Publications by authors named "Omar Abdel-Rahman"

292 Publications

Sex-based differences in the outcomes of patients with lung carcinoids.

J Comp Eff Res 2022 May 7;11(7):523-531. Epub 2022 Apr 7.

Department of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, European Institute of Oncology, Milan, Italy.

To assess the impact of sex on the outcomes of patients with well-differentiated lung neuroendocrine neoplasms in a real-world setting. The Surveillance, Epidemiology and End Results Research Plus database (2000-2018) was accessed, and patients with a diagnosis of typical or atypical carcinoid of the lung were reviewed. Trends in age-standardized rates (per 100,000) of the incidence of lung carcinoid tumors were reviewed among male and female patients as well as the overall population, and annual percent change (APC) was determined for the three groups. Multivariate Cox regression analysis was then used to assess the factors associated with overall and cancer-specific survival. Among all patients, APC (2000-2018) for lung carcinoid diagnosis was 2.9 (95% CI: 2.4-3.5). Among male patients, APC (2000-2018) for lung carcinoid diagnosis was 1.8 (95% CI: 1.2-2.5). By contrast, among female patients, APC (2000-2018) for lung carcinoid diagnosis was 3.4 (95% CI: 2.8-4.1). Based on Kaplan-Meier survival estimates, female sex was associated with better overall survival compared with male sex (p < 0.001). Based on multivariate Cox regression analysis, the following factors were associated with worse cancer-specific survival: older age (hazard ratio [HR]: 1.036; 95% CI: 1.031-1.041), atypical carcinoid histology (HR: 3.10; 95% CI: 2.71-3.56), stage (distant vs localized stage HR: 4.05; 95% CI: 3.48-4.71), sex (male vs female sex HR: 1.76; 95% CI: 1.56-1.99) and no surgical treatment (HR: 3.77; 95% CI: 3.22-4.42). Female patients with lung carcinoid tumors have better overall survival compared with male patients, particularly among patients with typical carcinoid tumors.
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http://dx.doi.org/10.2217/cer-2021-0205DOI Listing
May 2022

Changes in Survival Outcomes of Patients With Neuroendocrine Neoplasms Over the Past 15 Years: A Real-World Study.

Am J Clin Oncol 2022 May 6;45(5):208-214. Epub 2022 Apr 6.

Department of Oncology, Cross Cancer Institute, University of Alberta, Edmonton.

Background: The past 2 decades have observed a number of advances in therapeutic approaches to patients with neuroendocrine neoplasms (NENs). This study aims to assess whether survival outcomes have changed among patients with NENs over the past 15 years, in a real-world, population-based study.

Materials And Methods: We accessed administrative databases within the province of Alberta, Canada, and we reviewed patients with invasive NENs diagnosed 2004 to 2019. Patients were classified according to the year of diagnosis into 3 groups: 2004 to 2008; 2009 to 2013; and 2014 to 2019. Kaplan-Meier survival estimates were used to compare overall survival (OS) according to different baseline characteristics (including the year of diagnosis). Multivariable Cox regression modeling was used to examine factors associated with the risk of death in this cohort.

Results: We included a total of 3431 patients in the study cohort. Using multivariable Cox regression analysis, the following factors were associated with worse survival: older age at diagnosis (hazard ratio [HR]: 3.45; 95% CI [confidence interval]: 2.74-4.35), male sex (HR: 1.38; 95% CI: 1.21-1.56), lung primary site (HR for lung vs. appendicular primary: 1.39; 95% CI: 1.01-1.92), Stage 4 disease (HR: 2.80; 95% CI: 2.38-3.30), South zone of the province (HR for South zone vs. Calgary zone: 1.85; 95% CI: 1.49-2.30), and higher comorbidity index (HR for ≥3 vs. 0: 2.66; 95% CI: 2.19-3.24). Although Kaplan-Meier method showed significant difference in OS according to diagnosis period, multivariable regression model showed that the period of diagnosis did not appear to impact OS (HR for diagnosis period 2004 to 2009 vs. 2014 to 2019: 1.04; 95% CI: 0.89-1.22).

Conclusions: Over the study period (2004 to 2019), patients diagnosed during later periods did not appear to experience better OS compared with patients diagnosed at an earlier time.
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http://dx.doi.org/10.1097/COC.0000000000000906DOI Listing
May 2022

Cyclin-dependent Kinases 4/6 Inhibitors in Neuroendocrine Neoplasms: from Bench to Bedside.

Curr Oncol Rep 2022 Jun 9;24(6):715-722. Epub 2022 Mar 9.

Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, European Institute of Oncology, IEO, IRCCS, Via Ripamonti 43520141, Milan, Italy.

Purpose Of Review: Cyclin-dependent kinases (CDKs) are key regulators that play an important role in cell division. Palbociclib, ribociclib and abemaciclib showed significant antitumor activity in several malignancies and, recently, also a myeloprotective effect for trilaciclib when added to chemotherapy. The purpose of this review is to highlight the current evidence for CDK4/6 inhibitors in neuroendocrine neoplasms (NENs).

Recent Findings: Preclinical results showed a promising antitumor activity of CDK4/6 inhibitors in neuroendocrine tumors (NETs), but so far, the very few small clinical trials did not show a strong impact on progression free survival (PFS) and objective response in NETs. Meanwhile, the CDK4/6 inhibitor trilaciclib revealed significant effects in reducing chemotherapy-induced myelosuppression in small cell lung cancer (SCLC). Up to date, CDK4/6 inhibitors are still considered investigational in NETs as antitumor agents, whereas trilaciclib can be used in the routine clinical practice in extensive stage SCLC patients for reducing myelotoxicity of standard chemotherapy.
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http://dx.doi.org/10.1007/s11912-022-01251-xDOI Listing
June 2022

Cancer Burden Among Arab-World Females in 2020: Working Toward Improving Outcomes.

JCO Glob Oncol 2022 03;8:e2100415

King Hussein Cancer Center, Amman, Jordan.

Purpose: Cancer is the leading cause of morbidity and mortality worldwide. This work presents the Arab-world females' cancers (AFCs) statistics in 2020, compared with the 2018 AFCs statistics, the Arab-world male cancers statistics, and the world females' cancers (WFCs) statistics in 2020. This can help set the stage for a better policy for cancer control programs and improve outcomes.

Materials And Methods: A descriptive review of the 2020 Global Cancer Observatory concerning AFCs was performed. Data on various cancers were compiled and compared among the countries in the region and WFCs.

