Winson Y. Cheung

The utility of abbreviated patient-reported outcomes for predicting survival in early stage colorectal cancer

Patient‐reported outcomes (PROs) are increasingly used in clinical settings. Prior research suggests that PROs collected at baseline may be associated with cancer survival, but most of those studies were conducted in patients with breast or lung cancer. The objective of this study was to determine the correlation between prospectively collected PROs and cancer‐specific outcomes in patients with early stage colorectal cancer.

Impact of smoking history on the outcomes of women with early-stage breast cancer: a secondary analysis of a randomized study

To assess the impact of smoking history on the outcomes of early-stage breast cancer patients treated with sequential anthracyclines–taxanes in a randomized study. This is a secondary analysis of patient-level data of 1242 breast cancer patients referred for adjuvant chemotherapy in the BCIRG005 clinical trial. Overall survival was assessed according to smoking history through Kaplan–Meier analysis. Univariate and multivariate Cox regression analyses of factors affecting overall and relapse-free survival were subsequently conducted. Factors that were evaluated included: age, performance status, number of chemotherapy cycles, T stage, lymph node ratio, estrogen receptor status, adjuvant radiotherapy and smoking history. Kaplan–Meier analysis of overall survival according to smoking status (ever smoker vs. never smoker) was conducted. There was a trend toward a better overall survival among never smokers compared to ever smokers; however, it was not statistically significant (Pu2009=u20090.098). The following factors were associated with better overall survival in multivariate analysis: older age (Pu2009=u20090.011), complete chemotherapy course (Pu2009=u20090.002), lower T stage (Pu2009<u20090.0001), lower lymph node ratio (Pu2009<u20090.0001) and positive estrogen receptor status (Pu2009=u20090.006). Otherwise, the following factors were associated with better relapse-free survival in multivariate analysis: older age (Pu2009=u20090.001), never smoking status (Pu2009=u20090.021), lower T stage (Pu2009=u20090.028), lower lymph node ratio (Pu2009<u20090.0001) and positive estrogen receptor status (Pu2009<u20090.0001). Early-stage breast cancer patients with a positive smoking history experienced worse relapse-free survival compared to never smokers. Physicians managing breast cancer patients should prioritize discussion about the benefits of smoking cessation when counseling their patients.

A Contemporary Review of the Treatment Landscape and the Role of Predictive and Prognostic Biomarkers in Pancreatic Adenocarcinoma

Pancreatic cancer continues to represent one of the leading causes of cancer-related morbidity and mortality in the developed world. Over the past decade, novel systemic therapy combination regimens have contributed to clinically meaningful and statistically significant improvements in overall survival as compared to conventional monotherapy. However, the prognosis for most patients remains guarded secondary to the advanced stages of disease at presentation. There is growing consensus that outcomes can be further optimized with the use of predictive and prognostic biomarkers whereby the former can be enriching for patients who would benefit from therapies and the latter can inform decision-making regarding the need and timing of advanced care planning. One of the challenges of current biomarkers is the lack of standardization across clinical practices such that comparability between jurisdictions can be difficult or even impossible. This inconsistency can impede widespread implementation of their use. In this review article, we provide a comprehensive overview of the contemporary treatment options for pancreatic cancer and we offer some insights into the existing landscape and future directions of biomarker development for this disease.

A retrospective review of the multidisciplinary management of medullary thyroid cancer: eligibility for systemic therapy

BackgroundMedullary thyroid carcinoma (MTC) accounts for 1-2% of all thyroid cancers. The clinical course of metastatic disease can be indolent. Our aim was to characterize the natural history of disease to evaluate the true proportion of patients who would be eligible for the currently available systemic therapies.MethodsThe British Columbia Cancer Agency (BCCA) provides cancer care to a population of 4.6 million. A retrospective chart review was conducted of all patients with MTC referred to the BCCA from 1991 to 2013. Clinical characteristics, pathology, treatment and outcome data were collected. Relapse free survival and overall survival was determined for patients based on staging at the time of diagnosis.ResultsOf the 98 patients referred to the BCCA during the study period, inherited mutations were found in 6% though 60% did not undergo genetic testing. Based on clinical SEER staging at diagnosis 50% had localized disease, 38% regional, and 12% had distant metastasis. 77% had complete surgical resection of which 25% received adjuvant radiation therapy. Five year relapse free survival (RFS) for localized and regional disease was 75% and 66%, respectively (pxa0=xa00.006). Initial treatment of 23 patients with locally unresectable and metastatic disease predominantly involved multiple modalities. Of the 37 patients with relapsed or metastatic MTC only 7 (19%) patients received one or more course of chemotherapy for metastatic disease: 1 temsirolimus, 2 adriamycin, 3 sunitinib, 3 sorafenib, and 3 vandetanib. Five year OS based on clinical SEER stage: localized 93%, regional 72% and distant 33% (pxa0<xa00.001).ConclusionLocalized and regional MTC treatment patterns reflect multidisciplinary management based on disease characteristics. Patients with distant disease had poor outcomes with 28% of patients dying from disease. In our cohort the minority of patients ultimately received systemic therapy due to timing and lack of TKI availability.

