Publications by authors named "P C Lambert"

1,941 Publications

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Treatment Patterns, Toxicity, and Outcomes of Older Adults With Advanced Pancreatic Cancer Receiving First-line Palliative Chemotherapy.

Am J Clin Oncol 2022 Feb;45(2):55-60

Departments of Internal Medicine.

Objectives: Advanced pancreatic cancer (APC) disproportionately impacts older adults. Randomized trials demonstrate improved overall survival (OS) with combination chemotherapy including 5-fluorouracil, irinotecan, leucovorin, and oxaliplatin (FOLFIRINOX) or nab-paclitaxel and gemcitabine compared with gemcitabine alone, but with increased toxicity. Older adults are at increased risk of side effects from chemotherapy. The aim of this study was to assess the efficacy and toxicity of chemotherapy in older adults with APC.

Methods: Patients diagnosed with APC from 2011 to 2016 were identified using the Manitoba Cancer Registry. Patient and treatment characteristics, toxicity, and outcomes of patients 65 years of age and above treated with palliative chemotherapy were compared by treatment regimen. OS was assessed using the Kaplan-Meier method. A Cox regression was used to identify independent predictors of OS.

Results: A total of 87 patients aged 65 years and above received palliative chemotherapy: 52 (59.7%) FOLFIRINOX, 21 (24.1%) nab-paclitaxel and gemcitabine, and 14 (16.1%) gemcitabine, with a median age of 69 (65 to 84), 75 (65 to 88), and 73 (67 to 82), Eastern Cooperative Oncology Group (ECOG) performance status difference in hematologic toxicity between regimens (P=0.807). An increase in nonhematologic toxicity was seen with FOLFIRINOX (P<0.001), specifically neuropathy (P=0.008), fatigue (P<0.001), and nausea/vomiting (P=0.008). FOLFIRINOX was associated with improved radiologic response (P=0.05) and OS (P=0.035). PS, baseline carbohydrate antigen 19-9 level, and chemotherapy regimen were independent predictors of survival.

Conclusions: FOLFIRINOX is associated with improved response and OS in older adults with APC. FOLFIRINOX has a manageable safety profile in this population and should be considered in fit older adults with APC.
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http://dx.doi.org/10.1097/COC.0000000000000882DOI Listing
February 2022

Evaluating the impact of the COVID-19 pandemic on cancer screening in a central Canadian province.

Prev Med 2022 Jan 19;155:106961. Epub 2022 Jan 19.

CancerCare Manitoba Research Institute, CancerCare Manitoba, 675 McDermot Avenue, Winnipeg, MB R3E 0V9, Canada; Department of Epidemiology and Cancer Registry, CancerCare Manitoba, 675 McDermot Avenue, Winnipeg, MB R3E 0V9, Canada.

We evaluated the impact of COVID-19 on cancer screening in Manitoba, Canada using an interrupted time series (ITS) design and data from Manitoba's population-based, organized cancer screening programs from April 2020 to August 2021. In June 2020 (breast screening was suspended during April and May 2020), there was a 54% decrease between the predicted (i.e., observed data produced from regression models) and expected (i.e., counterfactual values produced for the COVID-19 period by assuming COVID-19 did not occur) number of screening mammograms (ratio = 0.46, 95% Confidence Interval (CI) 0.28-0.64). By December 2020, there was no significant difference between predicted and expected number of screening mammograms (ratio = 0.95, 95% CI 0.80-1.10). In April 2020, there was an 83% decrease in the number of Pap tests (ratio = 0.17, 95% CI 0.04-0.30). By January 2021, there was no significant difference between predicted and expected number of Pap tests (ratio = 0.93, 95% CI 0.81-1.06). In April 2020, there was an 81% decrease in the number of screening program fecal occult blood tests (FOBTs) (ratio = 0.19, 95% CI 0.0-0.44). By September 2020, there was no significant difference between predicted and expected number of FOBTs (ratio = 0.95, 95% CI 0.65-1.24). The estimated cumulative deficit (i.e., backlog) from April 2020 to August 2021 was 17,370 screening mammograms, 22,086 Pap tests, and 5253 screening program FOBTs. Overall, screening programs adapted quickly to the COVID-19 pandemic. Additional strategies may be needed to address remaining backlogs.
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http://dx.doi.org/10.1016/j.ypmed.2022.106961DOI Listing
January 2022

Five ways to improve international comparisons of cancer survival: lessons learned from ICBP SURVMARK-2.

Br J Cancer 2022 Jan 20. Epub 2022 Jan 20.

Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.

Background: Comparisons of population-based cancer survival between countries are important to benchmark the overall effectiveness of cancer management. The International Cancer Benchmarking Partnership (ICBP) Survmark-2 study aims to compare survival in seven high-income countries across eight cancer sites and explore reasons for the observed differences. A critical aspect in ensuring comparability in the reported survival estimates are similarities in practice across cancer registries. While ICBP Survmark-2 has shown these differences are unlikely to explain the observed differences in cancer-specific survival between countries, it is important to keep in mind potential biases linked to registry practice and understand their likely impact.