Results: A total estimate of 244,317 new cases and 132,249 deaths is reported in AFCs; representing 2.65% and 2.99% of WFCs, respectively, with an average crude incidence/mortality ratio of 116.2 (/100,000 population)/62.9 (/100,000 population) and an age-standardized incidence/mortality ratio of 137.7(/100,000 population)/77.2(/100,000 population) compared with 238.8(/100,000 population)/114.6(/100,000 population) and 186(/100,000 population)/84.2(/100,000 population) of WFCs, respectively. Five-year prevalent cases were 585,295; 2.28% of WFCs. In comparison to males, females accounted for 47.8% of the whole population, 52.9% in incidence, 46.9% in mortality, and 56.9% in the prevalence of patients with cancer. Mortality-to-incidence ratio (MIR) was 0.54 (range 0.39-0.62 in Arab countries, compared with 0.48 globally), and it ranged from 0.14 to 0.97 in the 30 AFC types. Breast cancer was the most common cancer in incidence and mortality, with an MIR of 0.39.

Conclusion: The 2020 descriptive analysis of the females' cancers in the Arab world revealed a relatively high MIR compared with females' cancers worldwide; a lower MIR compared with the males; and comparable MIR to 2018 one. We call for more in-depth studies to determine the causes of these differences that might translate into actionable interventions and better outcomes.
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http://dx.doi.org/10.1200/GO.21.00415DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8920429PMC
March 2022

Patterns of emergency department visits preceding colorectal cancer diagnosis: a population-based study.

J Comp Eff Res 2022 04 22;11(5):311-318. Epub 2022 Feb 22.

Department of Oncology, University of Alberta, Cross Cancer Institute, Edmonton, AB, T6G1Z2, Canada.

To assess the patterns of emergency department (ED) visits in the 3 months preceding a diagnosis of colorectal cancer (CRC) in a real-world, population-based context. Linked provincial registries in Alberta, Canada, were accessed and patients with CRC diagnosed between 2004 and 2018 were identified. The National Ambulatory Care reporting system was used to identify patients who visited an ED within 3 months of a diagnosis of CRC. Multivariable logistic regression analysis was used to identify factors associated with any ED visits as well as frequent (≥3) ED visits. A total of 25,310 patients with CRC were included in the current study. These include 10,126 patients (40%) who had at least one visit to the ED in the 3 months before a diagnosis of CRC diagnosis and 613 patients (2.4%) who visited the ED multiple (≥3) times. The following factors were associated with any visit to an ED: older age (odds ratio [OR]: 1.010; 95% CI: 1.008-1.012), female gender (OR: 1.23; 95% CI: 1.16-1.30), higher comorbidity index (OR: 1.38; 95% CI: 1.35-1.41), metastatic disease (OR: 2.37; 95% CI: 2.23-2.53), proximal tumors (OR: 1.59; 95% CI: 1.50-1.68) and North zone (OR vs south zone: 1.75; 95% CI: 1.55-1.98). It is not uncommon for CRC patients to visit the ED at least once in the 3 months prior to having such a diagnosis. Factors associated with frequent pre diagnosis emergency visits included female gender, higher burden of comorbid disease, advanced stage, proximal tumors and living in the North zone of Alberta (where there is limited access to specialist care).
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http://dx.doi.org/10.2217/cer-2021-0163DOI Listing
April 2022

Managing 5FU Cardiotoxicity in Colorectal Cancer Treatment.

Cancer Manag Res 2022 23;14:273-285. Epub 2022 Jan 23.

Department of Oncology, Cross Cancer Institute, University of Alberta, Edmonton, AB, Canada.

Fluorouracil (5FU) is the backbone chemotherapy agent in the treatment of colorectal cancer (CRC). Cardiotoxicity represents an uncommon but serious side effect of treatment with 5FU. Here, we review the current literature on 5FU-cardiotoxicity in the setting of CRC specifically, with a focus on data from the modern era of combination chemotherapy. Despite decades of study, there is little consensus on risk factors and biomarkers for 5FU-cardiotoxicity, nor how patients with CRC should be managed following a cardiotoxicity event. Given the elevated risk of recurrent cardiotoxicity on rechallenge, the use of alternative regimens that do not contain 5FU is a critical aspect of management. Data on the cardiotoxicity risk and efficacy of non-5FU regimens in CRC are therefore reviewed in detail.
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http://dx.doi.org/10.2147/CMAR.S273544DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8799936PMC
January 2022

A real-world, population-based study for the outcomes of patients with metastatic colorectal cancer to the liver with distant lymph node metastases treated with metastasectomy.

J Comp Eff Res 2022 03 25;11(4):243-250. Epub 2022 Jan 25.

Department of Oncology, University of Alberta, Cross Cancer Institute, Edmonton, AB T6G 1Z2, Canada.

To assess the impact of metastasectomy on survival outcomes of patients with concurrent liver and distant nodal metastases. Surveillance, Epidemiology, and End Results (SEER) database was accessed and patients with colorectal liver metastases (with or without distant lymph node involvement) were reviewed. Kaplan-Meier survival estimates were then used to assess the impact of the presence of distant lymph node metastases as well as the impact of metastasectomy on overall and cancer-specific survival. A propensity score matching was then conducted between patients with distant lymph node metastases who had surgery versus those who did not have surgery. A total of 15,325 patients were included in the current analysis including 1603 patients who have liver and distant nodal metastases (10.5%) and 13,722 patients who have liver metastases only (89.5%). The following factors were associated with better overall survival (OS): younger age (hazard ratio [HR] with increasing age: 1.024; 95% CI: 1.022-1.025), white race (HR for African-American race vs white race: 1.233; 95% CI: 1.175-1.295), distal site of the primary (HR: 0.808; 95% CI: 0.778-0.840), absence of distant lymph nodes (HR: 0.697; 95% CI: 0.659-0.737), metastasectomy (HR for no metastasectomy vs metastasectomy: 1.954; 95% CI: 1.858-2.056). Within the postpropensity cohort, metastasectomy was associated with improved OS among patients with concurrent distant lymph node and liver metastases (median OS of 20 vs 11 months; p < 0.001). Metastasectomy seems to be associated with improved survival among patients with concurrent lymph node and liver metastases. It is unclear if improved survival is related to the surgical intervention or to the fact that surgically treated patients have a better baseline general condition and hence improved outcomes.
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http://dx.doi.org/10.2217/cer-2021-0133DOI Listing
March 2022

Outcomes of liver transplantation as an oncologic surgery for different primary liver cancers: A real-world, population-based study.

Hepatobiliary Pancreat Dis Int 2021 Nov 5. Epub 2021 Nov 5.

Department of Oncology, Cross Cancer Institute and the University of Alberta, Edmonton, Canada. Electronic address:

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http://dx.doi.org/10.1016/j.hbpd.2021.11.004DOI Listing
November 2021

Patterns of colorectal cancer diagnosis among younger adults in a real-world, population-based cohort.

Future Oncol 2022 Jan 12;18(1):47-54. Epub 2021 Nov 12.

Department of Oncology, University of Alberta, Cross Cancer Institute, Edmonton, AB, T6G 1Z2, Canada.

