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Fields T, M Bremova T, Billington I, Churchill GC, Evans W, Fields C, Galione A, Kay R, Mathieson T, Martakis K, Patterson M, Platt F, Factor M, Strupp M. N-acetyl-L-leucine for Niemann-Pick type C: a multinational double-blind randomized placebo-controlled crossover study. Trials 2023; 24:361. [PMID: 37248494 DOI: 10.1186/s13063-023-07399-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 05/22/2023] [Indexed: 05/31/2023] Open
Abstract
BACKGROUND Niemann-Pick disease type C (NPC) is a rare autosomal recessive neurodegenerative lysosomal disease characterized by multiple symptoms such as progressive cerebellar ataxia and cognitive decline. The modified amino acid N-acetyl-leucine has been associated with positive symptomatic and neuroprotective, disease-modifying effects in various studies, including animal models of NPC, observational clinical case studies, and a multinational, rater-blinded phase IIb clinical trial. Here, we describe the development of a study protocol (Sponsor Code "IB1001-301") for the chronic treatment of symptoms in adult and pediatric patients with NPC. METHODS This multinational double-blind randomized placebo-controlled crossover phase III study will enroll patients with a genetically confirmed diagnosis of NPC patients aged 4 years and older across 16 trial sites. Patients are assessed during a baseline period and then randomized (1:1) to one of two treatment sequences: IB1001 followed by placebo or vice versa. Each sequence consists of a 12-week treatment period. The primary efficacy endpoint is based on the Scale for the Assessment and Rating of Ataxia, and secondary outcomes include cerebellar functional rating scales, clinical global impression, and quality of life assessments. DISCUSSION Pre-clinical as well as observational and phase IIb clinical trials have previously demonstrated that IB1001 rapidly improved symptoms, functioning, and quality of life for pediatric and adult NPC patients and is safe and well tolerated. In this placebo-controlled cross-over trial, the risk/benefit profile of IB1001 for NPC will be evaluated. It will also give information about the applicability of IB1001 as a therapeutic paradigm for other rare and common neurological disorders. TRIAL REGISTRATIONS The trial (IB1001-301) has been registered at www. CLINICALTRIALS gov (NCT05163288) and www.clinicaltrialsregister.eu (EudraCT: 2021-005356-10). Registered on 20 December 2021.
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Affiliation(s)
- T Fields
- IntraBio Ltd, Begbroke Science Park, Begroke Hill, Woodstock Road, Oxford, OX5 1PF, UK.
| | - T M Bremova
- Department of Neurology, Inselspital, University Hospital Bern, and University of Bern, Bern, Switzerland
| | - I Billington
- IntraBio Ltd, Begbroke Science Park, Begroke Hill, Woodstock Road, Oxford, OX5 1PF, UK
| | - G C Churchill
- Department of Pharmacology, University of Oxford, Mansfield Road, Oxford, OX1 3QT, UK
| | - W Evans
- Niemann-Pick UK, Suite 2, Vermont House, Concord, Tyne and Wear, Washington, NE37 2SQ, UK
- Primary Care Stratified Medicine (PRISM), Division of Primary Care, University of Nottingham, Nottingham, UK
| | - C Fields
- IntraBio Ltd, Begbroke Science Park, Begroke Hill, Woodstock Road, Oxford, OX5 1PF, UK
| | - A Galione
- Department of Pharmacology, University of Oxford, Mansfield Road, Oxford, OX1 3QT, UK
| | - R Kay
- RK Statistics, Brook House, Mesne Lane, Bakewell, DE45 1AL, UK
| | - T Mathieson
- Niemann-Pick UK, Suite 2, Vermont House, Concord, Tyne and Wear, Washington, NE37 2SQ, UK
- RK Statistics, Brook House, Mesne Lane, Bakewell, DE45 1AL, UK
| | - K Martakis
- Department of Pediatric Neurology, University Children's Hospital (UKGM) and Medical Faculty, Justus Liebig University of Giessen, Giessen, Germany
| | - M Patterson
- Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - F Platt
- Department of Pharmacology, University of Oxford, Mansfield Road, Oxford, OX1 3QT, UK
