Riaz Alvi

Extrapulmonary small cell cancer: a Canadian province's experience.

The objective of this study was to determine variables that correlate with the survival of patients with extrapulmonary small cell carcinoma (EPSCC).

Survival impact of surgical resection of primary tumor in patients with stage IV colorectal cancer: Results from a large population‐based cohort study

Currently, there is very low‐quality evidence available regarding benefit of surgical resection of the primary tumor (SRPT), in patients with stage IV colorectal cancer (CRC). In the absence of randomization, the reported benefit may reflect selection of younger and healthier patients with good performance status. A large population‐based cohort study was undertaken to determine the survival benefit of SRPT in advanced CRC by eliminating various biases reported in the literature.

Comparison of Treatment Received Versus Long- Standing Guidelines for Stage III Colon and Stage II/III Rectal Cancer Patients Diagnosed in Alberta, Saskatchewan, and Manitoba in 2004

PURPOSE Guideline-recommended treatment for stage II/III colorectal cancer includes postsurgical chemotherapy and/or radiation as standard of care. This study measures adherence to guidelines across 3 Canadian provinces and evaluates the relationship of patient characteristics with receiving standard care. PATIENTS AND METHODS All surgically treated patients diagnosed in 2004 with stage III colon or stage II/III rectal cancer and residing in Alberta, Saskatchewan, or Manitoba were identified from provincial cancer registries. Sex, age at diagnosis, and area of residence were also obtained from the cancer registry. The primary outcome of interest was receipt of standard care: surgery followed by chemotherapy or radiation therapy (adjuvant therapy). chi2 tests and binary regression with log link assessed the relationship of patient demographic characteristics (age, sex, residence, cancer disease stage) with receipt of standard care. RESULTS About half of the patients received adjuvant therapy. Patients with stage III rectal cancer were more likely to receive adjuvant treatment than stage II patients in Alberta and Saskatchewan. There was a large decrease in the percentage of patients who received adjuvant treatment with increasing age in all the provinces (P < .001), ranging from about 80% of those aged < 65 years to about 20% of those aged >or= 75 years for colon cancer patients and from about 70% to 30%, respectively, for rectal cancer patients. The decrease of adjuvant treatment with increasing age was most marked in Alberta. CONCLUSION The percentage of patients receiving guideline-recommended treatment is low. Reasons for lack of adherence to guidelines need to be addressed.

Early Discontinuation but Not the Timing of Adjuvant Therapy Affects Survival of Patients With High-Risk Colorectal Cancer: A Population-Based Study

BACKGROUND: Adjuvant therapy results in significant improvement in survival of patients with high-risk colorectal cancer. Little is known about the significance of timing and early discontinuation of adjuvant treatment in such patients. Our study aims to determine the prognostic impact of timing and completion of adjuvant therapy in patients with high-risk colorectal cancer. METHODS: Medical records of patients with stage III colon and stage II/III rectal cancer diagnosed between 1993 and 2000 in the province of Saskatchewan were reviewed. Cox proportional hazards models were used to analyze the impact of timing and completion of adjuvant therapy on survival. RESULTS: Six hundred sixty-three eligible patients with a median age of 66 years were identified. Sixty-five percent patients received adjuvant <56 days after surgery and 79% patients completed planned treatment. Median follow-up was 54.6 months. Five-year disease-free survival and overall survival of patients who received adjuvant therapy <56 days after surgery was 54.6% and 59.5%, respectively, compared with 51.9% and 57.1%, respectively, of patients who received therapy ≥56 days after surgery (P = NS). The five-year disease disease-free survival and overall survival of patients who completed planned treatment was 56.7% and 62.3%, respectively, compared with 42.1% and 45%, respectively, of patients who required early treatment discontinuation (P < .0001). On multivariate analysis, age ≥65 years, T4 tumor, grade 3 cancer, node-positive disease, rectal tumor, and early treatment discontinuation were identified as poor prognostic factors. CONCLUSIONS: Although time to adjuvant therapy following surgical resection did not impact the outcomes, failure to complete planned therapy was associated with adverse prognosis.

Low-serum GTA-446 anti-inflammatory fatty acid levels as a new risk factor for colon cancer