To review the patterns of early-onset (<50 years old) colorectal cancer (CRC) in Alberta across the past 15 years among different socioeconomic and demographic patient subgroups. This is a retrospective, population-based study based on Alberta administrative databases. Income level was identified via income information from the 2006 Canadian census. Patients with colorectal adenocarcinoma diagnosed 2004-2018 were included. Frequency analyses were used to examine the percentage of early-onset CRC cases among different subgroups over the period studied. Multivariable logistic regression analysis was used to examine factors associated with the development of early-onset CRC. A total of 24,912 patients were included, of whom 2096 (8.4%) were diagnosed at age <50 years and 22,816 (91.6%) at age ≥50 years. The percentage of patients diagnosed at age <50 years increased over time (10.2% in 2018 vs 7.9% in 2004; p < 0.003). Higher income was associated with younger age at diagnosis of CRC (odds ratio [OR] for quartile 1 vs quartile 4: 0.54; 95% CI: 0.47-0.62). Other factors associated with younger age at diagnosis included female sex (OR for male vs female: 0.85; 95% CI: 0.78-0.94), distal CRC (OR: 1.66; 95% CI: 1.50-1.84) and North zone (OR for South zone vs North zone: 0.74; 95% CI: 0.60-0.92). The proportion of patients (out of the overall CRC population) with early-onset CRC, increased in Alberta throughout the study duration (particularly left-sided CRC). There is a need to reassess the current age limits for CRC screening in Canada in view of these findings.
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http://dx.doi.org/10.2217/fon-2021-0592DOI Listing
January 2022

Factors associated with fatal coronavirus disease 2019 infections among cancer patients in the US FDA Adverse Event Reporting System database.

Future Oncol 2021 Dec 2;17(36):5045-5051. Epub 2021 Nov 2.

Department of Oncology, University of Alberta, Cross Cancer Institute, Edmonton, Alberta T6G 1Z2, Canada.

To explore factors affecting coronavirus disease 2019 (COVID-19) mortality among cancer patients based on a pharmacovigilance database. US FDA Adverse Event Reporting System (FAERS) quarterly data extract files were reviewed for quarters two, three and four of 2020 (i.e., April to December). Patients with an indication related to malignancy and a reported COVID-related reaction were selected. Multivariate logistic regression analysis for factors associated with a fatal outcome was conducted. A total of 2708 patients were included. The following factors were associated with fatal COVID-19 infection: older age (odds ratio [OR]: 1.03; 95% CI: 1.01-1.04), male sex (OR: 1.43; 95% CI: 1.07-1.91), non-US report source (OR: 2.46; 95% CI: 1.93-3.13), hematological malignancy (OR: 1.62; 95% CI: 1.28-2.07), potentially immunosuppressive treatment (OR: 1.83; 95% CI: 1.30-2.58) and diagnosis in quarter two versus quarter four (OR: 1.62; 95% CI: 1.27-2.07). Within FAERS reports, cancer patients who are older, males and receiving immunosuppressive treatment and those with hematological malignancies were at a higher risk of death because of COVID-19 infection.
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http://dx.doi.org/10.2217/fon-2021-0816DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8582593PMC
December 2021

Socioeconomic disparities in the prevalence of comorbid chronic conditions among Canadian adults with cancer.

Acta Oncol 2022 Mar 2;61(3):294-301. Epub 2021 Nov 2.

Department of Oncology, University of Alberta and Cross Cancer Institute, Edmonton, Alberta, Canada.

Objective: To evaluate the prevalence of comorbid chronic conditions among Canadian adults with cancer and the impact of socioeconomic background on the distribution of these conditions.

Methods: Canadian Community Health Survey (CCHS) 2017-2018 dataset was accessed and individuals with complete information about cancer history were reviewed. The prevalence of the following 10 chronic conditions was reviewed: asthma, chronic obstructive pulmonary disease, arthritis, hypertension, hypercholesterolemia/hyperlipidemia, heart disease, stroke, diabetes, mood disorder, and anxiety disorder. Stratification of the prevalence was done according to age, sex, and racial subgroups. Multivariable logistic regression analysis was done to evaluate the association between sociodemographic characteristics and having multiple comorbid conditions.

Results: A total of 104,362 participants were included in the current study (including 10,782 participants with a history of cancer; and 93,580 participants without a history of cancer). Among all age, sex, and race strata, participants with a history of cancer were more likely to have multiple chronic conditions ( < 0.05 for all comparisons). The most common three individual comorbid conditions among participants with cancer were arthritis (40.2%), hypertension (36.1%), and hypercholesterolemia (25.2%); while the most common cancer-comorbidity triad among participants with cancer was cancer/arthritis/hypertension (17.7%). In a multivariable logistic regression analysis among participants with cancer, the following sociodemographic factors were associated with having multiple comorbid conditions: older age (OR for age 80+ versus age 18-20 years: 8.32; 95% CI: 5.17-13.39), indigenous racial group (OR: 1.94; 95% CI: 1.43-2.63) and lower income (OR for income ≥80,000 Canadian dollars (CAD) versus income: ≤20,000 CAD: 0.29; 95% CI: 0.23-0.37).

Conclusion: History of cancer is associated with a higher probability of many comorbid conditions. This excess comorbidity burden seems to be unequally shouldered by individuals in the lower socioeconomic stratum as well as minority populations.
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http://dx.doi.org/10.1080/0284186X.2021.1995892DOI Listing
March 2022

Association between PD-L1 inhibitor, tumor site and adverse events of potential immune etiology within the US FDA adverse event reporting system.

Immunotherapy 2021 12 28;13(17):1407-1417. Epub 2021 Oct 28.

Department of Oncology, University of Alberta, Cross Cancer Institute, Edmonton, AB, T6G 1Z2, Canada.

To analyze tumor- and treatment-related factors that might impact the development of certain adverse events (AEs) of potential immune etiology among patients receiving PD-L1 inhibitors.  The FDA Adverse Event Reporting System (FAERS) was accessed, and AE reports related to the use of PD-L1 inhibitors were reviewed. Associations between treatment, tumor type and occurrence of AEs of special interest were analyzed through multivariable logistic regression analysis. A total of 80,304 AE reports were included in the current analysis. Diagnosis with lung cancer was associated with a higher probability of pneumonitis; diagnosis with melanoma was associated with a higher probability of hepatitis, hypophysitis/hypopituitarism and uveitis; and diagnosis with genitourinary cancers was associated with a higher probability of nephritis, adrenal insufficiency and myocarditis.  Within this cohort limited to AEs reported to the FAERS, there is an association between different AEs of special interest, agent(s) used and tumor(s) treated.
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http://dx.doi.org/10.2217/imt-2021-0068DOI Listing
December 2021

Cisplatin-Based versus Carboplatin-Based Chemotherapy for Extrapulmonary Neuroendocrine Carcinomas: A Real-World Study.

Neuroendocrinology 2021 Oct 14. Epub 2021 Oct 14.

Department of Oncology, Cross Cancer Institute and the University of Alberta, Edmonton, Alberta, Canada.

