and 306 (33.6%) had surgery alone. Factors related to not having a consultation with an oncologist included older age, co-morbidities, cancer stage II and region of residence. Older age was the most significantly associated factor with not receiving treatment (relative risk=2.23; 95% confidence interval: 1.89, 2.64).
Disparities exist in the receipt of treatment in stage II/III rectal cancer. Factors such as age, region of residence and stage should not be barriers to consulting an oncologist to discuss or receive treatment. The reasons for these disparities need to be identified and addressed.
Several systemic agents have been approved for patients with advanced renal cell carcinoma (RCC) and others are in various stages of development. We surveyed members of the Society of Urologic Oncology (SUO) regarding the importance of adjuvant and neoadjuvant systemic therapy for RCC and their participation in such trials.
A survey was sent in October 2010 to 564 U.S. and Canadian members of the SUO and the SUO-Clinical Trials Committee with a valid e-mail address. A total of 136 urologic cancer specialists from a mixture of practice patterns responded to the questionnaire (24% participation rate).
At the time of the study, 75% participated in adjuvant or neoadjuvant treatment protocols, including 75% with adjuvant and 16% with neoadjuvant protocols. There was universal support for continued investigation of agents for adjuvant use in RCC with locoregional metastasis (100%) and nearly universal support for investigation of agents in patients with "high risk" (99%) and "intermediate risk" (91%) localized RCC after nephrectomy. The vast majority of respondents also supported investigation of neoadjuvant therapies in patients with advanced RCC (98%) or locally-advanced RCC (98%), with 70% also supporting neoadjuvant trials in patients with localized RCC. Importantly, 98% of respondents indicated interest in participating in future adjuvant and neoadjuvant trials.
Urologic cancer specialists surveyed in late 2010 demonstrated nearly universal support for trials to investigate the role of neoadjuvant and adjuvant therapies for RCC of all stages. With appropriate patient selection and outcome assessment, this widespread support indicates great potential for future clinical trials which will require the participation of urologic surgeons.
Capecitabine is an active agent in the treatment of breast cancer. It is not known whether integration of capecitabine into an adjuvant regimen that contains a taxane, an anthracycline, and cyclophosphamide improves outcome in early breast cancer.
Women with axillary node-positive or high-risk node-negative breast cancer were randomly assigned to receive either three cycles of docetaxel and capecitabine (TX) followed by three cycles of cyclophosphamide, epirubicin, and capecitabine (CEX; n = 753) or three cycles of docetaxel (T) followed by three cycles of cyclophosphamide, epirubicin, and fluorouracil (CEF; n = 747). The primary end point was recurrence-free survival (RFS).
During a median follow-up time of 59 months, 214 RFS events occurred (local or distant recurrences or deaths; TX/CEX, n = 96; T/CEF, n = 118). RFS was not significantly different between the groups (hazard ratio [HR], 0.79; 95% CI, 0.60 to 1.04; P = .087; 5-year RFS, 86.6% for TX/CEX v 84.1% for T/CEF). Fifty-six patients assigned to TX/CEX died during the follow-up compared with 75 of patients assigned to T/CEF (HR, 0.73; 95% CI, 0.52 to 1.04; P = .080). In exploratory analyses, TX/CEX improved breast cancer-specific survival (HR, 0.64; 95% CI, 0.44 to 0.95; P = .027) and RFS in women with triple-negative disease and in women who had more than three metastatic axillary lymph nodes at the time of diagnosis. We detected little severe late toxicity.
Integration of capecitabine into a regimen that contains docetaxel, epirubicin, and cyclophosphamide did not improve RFS significantly compared with a similar regimen without capecitabine.
Comment In: J Clin Oncol. 2012 Jan 1;30(1):1-222105825
Capecitabine is not considered a standard agent in the adjuvant treatment of early breast cancer. The results of this study suggest that addition of adjuvant capecitabine to a regimen that contains docetaxel, epirubicin, and cyclophosphamide improves survival outcomes of patients with triple-negative breast cancer (TNBC).