Gastrointestinal tract acid‐446 (GTA‐446) is a long‐chain polyunsaturated fatty acid present in the serum. A reduction of GTA‐446 levels in colorectal cancer (CRC) patients has been reported previously. Our study compared GTA‐446 levels in subjects diagnosed with CRC at the time of colonoscopy to the general population. Serum samples and pathology data were collected from 4,923 representative subjects undergoing colonoscopy and from 964 subjects from the general population. Serum GTA‐446 levels were determined using a triple‐quadrupole tandem mass spectrometry method. A low‐serum GTA‐446 level was based on the bottom tenth percentile of subjects with low risk based on age (40–49 years old) in the general population. Eighty‐six percent of newly diagnosed CRC subjects (87% for stages 0–II and 85% for stages III–IV) showed low‐serum GTA‐446 levels. A significant increase in the CRC incidence rate with age was observed in subjects with low GTA‐446 levels (p = 0.019), but not in subjects with normal levels (p = 0.86). The relative risk of CRC given a low GTA‐446 level was the highest for subjects under age 50 (10.1, 95% confidence interval [C.I.] = 6.4–16.4 in the reference population, and 7.7, 95% C.I. = 4.4–14.1 in the colonoscopy population, both p < 0.0001), and declined with age thereafter. The CRC incidence rate in subjects undergoing colonoscopy with low GTA‐446 levels was over six times higher than for subjects with normal GTA‐446 levels and twice that of subjects with gastrointestinal symptoms. The results show that a low‐serum GTA‐446 level is a significant risk factor for CRC, and a sensitive predictor of early‐stage disease.

Analysis of health related quality of life (HRQoL) of patients with clinically localized prostate cancer, one year after treatment with external beam radiotherapy (EBRT) alone versus EBRT and high dose rate brachytherapy (HDRBT)

PurposeProstate cancer is the leading form of cancer diagnosed among North American men. Most patients present with localized disease, which can be effectively treated with a variety of different modalities. These are associated with widely different acute and late effects, which can be both physical and psychological in nature. HRQoL concerns are therefore important for these patients for selecting between the different treatment options.Materials and methodsOne year after receiving radiotherapy for localised prostate cancer 117 patients with localized prostate cancer were invited to participate in a quality of life (QoL) self reported survey. 111 patients consented and participated in the survey, one year after completion of their treatment. 88 patients received EBRT and 23 received EBRT and HDRBT. QoL was compared in the two groups by using a modified version of Functional Assessment of Cancer Therapy-Prostate (FACT-P) survey instrument.ResultsOne year after completion of treatment, there was no significant difference in overall QoL scores between the two groups of patients. For each component of the modified FACT-P survey, i.e. physical, social/family, emotional, and functional well-being; there were no statistically significant differences in the mean scores between the two groups.ConclusionIn prostate cancer patients treated with EBRT alone versus combined EBRT and HDRBT, there was no significant difference in the QoL scores at one year post-treatment.

Across-province standardization and comparative analysis of time-to-care intervals for cancer

BackgroundA set of consistent, standardized definitions of intervals and populations on which to report across provinces is needed to inform the Provincial/Territorial Deputy Ministries of Health on progress of the Ten-Year Plan to Strengthen Health Care. The objectives of this project were to: 1) identify a set of criteria and variables needed to create comparable measures of important time-to-cancer-care intervals that could be applied across provinces and 2) use the measures to compare time-to-care across participating provinces for lung and colorectal cancer patients diagnosed in 2004.MethodsA broad-based group of stakeholders from each of the three participating cancer agencies was assembled to identify criteria for time-to-care intervals to standardize, evaluate possible intervals and their corresponding start and end time points, and finalize the selection of intervals to pursue. Inclusion/exclusion criteria were identified for the patient population and the selected time points to reduce potential selection bias. The provincial 2004 colorectal and lung cancer data were used to illustrate across-province comparisons for the selected time-to-care intervals.ResultsCriteria identified as critical for time-to-care intervals and corresponding start and end points were: 1) relevant to patients, 2) relevant to clinical care, 3) unequivocally defined, and 4) currently captured consistently across cancer agencies. Time from diagnosis to first radiation or chemotherapy treatment and the smaller components, time from diagnosis to first consult with an oncologist and time from first consult to first radiation or chemotherapy treatment, were the only intervals that met all four criteria. Timeliness of care for the intervals evaluated was similar between the provinces for lung cancer patients but significant differences were found for colorectal cancer patients.ConclusionWe identified criteria important for selecting time-to-care intervals and appropriate inclusion criteria that were robust across the agencies that did not result in an overly selective sample of patients to be compared. Comparisons of data across three provinces of the selected time-to-care intervals identified several important differences related to treatment and access that require further attention. Expanding this collaboration across Canada would facilitate improvement of and equitable access to quality cancer care at a national level.