Objective: This study aimed to assess the survival differences between cisplatin/etoposide versus carboplatin/etoposide chemotherapy regimens in the management of patients with extrapulmonary neuroendocrine carcinomas (NECs).

Methods: Administrative cancer care databases in the province of Alberta, Canada, were reviewed, and patients with extrapulmonary NECs (including those with small cell and large cell neuroendocrine carcinomas) who were treated with either cisplatin/etoposide or carboplatin/etoposide, 2004-2019, were reviewed. Kaplan-Meier survival estimates were used to compare the survival outcomes according to the type of platinum agent, and multivariable Cox regression analysis was used to assess the impact of the type of platinum agent on overall survival outcomes.

Results: A total of 263 eligible patients were included in this analysis. These include 176 patients who received cisplatin/etoposide and 87 patients who received carboplatin/etoposide. Using Kaplan-Meier survival estimates, patients treated with cisplatin had better overall survival compared to patients treated with carboplatin (p = 0.005). Multivariable Cox regression analysis suggested that the following factors were associated with worse overall survival: higher Charlson comorbidity index (HR: 1.17; 95% CI: 1.05-1.30), gastrointestinal primary site (HR: 1.55; 95% CI: 1.12-2.14), stage IV disease (HR: 1.75; 95% CI: 1.28-2.38), and use of carboplatin (HR: 1.40; 95% CI: 1.02-1.92).

Conclusions: The current study suggested that cisplatin/etoposide might be associated with better overall survival compared to carboplatin/etoposide among patients with extrapulmonary NECs. It is unclear if this is related to differences in inherent responsiveness to the 2 platinum agents or due to differences in comorbidity burden between the 2 treatment groups.
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http://dx.doi.org/10.1159/000520193DOI Listing
October 2021

Prognostic and predictive value of microsatellite instability status among patients with colorectal cancer.

J Comp Eff Res 2021 11 5;10(16):1197-1214. Epub 2021 Oct 5.

Department of Oncology, University of Alberta, Cross Cancer Institute, Edmonton, AB, T6G 1Z2, Canada.

Compare overall survival (OS) between microsatellite instability (MSI) high and MSI-stable and analyze the effect of chemotherapy on OS. National cancer database was queried for patients diagnosed with colorectal adenocarcinoma between 2010 and 2016. We evaluated the OS and the chemotherapy effect using Kaplan-Meier estimates and multivariate Cox regression analyses. Total of 30,436 stage II patients and 30,302 stage III patients were included. In stage II with high-risk features and MSI-high, patients who received chemotherapy had better OS compared to patients who didn't receive chemotherapy. The same was found in stage II with no high-risk features and MSI-high group. Stage II colorectal cancer patients with high-risk features and MSI-high who received chemotherapy have better OS compared to patients who didn't receive chemotherapy.
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http://dx.doi.org/10.2217/cer-2021-0013DOI Listing
November 2021

Outcomes of patients with nonmetastatic gastric adenocarcinoma according to perioperative treatment strategy: a real-world, population-based study.

J Comp Eff Res 2021 10 13;10(15):1143-1151. Epub 2021 Sep 13.

Department of Oncology, University of Alberta, Edmonton, AB, T6G1Z2, Canada.

To assess the survival outcomes of patients with nonmetastatic gastric cancer according to the type of perioperative treatment strategy used (surgery-only, adjuvant chemo-radiotherapy, adjuvant chemotherapy, perioperative chemotherapy) in a population-based setting. Surveillance, Epidemiology and End Results research-plus database was explored, and patients with nonmetastatic gastric cancer who were treated with an oncologic surgery were reviewed. Multivariable Cox regression analysis was used to examine the impact of treatment strategy on overall and cancer-specific survival. A total of 11,526 patients were found to be eligible and they were included in the current analysis. Looking at the percentages of different treatment strategies throughout the study years (2006-2017), the use of the following strategies increased: adjuvant chemotherapy (20.1 vs 10.6%), and perioperative chemotherapy (21.3 vs 0.5%); while the use of the following strategies decreased: surgery only (36.2 vs 58.2%), and adjuvant chemo-radiotherapy (22.4 vs 30.6%). Using multivariable Cox regression analysis, the following factors were associated with worse overall survival: older age (hazard [HR]: 1.021; 95% CI: 1.018-1.023), males (HR: 1.09; 95% CI: 1.04-1.14), Black race (HR: 1.11; 95% CI: 1.04-1.19), cardia subsite (HR: 1.09; 95% CI: 1.02-1.17), grade 3-4 (HR:1.32; 95% CI: 1.25-1.40), diffuse histology (HR: 1.46; 95% CI: 1.35-1.58), clinically node positive (HR:1.43; 95% CI: 1.34-1.53), total gastrectomy (HR: 1.20; 95% CI: 1.13-1.28), and surgery-only approach (HR: 1.65; 95% CI: 1.55-1.75). Among patients with localized gastric cancer, patients who were treated with surgery-only, and to a less extent, patients who were treated with surgery followed by adjuvant chemotherapy have worse survival outcomes; while those treated with perioperative chemotherapy have the best survival outcomes.
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http://dx.doi.org/10.2217/cer-2021-0113DOI Listing
October 2021

Impact of postoperative radiotherapy on the outcomes of resected adrenocortical carcinoma-a real-world, population-based study.

Strahlenther Onkol 2022 Jan 2;198(1):73-79. Epub 2021 Sep 2.

Department of Oncology, Cross Cancer Institute, University of Alberta, T6G 1Z2, Edmonton, Alberta, Canada.

Objective: To assess the impact of postoperative radiotherapy on the outcomes of resected adrenocortical carcinoma in a real-world setting.

Methods: The Surveillance, Epidemiology, and End Results Research Plus database was accessed, and patients with resected non-metastatic adrenocortical carcinoma diagnosed 2010-2015 were reviewed. Kaplan-Meier estimates and log-rank testing were used to examine the impact of postoperative radiotherapy on overall and cancer-specific survival. Multivariable Cox regression analysis was used to explore factors associated with overall and cancer-specific survival.

Results: A total of 294 patients were included in the final analysis, including 60 patients (20.4%) who received postoperative radiotherapy. Using Kaplan-Meier estimates, individuals who received postoperative radiotherapy have better overall survival (P = 0.002). Multivariable cox regression analysis showed that the following factors were associated with worse overall survival: older age (HR: 1.01; 95% CI: 1.00-1.03), male sex (HR for female sex versus male sex: 0.61; 95% CI: 0.43-0.85), and non-receipt of postoperative radiation therapy (HR: 2.29; 95% CI: 1.38-3.77). Systemic therapy was not associated with differences in overall survival (HR: 0.77; 95% CI: 0.54-1.10). Likewise, the following factors were associated with worse cancer-specific survival: male sex (HR for female sex versus male sex: 0.60; 95% CI: 0.41-0.88), non-receipt of postoperative radiation therapy (HR: 2.17; 95% CI: 1.27-3.70), and receipt of perioperative systemic therapy (HR: 0.67; 95% CI: 0.45-0.99).