Methods: Based on experiences gained within ICBP Survmark-2, we have developed a set of recommendations that seek to optimally harmonise cancer registry datasets to improve future benchmarking exercises.

Results: Our recommendations stem from considering the impact on cancer survival estimates in five key areas: (1) the completeness of the registry and the availability of registration sources; (2) the inclusion of death certification as a source of identifying cases; (3) the specification of the date of incidence; (4) the approach to handling multiple primary tumours and (5) the quality of linkage of cases to the deaths register.

Conclusion: These recommendations seek to improve comparability whilst maintaining the opportunity to understand and act upon international variations in outcomes among cancer patients.
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http://dx.doi.org/10.1038/s41416-022-01701-0DOI Listing
January 2022

Combined Effect of Temperature and Relative Humidity on the Survival of Isolates on Stainless Steel Coupons.

Int J Environ Res Public Health 2022 Jan 14;19(2). Epub 2022 Jan 14.

College of Health & Life Sciences, Aston University, Birmingham B4 7ET, UK.

The survival on stainless steel of ten isolates from food factory, clinical and veterinary sources was investigated. Stainless steel coupons inoculated with were dried and stored at a range of temperatures and relative humidity (RH) levels representing factory conditions. Viability was determined from 1 to 22 days. Survival curves obtained for most isolates and storage conditions displayed exponential inactivation described by a log-linear model. Survival was affected by environmental temperatures and RH with decimal reduction times (DRTs) ranging from <1 day to 18 days. At 25 °C/15% RH, all isolates survived at levels of 10 to 10 cfu for >22 days. Furthermore, temperatures and RH independently influenced survival on stainless steel; increasing temperatures between 10 °C and 37 °C and increasing RH levels from 30-70% both decreased the DRT values. Survival curves displaying a shoulder followed by exponential death were obtained for three isolates at 10 °C/70% RH. Inactivation kinetics for these were described by modified Weibull models, suggesting that cumulative injury occurs before cellular inactivation. This study highlights the need to control temperature and RH to limit microbial persistence in the food manufacturing environment, particularly during the factory shut-down period for cleaning when higher temperature/humidity levels could be introduced.
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http://dx.doi.org/10.3390/ijerph19020909DOI Listing
January 2022

Impact of Pre-Treatment NLR and Other Hematologic Biomarkers on the Outcomes of Early-Stage Non-Small-Cell Lung Cancer Treated with Stereotactic Body Radiation Therapy.

Curr Oncol 2022 Jan 4;29(1):193-208. Epub 2022 Jan 4.

Department of Radiation Oncology, CancerCare Manitoba, Winnipeg, MB R3E 0V9, Canada.

Introduction: We evaluated the association of pre-treatment immunologic biomarkers on the outcomes of early-stage non-small-cell lung cancer (NSCLC) patients treated with stereotactic body radiation therapy (SBRT).

Materials And Methods: In this retrospective study, all newly diagnosed early-stage NSCLC treated with SBRT between January 2010 and December 2017 were screened and included for further analysis. The pre-treatment neutrophil-lymphocyte ratio (NLR), monocyte lymphocyte ratio (MLR), and platelet-lymphocyte ratio (PLR) were calculated. Overall survival (OS) and recurrence-free survival (RFS) were estimated by Kaplan-Meier. Multivariable models were constructed to determine the impact of different biomarkers and the Akaike information criterion (AIC), index of adequacy, and scaled Brier scores were calculated.

Results: A total of 72 patients were identified and 61 were included in final analysis. The median neutrophil count at baseline was 5.4 × 10/L (IQR: 4.17-7.05 × 10/L). Median lymphocyte count was 1.63 × 10/L (IQR: 1.29-2.10 × 10/L), median monocyte count was 0.65 × 10/L (IQR: 0.54-0.83 × 10/L), median platelet count was 260.0 × 10/L (IQR: 211.0-302.0 × 10/L). The median NLR was 3.42 (IQR: 2.38-5.04), median MLR was 0.39 (IQR: 0.31-0.53), and median PLR was 156.4 (IQR: 117.2-197.5). On multivariable regression a higher NLR was associated with worse OS ( = 0.01; HR-1.26; 95% CI 1.04-1.53). The delta AIC between the two multivariable models was 3.4, suggesting a moderate impact of NLR on OS. On multivariable analysis, higher NLR was associated with poor RFS ( = 0.001; NLR^1 HR 0.36; 0.17-0.78; NLR^2 HR-1.16; 95% CI 1.06-1.26) with a nonlinear relationship. The delta AIC between the two multivariable models was 16.2, suggesting a strong impact of NLR on RFS. In our cohort, MLR and PLR were not associated with RFS or OS in multivariable models.

Conclusions: Our study suggests NLR, as a biomarker of systemic inflammation, is an independent prognostic factor for OS and RFS. The nonlinear relationship with RFS may indicate a suitable immunological environment is needed for optimal SBRT action and tumoricidal mechanisms. These findings require further validation in independent cohorts.
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http://dx.doi.org/10.3390/curroncol29010019DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8774597PMC
January 2022
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