Abstract 4515: Low serum levels of a novel anti-inflammatory fatty acid as a new risk factor for colorectal cancer

Low serum levels of novel, long-chain, hydroxylated and polyunsaturated fatty acids (GTAs) in colorectal cancer (CRC) patients has been previously reported. This study prospectively investigated the relationship between serum GTA levels and CRC incidence among subjects undergoing colonoscopy. Serum samples and pathology data were collected from 4923 representative subjects undergoing colonoscopy in a typical, non-screening, colonoscopy population and from 964 representative age and geographically-matched subjects from the general population. Serum GTA-446 levels were determined on all subjects using a sensitive tandem mass spectrometric method. A low serum GTA-446 level was defined as a GTA-446 concentration below the tenth percentile of 40-49 year-olds in the general population sampling. Eighty-six percent of newly diagnosed CRC subjects (87% for stage 0-II and 85% for stage III-IV) were observed to have low serum GTA-446 levels, with a PPV of 15% and NPV of 99.7%. CRC incidence was observed to increase significantly with age in all subjects (p Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 4515. doi:1538-7445.AM2012-4515

Largest series of extrapulmonary small cell carcinoma (ESCC): The Saskatchewan Experience

9681 Background: : Although ESCC has been recognized as a rare and distinct clinicopathologic entity, limited data is available about its clinical behavior and outcome. Our experience with ESCC over the past 3 decades is presented here. METHODS Patients with ESCC were identified using Saskatchewan Cancer Registry - Canada, from 1971-2002. Diagnosis was based on immunohistochemistry and/or morphology. Patients with abnormal chest radiology at diagnosis or with well-differentiated neuroendocrine tumor or Merkel cell carcinoma were excluded. Survival was calculated using the Kaplan-Meier method. RESULTS A total of 101 eligible patients with ESCC were identified. Median age was 72 yrs (24-100) and M:F was 1.4:1. Median duration of symptoms prior to definitive diagnosis was 2 months [m] (0.25-40). 51 patients had localized disease and 50 had extensive disease.No significant difference was noted in age, gender distribution, comorbid illness, and incidence of of secondary cancer, however 96% of patients with limited disease (LD) had ECOG performance status of ≤2 compared with 52% in extensive disease (ED) [p=<0.0001]. The primary disease sites were as follows: Breast n=9; gastrointestinal n=20, genitourinary n=18, gynecologic n=11, head & neck n=10, thymus n=2, and unknown primary n=31 . Ninety percent of patients with LD received treatment and 98% of them had an objective response (OR). In contrast, 54% patients with ED received therapy and 44% of them had OR(p<0.0001). Median progression/relapse free survival in responding patients with LD was 20+ m (2-276) compared with 12+ m (2-68) in ED (p<0.0001). All the patients with LD had median OS of 34+ m (0.2-276) compared with 2+ m (0.1-108) in patients with ED (p<0.0001). 5 year survival in patients with LD was 31% compared with 2% in patients with ED. CONCLUSIONS Our results reveal that natural history of ESCC seems comparable to small cell carcinoma of lung and that extent of disease is an important factor predicting survival. No significant financial relationships to disclose.

Predictive markers of utilization of chemotherapy in patients with advanced colorectal cancer (CRC): A population-based study.

6053 Background: The introduction of second generation therapy has significantly improved the prognosis of patients with advanced CRC. In clinical practice compared with a clinical trial setting less strict eligibility criteria are used for utilization of chemotherapy. Our study aims to determine the predictive factors of chemotherapy utilization in advanced CRC patients in the era of second generation chemotherapy. METHODS Medical records of patients with advanced CRC diagnosed in the province of Saskatchewan from 1992-2005 who were treated at the two major Cancer Center were reviewed. A logistic regression model was used to assess various clinical factors for their correlation with utilization of palliative chemotherapy in patients with advanced CRC. RESULTS A total of 1378 eligible patients were indentified. Median age was 71 yrs (range: 22-98) and M: F was 57:43. Of 1378 patients, 583 (42%) patients received 5FU-based therapy and 222 (16%) received a second line therapy. Median overall survival (OS) of all patients was 7.2 months. Patients who received chemotherapy had median OS of 15.9 months compared with 3.6 months if they did not receive chemotherapy (p<0.0001). 46.3% of patients who were diagnosed after the year 1999 received chemotherapy with a median survival of 17.5 months compared with 38.9% patients with a median survival of 14.7 months who were diagnosed before the year 2000 (p=0.0058). On multivariate analysis ECOG performance status (PS) <2 (odd ratio [OR] 4.1, 95% CI: 3.0-5.7), age <65 years (OR 2.6 (95% CI: 2.0-3.3), liver metastases (OR 2.3, 95% CI: 1.7-3.1), removal of primary tumor (OR 2.3, 95% CI: 1.7-3.1), palliative radiation (OR 2.0, 95% CI: 1.4-3.0), metastesectomy (OR 1.7, 95% CI: 1.2-2.5), diagnoses after the year 1999 (OR 1.5, 95% CI: 1.2-1.9), and treatment center (OR 1.33, 95% CI: 1.03-1.73) were significantly correlated with utilization of palliative chemotherapy. CONCLUSIONS In addition to known variables such as good PS, patients who were treated with curative resection or underwent removal of the primary tumor were more likely to received chemotherapy. A greater utilization of palliative chemotherapy was noted with the availability of second line therapy.