Conclusion: Postoperative radiotherapy following resection of adrenocortical carcinoma is associated with better overall and cancer-specific survival.
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http://dx.doi.org/10.1007/s00066-021-01838-6DOI Listing
January 2022

Assessment of the AJCC staging system of pheochromocytomas/paragangliomas.

Endocrine 2022 Jan 27;75(1):239-243. Epub 2021 Aug 27.

Department of Oncology, University of Alberta, Cross Cancer Institute, Edmonton, AB, Canada.

Objective: This study aims to assess the performance of the AJCC 8th staging system for pheochromocytomas and paragangliomas (PPGLs) based on a population-based cohort.

Methods: Surveillance, epidemiology, and end results (SEER)-18 registry database was reviewed, and patients with PPGLs diagnosed 2004-2015 were reviewed. AJCC stage for each patient was reconstructed from the collaborative stage dataset. Kaplan-Meier survival estimates according to the AJCC stage were reviewed, and multivariable Cox regression analysis was conducted to determine the impact of AJCC stages on overall and cancer-specific survival.

Results: A total of 416 patients with PPGLs were eligible and were included in the current analysis. Using Kaplan-Meier survival estimates, patients with stage IV seem to have the worst overall survival (P < 0.001). When the results were stratified by the site of origin (adrenal vs. extra-adrenal), similar findings were observed in both strata (P < 0.001 in each stratum). Using multivariable Cox regression analysis for overall survival, HR for stage I vs. II was: 0.59; (95% CI: 0.27-1.27), HR for stage II vs. III: 0.82; (95% CI: 0.41-1.63), and HR for stage III vs. IV was: 0.37; (95% CI: 0.24-0.58). Likewise, for cancer-specific survival, HR for stage I vs. II was: 0.72; (95% CI: 0.26-1.97), HR for stage II vs. III: 0.64; (95% CI: 0.25-1.63), and HR for stage III vs. IV was: 0.33; (95% CI: 0.19-0.56). C-statistic for AJCC 8th staging system was: 0.723 (95% CI: 0.669-0.776).

Conclusion: Further improvements within AJCC 8th edition are possible, including the inclusion of the extent of metastatic disease in the subclassification of stage IV disease, and not considering primary tumor site when assigning T stage.
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http://dx.doi.org/10.1007/s12020-021-02854-3DOI Listing
January 2022

Disparities in modifiable cancer risk factors among Canadian provinces, territories, and health regions.

Curr Med Res Opin 2021 11 6;37(11):1973-1989. Epub 2021 Sep 6.

Department of Oncology, University of Alberta and Cross Cancer Institute, Edmonton, Canada.

Background: Data about small area estimates of cancer risk factors are difficult to obtain in Canada. The current study aims to provide an assessment of the prevalence of different behavioral risk factors of cancer at the level of Canadian provinces/territories and sub provincial health regions/units.

Methods: Canadian Community Health Survey (CCHS) datasets for 2017/2018 were reviewed and adult participants (≥ 18 years old) were included. Baseline demographic data and health behaviors (including ever-smoking, current smoking, alcohol drinking in the past 12 months, below-recommended physical activity, and obesity) were reviewed. Prevalence of each of these behaviors within different provinces/territories as well as within each health region was reviewed. Multivariable logistic regression analysis was then done to examine the association between place of residence and cancer risk factors.

Results: A total of 104,636 adult participants were included in the current analysis. For ever-smoking, the highest prevalence was noted in Nunavut (79.7%); for current smoking, the highest prevalence was noted in Nunavut (67.2%); for alcohol drinking in the past 12 months, the highest prevalence was noted in Quebec (89.3%); for below-recommended physical activity, the highest prevalence was noted in Nunavut (51.3%); for obesity, the highest prevalence was noted in Northwest territories (31.5%). Compared to individuals living within a territory, individuals living within a province were less likely to ever smoke (OR: 0.62; 95% CI: 0.54-0.71), currently smoke (OR: 0.51; 95% CI: 0.45-0.59), be obese (OR: 0.82; 95% CI: 0.71-0.95), but more likely to drink alcohol in the past 12 months (OR: 1.41; 95% CI: 1.20-1.65). There is no difference between both categories with regards to physical activity (OR: 1.02; 95% CI: 0.89-1.15).

Conclusions: There is a general province/territory disparity in the prevalence of different modifiable cancer risk factors as well as disparity between individual provinces/health regions in Canada.
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http://dx.doi.org/10.1080/03007995.2021.1971184DOI Listing
November 2021

Risk of arterial and venous thromboembolic events among patients with colorectal carcinoma: a real-world, population-based study.

Future Oncol 2021 Oct 3;17(30):3977-3986. Epub 2021 Aug 3.

Department of Oncology, University of Alberta, Cross Cancer Institute, Edmonton, AB, T6G 1Z2, Canada.

To assess real-world patterns of arterial and venous thromboembolism among patients with colorectal carcinoma. The Alberta provincial cancer registry and other provincial medical records were used to identify patients with colorectal cancer (2004-2018) with no preceding or succeeding cancer diagnosis. The incidence of both arterial and venous thromboembolism in this patient population as well as factors associated with these thromboembolic events were examined through logistic regression analysis. A total of 17,296 patients were found eligible and were included into the current study. We observed that 1564 patients (9%) experienced a thromboembolic event and 15,732 patients (91%) did not. The following factors were associated with any thromboembolic event: male sex (odds ratio [OR]: 1.20; 95% CI: 1.08-1.34), higher comorbidity (OR: 1.36; 95% CI: 1.31-1.41), metastatic disease (OR for nonmetastatic vs metastatic disease: 0.53; 95% CI: 0.47-0.60), living within North zone (OR for Edmonton zone vs North zone: 0.70; 95% CI: 0.59-0.84), treatment with fluoropyrimidines (OR for no fluoropyrimidines vs fluoropyrimidines: 0.53; 95% CI: 0.47-0.60) and treatment with bevacizumab (OR: for no bevacizumab vs bevacizumab: 0.53; 95% CI: 0.47-0.60). Factors associated with venous thromboembolism include, younger age (continuous OR with increasing age: 0.99; 95% CI: 0.98-0.99), higher comorbidity (OR: 1.10; 95% CI: 1.04-1.17), metastatic disease (OR for nonmetastatic disease vs metastatic disease: 0.40; 95% CI: 0.35-0.47), North zone (OR for Edmonton zone vs North zone: 0.70; 95% CI: 0.56-0.86), treatment with fluoropyrimidines (OR for no fluoropyrimidines vs fluoropyrimidines: 0.45; 95% CI: 0.39-0.53) and treatment with bevacizumab (OR for no bevacizumab vs bevacizumab: 0.73; 95% CI: 0.58-0.93). Thromboembolic events are not uncommon among colorectal cancer patients, and the risk is increased with male sex, higher comorbidity, presence of metastatic disease, living within the North zone of the province (where there is limited access to tertiary care centers) and treatment with fluoropyrimidines or bevacizumab.
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http://dx.doi.org/10.2217/fon-2021-0252DOI Listing
October 2021

What is the real value of metronomic chemotherapy in the treatment of gastrointestinal cancer?