To investigate the effect of capecitabine on long-term survival outcomes of patients with early breast cancer, particularly in subgroups defined by cancer estrogen receptor (ER) and progesterone receptor (PR) content, and HER2 content (human epidermal growth factor receptor 2).
This is an exploratory analysis of the multicenter FinXX randomized clinical trial that accrued 1500 women in Finland and Sweden between January 27, 2004, and May 29, 2007. About half received 3 cycles of docetaxel followed by 3 cycles of cyclophosphamide, epirubicin, and fluorouracil (T+CEF), while the other half received 3 cycles of docetaxel plus capecitabine followed by 3 cycles of cyclophosphamide, epirubicin, and capecitabine (TX+CEX). Data analysis took place between January 27, 2004, and December 31, 2015.
Recurrence-free survival (RFS).
Following random allocation, 747 women received T+CEF, and 753 women received TX+CEX. Five patients were excluded from the intention-to-treat population (3 had overt distant metastases at the time of randomization; 2 withdrew consent). The median age of the remaining 1495 patients was 53 years at the time of study entry; 157 (11%) had axillary node-negative disease; 1142 (76%) had ER-positive cancer; and 282 (19%) had HER2-positive cancer. The median follow-up time after random allocation was 10.3 years. There was no significant difference in RFS or overall survival between the groups (hazard ratio [HR], 0.88; 95% CI, 0.71-1.08; P?=?.23; and HR, 0.84, 95% CI, 0.66-1.07; P?=?.15; respectively). Breast cancer-specific survival tended to favor the capecitabine group (HR, 0.79; 95% CI, 0.60-1.04; P?=?.10). When RFS and survival of the patients were compared within the subgroups defined by cancer steroid hormone receptor status (ER and/or PR positive vs ER and PR negative) and HER2 status (positive vs negative), TX+CEX was more effective than T+CEF in the subset of patients with TNBC (HR, 0.53; 95% CI, 0.31-0.92; P?=?.02; and HR, 0.55, 95% CI, 0.31-0.96; P?=?.03; respectively).
Capecitabine administration with docetaxel, epirubicin, and cyclophosphamide did not prolong RFS or survival compared with a regimen that contained only standard agents. Patients with TNBC had favorable survival outcomes when treated with the capecitabine-containing regimen in an exploratory subgroup analysis.
BACKGROUND: Adjuvant chemotherapy (5-fluorouracil, levamisole) is now standard practice in the treatment of Dukes' B and C coloretal carcinoma (CRC), and this has increased the financial burden on health care systems world-wide. PATIENTS AND METHODS: Between 1993 and 1996, 95 patients in northern Norway were included in a national randomised CRC study, and assigned to surgery plus adjuvant chemotherapy or surgery alone. In April 1996, 94 of the patients were evaluable and 82 were still alive. The total treatment costs (hospital stay, surgery, chemotherapy, administrative and travelling costs) were calculated. A questionnaire was mailed to all survivors for assessment of the quality of their lives (QoL) (EuroQol questionnaire, a simple QoL-scale, global QoL-measure of the EORTC QLQ-C30), and 62 of them (76%) responded. RESULTS: Adjuvant chemotherapy in Dukes' B and C CRC raised the total treatment costs by 3,369 pounds. The median QoL was 0.83 (0-1 scale) in both arms. Employing a 5% discount rate and an improved survival of adjuvant therapy ranging from 5% to 15%, we calculated the cost of one gained quality-adjusted life-year (QALY) to be between 4,800 pounds and 16,800 pounds. CONCLUSION: Using a cut-off point level of 20,000 pounds per QALY, adjuvant chemotherapy in CRC appears to be cost-effective only when the improvement in 5-year survival is > or = 5%. Adjuvant chemotherapy does not affect short-term QoL.