A Real-World Comparison of FOLFIRINOX, Gemcitabine Plus nab-Paclitaxel, and Gemcitabine in Advanced Pancreatic Cancers

PurposeFOLFIRINOX (FFN), nab-paclitaxel plus gemcitabine (GN), and gemcitabine are three systemic therapies that provide clinically meaningful benefit to patients with unresectable pancreatic cancer (UPC). There are no clinical trials that directly compare the efficacy of all three regimens. In this study, we aim to examine and compare the real-world effectiveness of these treatments.MethodsPatients diagnosed with UPC who initiated palliative chemotherapy from August 2014 to January 2016 at any one of six cancer centers in British Columbia were identified from the provincial pharmacy. Clinical, pathological, treatment, and outcome characteristics were compared.ResultsTwo hundred twenty-five patients were included: 55% men, 68% Eastern Cooperative Oncology Group 0/1, 58% metastatic disease. Patients who received FFN were younger (pu2009<u20090.001) and in better performance status (pu2009<u20090.001). Patients treated with FFN or GN experienced significantly longer median overall survival (OS) when compared to those treated with gemcitabine (14.1 vs 10.5 vs 4.2xa0months, respectively, pu2009<u20090.001). Progression-free survival (PFS) was also longer among patients on FFN or GN in comparison to gemcitabine (FFN, HR 0.44, 95% CI 0.24 to 0.814, pu2009=u20090.008; GN, HR 0.30, 95% CI 0.19 to 0.47, pu2009<u20090.001). A significantly higher proportion of patients require two or more dose modifications on FFN (40%) compared to GN (14%) or gemcitabine (9%) (pu2009<u20090.001).ConclusionsReceipt of modified FFN and GN portends a better prognosis than gemcitabine alone. In the absence of a randomized comparison of all three regimens, our population-based study reveals that the introduction of modified FFN and GN confers real-world effectiveness for UPC patients.

Young adult cancer survivors’ follow-up care expectations of oncologists and primary care physicians

PurposeYoung adult cancer survivors face unique challenges associated with their illness. While both oncologists and primary care physicians (PCPs) may be involved in the follow-up care of these cancer survivors, we hypothesized that there is a lack of clarity regarding each physician’s roles and responsibilities.MethodsA self-administered survey was mailed to young adult cancer survivors in British Columbia, Canada, who were aged 20 to 39xa0years at the time of diagnosis and alive at 2 to 5xa0years following the diagnosis to capture their expectations of oncologists and PCPs in various important domains of cancer survivorship care. Multivariate logistic regression models that adjusted for confounders were constructed to examine for predictors of the different expectations.ResultsOf 722 young cancer survivors surveyed, 426 (59%) responded. Among them, the majority were White women with breast cancer. Oncologists were expected to follow the patient’s most recent cancer and treatment-related side effects while PCPs were expected to manage ongoing and future cancer surveillance as well as general preventative care. Neither physician was perceived to be responsible for addressing the return to daily activities, reintegration to interpersonal relationships, or sexual function. Older survivors were significantly less likely to expect oncologists (pxa0=xa00.03) and PCPs (pxa0=xa00.01) to discuss family planning when compared to their younger counterparts. Those who were White were significantly more likely to expect PCPs to discuss comorbidities (pxa0=xa00.009) and preventative care (pxa0=xa00.001).ConclusionsYoung adult cancer survivors have different expectations of oncologists and PCPs with respect to their follow-up care. Physicians need to better clarify their roles in order to further improve the survivorship phase of cancer care for young adults.Implications for Cancer SurvivorsYoung adult cancer survivors have different expectations of their oncologists and PCPs. Clarification of the roles of each physician group during follow-up can enhance the quality of survivorship care for young adults.