Expert Opin Pharmacother 2021 Dec 24;22(17):2297-2302. Epub 2021 Jun 24.

Division of Medical Oncology, Department of Oncology Cross Cancer Centre, University of Alberta, Edmonton, Alberta, Canada.

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http://dx.doi.org/10.1080/14656566.2021.1940953DOI Listing
December 2021

Gender, socioeconomic status and emergency department visits among cancer survivors in the USA: a population-based study.

J Comp Eff Res 2021 08 22;10(12):969-977. Epub 2021 Jun 22.

Department of Oncology, University of Alberta, Cross Cancer Institute, Edmonton, AB, T6G 1Z2, Canada.

To assess patterns of emergency department visits and subsequent hospitalization in relation to gender and socioeconomic status among a cohort of cancer survivors in the USA. National Health Interview Survey datasets (2011-2017) were reviewed and participants with a history of cancer and complete information about emergency department visits in the past 12 months were included. Multivariable logistic regression analyses were used to assess factors associated with emergency department visits and subsequent hospitalization after the most recent emergency department visit. A total of 22,240 cancer survivors were included in the current analysis; of which 16,133 participants (72.5%) who have not visited an emergency department in the past 12 months and 6107 participants (27.5%) who have visited an emergency department in the past 12 months. Multivariable logistic regression analysis suggested the following factors are associated with emergency department visits; younger age (odds ratio [OR] with increasing age: 0.98; 95% CI: 0.98-0.99), female gender (OR: 1.07; 95% CI: 1.00-1.15), African American race (OR: 1.26; 95% CI: 1.13-1.40), unmarried status (OR for married vs unmarried: 0.79; 95% CI: 0.74-0.84), lower yearly earnings (OR: 1.36; 95% CI: 1.20-1.54), poor health status (OR: 7.02; 95% CI: 6.02-8.18) and incomplete health insurance coverage (OR for complete coverage vs incomplete coverage: 0.66; 95% CI: 0.54-0.80). On the other hand, the following factors were associated with subsequent hospitalization: older age (OR: 1.004; 95% CI: 1.000-1.008), male gender (OR for female vs male: 0.86; 95% CI: 0.78-0.94), unmarried status (OR for married vs unmarried status: 0.80; 95% CI: 0.73-0.88), not working (OR: 1.44; 95% CI: 1.23-1.68), lower yearly earnings (OR: 1.31; 95% CI: 1.07-1.60), poor health status (OR: 8.43; 95% CI: 6.76-10.51) and lack of health insurance coverage (OR for complete coverage vs incomplete coverage: 0.71; 95% CI: 0.55-0.93). Female cancer survivors were more likely to visit the emergency department, whereas they were less likely to be subsequently hospitalized. Cancer survivors with lower socioeconomic status were more likely to visit emergency departments and to be subsequently hospitalized.
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http://dx.doi.org/10.2217/cer-2020-0278DOI Listing
August 2021

Racial Background and Health Behaviors Among Adults With Cancer in Canada: Results of a National Survey.

J Natl Compr Canc Netw 2021 Jun 17:1-9. Epub 2021 Jun 17.

Background: This study was an assessment of the impact of racial background on health behaviors among Canadian adults with a concurrent or past history of a cancer diagnosis.

Methods: The Canadian Community Health Survey datasets (2015-2018) were accessed, and adults (age ≥18 years) with cancer were reviewed. Information about the racial background, socioeconomic status, and different health behaviors was reviewed. Multivariable logistic regression analyses for factors associated with different health behaviors were conducted.

Results: A total of 20,514 participants with a history of cancer were considered eligible and were included in the analysis. Compared with individuals who self-identified as White, those who self-identified as indigenous were less likely to have received an influenza vaccination in the past year (odds ratio [OR], 1.253; 95% CI, 1.084-1.448), less likely to have drunk alcohol in the past 12 months (OR, 0.641; 95% CI, 0.546-0.752), more likely to be current smokers (OR, 2.245; 95% CI, 1.917-2.630), and more likely to have used recreational drugs in the past 12 years (OR, 1.488; 95% CI, 1.076-2.057). Compared with individuals who self-identified as White, those who self-identified as non-White and nonindigenous were less likely to have received an influenza vaccination in the past year (OR, 1.207; 95% CI, 1.035-1.408), less likely to have drunk alcohol in the past 12 months (OR, 0.557; 95% CI, 0.463-0.671), and less likely to be current smokers (OR, 0.605; 95% CI, 0.476-0.769).

Conclusions: Within the Canadian context, there is a considerable variability in the health behaviors of adults with cancer according to their racial background. There is a need to tailor the survivorship care planning of patients with cancer based on socioeconomic context.
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http://dx.doi.org/10.6004/jnccn.2020.7681DOI Listing
June 2021

Patterns and association of vaccination among adults with a history of cancer in the USA: a population-based study.

J Comp Eff Res 2021 08 11;10(11):899-907. Epub 2021 Jun 11.

Department of Oncology, University of Alberta, Cross Cancer Institute, Edmonton, AB T4G1Z2, Canada.

To assess the association of vaccination status among adults with history of cancer in a population-based cohort in the USA. National Health Interview Survey datasets (2008-2018) have been accessed and information about the patterns and associations of the following vaccinations were collected (influenza vaccination, pneumococcal vaccination, hepatitis B vaccination, hepatitis A vaccination and shingles vaccination). Association of different sociodemographic variables with each of the above types of vaccination was studied through multivariable logistic regression analysis. Private health insurance (vs no private insurance) was associated with higher percentages of recommended vaccination (influenza vaccination: 65 vs 59.7%; pneumococcal vaccination: 74.9 vs 68.8%; hepatitis B vaccination: 22.9 vs 19.3%; hepatitis A vaccination: 10.1 vs 8.6%; shingles vaccination: 33.8 vs 26.7%; p < 0.001 for all comparisons). Within multivariable logistic regression analyses, African American race, lower education and lower income were associated with less probability of adherence to recommended vaccination (for influenza vaccination; odds ratio (OR) for black race vs white race: 0.785; 95% CI: 0.717-0.859; OR for ≤high school vs >high school education: 0.763; 95% CI: 0.723-0.805; OR for income ≤US$45,000 vs >US$45,000: 0.701; 95% CI: 0.643-0.764). There is evidence of socio-economic disparities in adherence to recommended vaccination among this cohort of cancer survivors in the USA. More efforts need to be done to ensure that recommended vaccination is being delivered to all cancer survivors in need (including enhancing coverage and awareness to under-represented groups of the society).
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http://dx.doi.org/10.2217/cer-2020-0251DOI Listing
August 2021

Real-world Patterns of Adjuvant Chemotherapy Following Neoadjuvant Chemoradiation for Patients With Resected Rectal Adenocarcinoma.

Am J Clin Oncol 2021 08;44(8):383-387

Department of Oncology, Cross Cancer Institute, University of Alberta, Edmonton, AB, Canada.

Objective: The objective of this study was to analyze patterns of adjuvant chemotherapy among patients with resected rectal adenocarcinomas following neoadjuvant chemoradiation and surgical resection.

Methods: Alberta Cancer Registry and other provincial electronic medical registries (2004 to 2018) identified patients with nonmetastatic rectal cancer who received neoadjuvant chemoradiation followed by surgical resection and either oxaliplatin-based or fluoropyrimidine-only adjuvant chemotherapy. Multivariable logistic regression analysis was then undertaken to identify factors associated with the use of either regimen. Kaplan-Meier survival estimates were used to compare overall survival between both groups and multivariable Cox regression analysis was then used to identify factors associated with worse overall survival.

Results: A total of 532 patients who fulfilled eligibility criteria were included in the current study: 347 patients received adjuvant fluoropyrimidine-only chemotherapy and 185 patients received adjuvant oxaliplatin-based chemotherapy. The following variables were associated with use of fluoropyrimidine-only adjuvant chemotherapy: older age (odds ratio [OR]: 1.04; 95% confidence interval [CI]: 1.02-1.06), higher Charlson comorbidity index (OR: 1.47; 95% CI: 1.00-2.15), and no involved lymph nodes in the surgical pathology (OR: 5.55; 95% CI: 3.66-8.41). Using Kaplan-Meier survival estimates, no difference in overall survival between patients treated with adjuvant oxaliplatin-based chemotherapy and those treated with adjuvant fluoropyrimidine-only chemotherapy was identified (P=0.152). Within multivariable Cox regression analysis, type of chemotherapy was not associated with a difference in overall survival (hazard ratio for fluoropyrimidine-only chemotherapy vs. oxaliplatin-based chemotherapy: 1.02; 95% CI: 0.61-1.71).

Conclusion: Oxaliplatin-based adjuvant chemotherapy is not associated with improved survival outcomes compared with fluoropyrimidine-only chemotherapy in this real-world study.
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http://dx.doi.org/10.1097/COC.0000000000000834DOI Listing
August 2021

Hospitalizations among early-stage colon cancer patients receiving adjuvant chemotherapy: a real-world study.

Int J Colorectal Dis 2021 Sep 21;36(9):1905-1913. Epub 2021 May 21.

Department of Oncology, Cross Cancer Institute, University of Alberta, Edmonton, AB, Canada.

Objective: To assess the patterns of hospitalizations among early-stage colon cancer patients receiving adjuvant chemotherapy and to identify high-risk groups that may benefit from more careful monitoring in a real-world, population-based context.

Methods: This is a population-based study using linked administrative databases from the province of Alberta, Canada. Any events of hospitalization among patients with non-metastatic colon cancer undergoing upfront surgery followed by adjuvant chemotherapy were reviewed. Multivariable logistic regression analysis was used to examine factors associated with risk of hospitalization, and the impact of hospitalization on overall survival was assessed through Kaplan-Meier estimates and Multivariable Cox regression analysis.

Results: A total of 2257 patients were considered eligible and were included in the current analysis, including 483 patients (21.4%) who were hospitalized within 6 months of the start of adjuvant chemotherapy, and 1774 patients (78.6%) who were not. The following factors were associated with a higher hospitalization risk: older age (OR: 1.02; 95% CI 1.01-1.03), higher comorbidity (OR: 1.48; 95% CI 1.31-1.67), women (OR for men versus women: 0.79; 95% CI 0.64-0.98), living in the North zone (OR for Edmonton zone versus North zone: 0.60; 95% CI 0.42-0.87), and CAPOX chemotherapy (OR for CAPOX versus FOLFOX: 1.50; 95% CI 1.12-2.00). Patients with a history of hospitalization during adjuvant chemotherapy had a worse overall survival compared to patients who were not hospitalized (P < 0.001).

Conclusion: In this study, one out of five colon cancer patients were hospitalized during adjuvant chemotherapy. Older individuals, women, those with higher comorbidity, and those receiving adjuvant CAPOX were more likely to be hospitalized.
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http://dx.doi.org/10.1007/s00384-021-03952-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8138106PMC
September 2021

Sex-Based Differences in Prognosis of Patients With Gastroenteropancreatic-Neuroendocrine Neoplasms: A Population-Based Study.

Pancreas 2021 May-Jun 01;50(5):727-731

Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, European Institute of Oncology, IEO, IRCCS, Milan, Italy.

Objectives: The aim of this study was to assess sex-based differences in prognosis of a contemporary cohort of gastroenteropancreatic-neuroendocrine neoplasm (GEP-NEN) patients.

Methods: Surveillance, Epidemiology, and End Results database was accessed, and cases with GEP-NENs were selected. Rates of GEP-NEN diagnosis from 1975 to 2016 for both male patients and female patients were reviewed. Survival outcomes of GEP-NEN patients diagnosed from 2010 to 2014 were determined through Kaplan-Meier estimates and multivariable Cox regression analysis. Overall survival analyses were stratified by stage and histology.

Results: A total of 20,836 GEP-NEN patients were diagnosed from 2010 to 2014, and they were included in the current analysis. These include 10,336 male patients and 10,500 female patients. Annual percent change for the age-adjusted rate for GEP-NENs in the United States (1975-2016) is 5.0 (95% confidence interval [CI], 4.8-5.2). When stratified by sex, annual percent change for male patients was 4.8 (95% CI, 4.6-5.1), whereas for female patients, it was 5.0 (95% CI, 4.8-5.3). Female patients have better overall survival compared with male patients among all substrata of patients (according to stage, histology, and differentiation) (P for all comparisons <0.01).

Conclusions: Female sex seems to be associated with better overall survival among patients with GEP-NENs. It is unclear if this is the result of differences in noncancer mortality or is the result of inherent biological differences.
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http://dx.doi.org/10.1097/MPA.0000000000001821DOI Listing
January 2022

Patterns of cost-related medication underuse among Canadian adults with cancer: a cross-sectional study using survey data.

CMAJ Open 2021 Apr-Jun;9(2):E474-E481. Epub 2021 May 6.

Department of Oncology, University of Alberta and Cross Cancer Institute, Edmonton, Alta.

Background: Cost-related medication underuse (CRMU) has been reported within the general population in Canada. In this study, we assessed patterns of CRMU among Canadian adults with cancer.