External validation of the prostascore model in patients with metastatic hormone‐sensitive prostate cancer recruited to the CHAARTED study

To externally validate ‘prostascore’ in patients with metastatic hormone‐sensitive prostate cancer recruited to the phase III CHAARTED study.

Asian and non-Asian disparities in outcomes of non-nasopharyngeal head and neck cancer: Asian vs. Non-Asian Outcomes of HNC

To evaluate disparities in overall survival (OS) between Asian and non‐Asian patients diagnosed with non‐nasopharyngeal head and neck cancer (HNC).

Impact of Duration of Neoadjuvant Radiation on Rectal Cancer Survival: A Real World Multi-center Retrospective Cohort Study

Background: The utility of neoadjuvant radiotherapy (nRT) for the treatment of stage II and III rectal cancer is well‐established. However, the optimal duration of nRT in this setting remains controversial. Using a population‐based cohort of patients with stage II and III rectal cancer (RC) treated with curative intent, our aims were to (1) examine the patterns of nRT use and (2) explore the relationship between different nRT schedules and survival in the real‐world setting. Methods: This is a multi‐center retrospective cohort study based on population‐based data from 5 regional comprehensive cancer centers in British Columbia, Canada. We analyzed patients diagnosed with clinical stage II or III RC from 2006 to 2010 and treated with either short‐course (SC) or long‐course (LC) nRT prior to curative intent surgery. Logistic regression models were constructed to determine the factors associated with the course of nRT delivered to patients. Kaplan‐Meier methods and Cox regression that accounted for known prognostic factors were used to evaluate the relationship between nRT schedule and overall (OS), disease‐free (DFS), local recurrence‐free (LRFS), and distant recurrence‐free survival (DRFS). Results: We identified 427 patients: the median age was 65 years (range, 31 to 94 years), 67% were men, 87% had T3 or T4 tumors, and 74% had N1 or N2 disease. Among them, 241 (56%) received SC and 186 (44%) received LC. Adjusting for confounders, patients with N1 or N2 disease were more likely to undergo LC (odds ratio [OR], 5.08; 95% confidence interval [CI], 2.51–11.22; P < .0001 and OR, 8.35; 95% CI, 3.35–22.39; P < .0001, respectively), whereas older age patients were less likely to receive LC (OR, 0.95; 95% CI, 0.94–0.98; P < .0001). In Kaplan‐Meier analysis, there were no significant differences observed in OS, DFS, LRFS, and DRFS between SC and LC. Likewise, multivariate analyses demonstrated that OS (hazard ratio [HR], 0.91; 95% CI, 0.61–1.37; P = .66), DFS (HR, 1.06; 95% CI, 0.68–1.64; P = .80), LRFS (HR, 0.79; 95% CI, 0.39–1.57; P = .50) and DRFS (HR, 0.99; 95% CI, 0.60–1.61; P = .95) were similar regardless of nRT schedules. Additional baseline clinical and tumor characteristics did not influence outcomes (all P > .05). Conclusion: Appropriate preoperative selection of SC versus LC nRT for locally advanced RC based on patient and tumor characteristics was not associated with differences in survival outcomes in the real‐world setting. Micro‐Abstract: The optimal duration of neoadjuvant radiotherapy in rectal cancer remains controversial. This is a multi‐center retrospective cohort study. Appropriate preoperative selection of radiotherapy duration was not associated with survival differences.

Revisiting the prognostic relevance of muscle mass among non-metastatic colorectal cancer

Colorectal cancer represents a global health problem, particularly as the general population continues to age. Currently, it ranks as the third most common cause of cancer mortality worldwide (1). To assist with clinical management, colorectal cancer is frequently categorized according to the American Joint Committee on Cancer (AJCC) staging system that considers tumor extent, nodal involvement, and presence of metastasis (2). Staging helps to stratify patients into different risk levels of cancer recurrence and survival. In doing so, it informs the appropriate use of systemic therapy and represents one major example of a tailored and risk-adjusted approach to guide the treatment of early stage colorectal cancer patients.