Methods: This is a cross-sectional study using survey data. We accessed data sets from the 2015/16 Canadian Community Health Survey (CCHS) and reviewed the records of adults (≥ 18 yr) with a history of cancer who were prescribed medication in the previous 12 months. We collected information about sociodemographic features, health behaviours and CRMU, and conducted a multivariable logistic regression analysis for factors associated with CRMU.

Results: A total of 8581 participants were eligible for the current study. In the weighted multivariable logistic regression analysis, the following factors were associated with CRMU: younger age (odds ratio [OR] 2.55, 95% confidence interval [CI] 1.79-3.63), female sex (male sex v. female sex OR 0.62, 95% CI 0.44-0.88), Indigenous racial background (Indigenous v. White OR 2.37, 95% CI 1.49- 3.77), unmarried status (OR 1.59, 95% CI 1.09-2.30), poor self-perceived health (excellent v. poor self-perceived health OR 0.36, 95% CI 0.17-0.77), lower annual income (< $20 000 v. income ≥ $80 000 OR 3.08, 95% CI 1.75-5.41) and lack of insurance for prescription medications (OR 2.49, 95% CI 1.77-3.50).

Interpretation: The toll of CRMU among adults seems to be unequally carried by women, racial minorities, and younger (< 65 yr) and uninsured patients with cancer. Discussion about a national pharmacare program for people without private insurance is needed.
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http://dx.doi.org/10.9778/cmajo.20200186DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8157980PMC
August 2021

Outcomes of small-cell versus large-cell gastroenteropancreatic neuroendocrine carcinomas: A population-based study.

J Neuroendocrinol 2021 May 19;33(5):e12971. Epub 2021 Apr 19.

Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, European Institute of Oncology, IEO); IRCCS, Milan, Italy.

The recent World Health Organization classification for gastroenteropancreatic neuroendocrine neoplasms (GEP-NENs) classified poorly differentiated GEP-NENs into small cell and large cell categories. The present study aimed to assess the differences in outcomes between patients with both histological categories. The Surveillance, Epidemiology and End Results (SEER) database (1975-2016) was accessed and patients with small cell and large cell GEP-neuroendocrine carcinomas (NECs) were extracted. Differences in survival outcomes were explored through Kaplan-Meier survival estimates and multivariable Cox regression models. In total, 2204 patients with GEP-NEC were identified in the survival cohort, including 1698 patients with small cell NEC (77%) and 506 patients with large cell NEC (23%). Using Kaplan-Meier analysis/log-rank testing, large cell GEP-NEC was associated with better overall survival compared to small cell NEC (P < 0.01). Using multivariable Cox regression analysis, large cell GEP-NEC was associated with better overall survival (large cell GEP-NEC versus small cell GEP-NEC, hazard ratio = 0.77; 95% confidence interval = 0.68-0.86) and cancer-specific survival (large cell GEP-NEC versus small cell GEP-NEC, hazard ratio = 0.79; 95% 95% confidence interval = 0.69-0.91). Patients with small cell GEP-NEC have worse survival outcomes compared to those with large cell GEP-NEC. Further efforts are needed to identify biological differences and treatment sensitivities between both histological categories.
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http://dx.doi.org/10.1111/jne.12971DOI Listing
May 2021

The impact of gender and HPV status on anal squamous cell carcinoma survival.

Int J Colorectal Dis 2021 Oct 31;36(10):2093-2109. Epub 2021 Mar 31.

Department of Oncology, Cross Cancer Institute, University of Alberta, Edmonton, Alberta, Canada.

Background: Anal cancer is a rare entity and the effect of gender and HPV status on survival is controversial. We aimed to evaluate the difference in overall survival (OS) according to gender and analyzed the effect of HPV status on OS.

Patients And Methods: The National Cancer Database (NCDB) was queried for patients with anal squamous cell carcinoma between 2004 and 2016. We evaluated the OS based on gender and HPV status using Kaplan-Meier estimates and we used multivariate Cox regression analyses to evaluate factors associated with overall survival.

Results: A total of 6133 patients with known HPV status were included for analysis. In the non-metastatic group, male gender was associated with worse OS (HR 1.50, 95% CI 1.32-1.70; P<0.001) whereas HPV status did not affect the OS (HR 1.08, 95% CI 0.96-1.22; P=0.213). In the metastatic group, there was no difference in OS based on gender (HR 1.29, 95% CI 0.91-1.82; P=0.148), whereas HPV-negative status was associated with worse OS (HR 1.52, 95% CI 1.09-2.12; P=0.014).

Conclusion: Females had better OS only in non-metastatic anal squamous cell carcinoma (ASCC). HPV-negative status was associated with worse OS only in metastatic ASCC.
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http://dx.doi.org/10.1007/s00384-021-03910-0DOI Listing
October 2021

Outcomes of Ramucirumab Plus Paclitaxel Among Patients With Previously Treated Metastatic Gastric/Lower Esophageal Cancer: A Real-world Study.

Am J Clin Oncol 2021 04;44(4):158-161

Department of Oncology, University of Alberta, Cross Cancer Institute, Edmonton, AB, Canada.

Objective: The objective of this study was to review real-world patterns of chemotherapy utilization among patients with metastatic gastric/lower esophageal adenocarcinoma with particular focus on the use of ramucirumab plus paclitaxel in previously treated patients.

Methods: This is a retrospective, registry-based study using datasets from Alberta Cancer Registry and other provincial databases in Alberta, Canada. Multivariable logistic regression analysis was used to identify factors associated with palliative chemotherapy use. Among patients who received >1 line of chemotherapy, Kaplan-Meier survival estimates were used to compare outcomes according to ramucirumab plus paclitaxel use. Multivariable Cox regression analysis was then used to identify factors associated with overall survival (OS) in this cohort.

Results: A total of 1590 patients were included (including 1070 gastric patients and 520 lower esophageal patients). The following factors were associated with use of palliative chemotherapy: younger age (odds ratio with increasing age: 0.95; 95% confidence interval [CI]: 0.94-0.95), and lower Charlson Comorbidity Index (odds ratio with increasing index: 0.82; 95% CI: 0.74-0.91). Within the subcohort of patients who received >1 line of chemotherapy, use of ramucirumab/paclitaxel was associated with better OS (P=0.033). Multivariable Cox regression analysis suggested that the following factors are associated with better OS: use of ramucirumab/paclitaxel (hazard ratio [HR]: 1.56; 95% CI: 1.07-2.29) and living within urban zones including Calgary or Edmonton zones (vs. Northern zone) (HR for Calgary zone vs. Northern zone: 0.44; 95% CI: 0.23-0.85; HR for Edmonton zone vs. Northern zone: 0.41; 95% CI: 0.22-0.77).

Conclusions: Use of paclitaxel/ramucirumab combination beyond first-line treatment is associated with improved OS among patients with metastatic gastric/lower esophageal adenocarcinoma in this real-world study. Further work is needed to reduce disparity in our health care system between individuals living in rural versus urban areas.
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http://dx.doi.org/10.1097/COC.0000000000000799DOI Listing
April 2021
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