| | - M Factor
- IntraBio Ltd, Begbroke Science Park, Begroke Hill, Woodstock Road, Oxford, OX5 1PF, UK
| | - M Strupp
- Department of Neurology and German Center for Vertigo and Balance Disorders, Ludwig Maximilians University, Munich, Germany
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Cyrus K, Jerome M, Reeves A, Nguyen K, Shankaran M, Evans W, Salas A. Is measuring skeletal muscle mass with the D3-$$$creatine dilution method feasible in premature infants? Am J Med Sci 2023. [DOI: 10.1016/s0002-9629(23)00730-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Eng L, Brual J, Nagee A, Mok S, Fazelzad R, Chaiton M, Saunders D, Mittmann N, Truscott R, Liu G, Bradbury P, Evans W, Papadakos J, Giuliani M. Reporting of tobacco use and tobacco-related analyses in cancer cooperative group clinical trials: a systematic scoping review. ESMO Open 2022; 7:100605. [PMID: 36356412 PMCID: PMC9646674 DOI: 10.1016/j.esmoop.2022.100605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 09/21/2022] [Accepted: 09/23/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Continued smoking after a diagnosis of cancer negatively impacts cancer outcomes, but the impact of tobacco on newer treatments options is not well established. Collecting and evaluating tobacco use in clinical trials may advance understanding of the consequences of tobacco use on treatment modalities, but little is known about the frequency of reporting and analysis of tobacco use in cancer cooperative clinical trial groups. PATIENTS AND METHODS A comprehensive literature search was conducted to identify cancer cooperative group clinical trials published from January 2017-October 2019. Eligible studies evaluated either systemic and/or radiation therapies, included ≥100 adult patients, and reported on at least one of: overall survival, disease/progression-free survival, response rates, toxicities/adverse events, or quality-of-life. RESULTS A total of 91 studies representing 90 trials met inclusion criteria with trial start dates ranging from 1995 to 2015 with 14% involving lung and 5% head and neck cancer patients. A total of 19 studies reported baseline tobacco use; 2 reported collecting follow-up tobacco use. Seven studies reported analysis of the impact of baseline tobacco use on clinical outcomes. There was significant heterogeneity in the reporting of baseline tobacco use: 7 reported never/ever status, 10 reported never/ex-smoker/current smoker status, and 4 reported measuring smoking intensity. None reported verifying smoking status or second-hand smoke exposure. Trials of lung and head and neck cancers were more likely to report baseline tobacco use than other disease sites (83% versus 6%, P < 0.001). CONCLUSIONS Few cancer cooperative group clinical trials report and analyze trial participants' tobacco use. Significant heterogeneity exists in reporting tobacco use. Routine standardized collection and reporting of tobacco use at baseline and follow-up in clinical trials should be implemented to enable investigators to evaluate the impact of tobacco use on new cancer therapies.
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Affiliation(s)
- L. Eng
- Division of Medical Oncology and Hematology, Department of Medicine, Princess Margaret Cancer Centre/University Health Network and University of Toronto, Toronto, Canada,Prof L. Eng, Princess Margaret Cancer Centre, 610 University Avenue, Toronto, Ontario M5G 2M9, Canada. Tel: +1-416-946-2953; Fax: +1-416-946-6546 @Lawson_Eng@MeredithGiulia1@PMcancercentre
| | - J. Brual
- Cancer Education Program, Princess Margaret Cancer Centre, Toronto, Canada
| | - A. Nagee
- Cancer Education Program, Princess Margaret Cancer Centre, Toronto, Canada
| | - S. Mok
- Cancer Education Program, Princess Margaret Cancer Centre, Toronto, Canada
| | - R. Fazelzad
- Library and Information Services, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - M. Chaiton
- Centre for Addiction and Mental Health, University of Toronto, Toronto, Canada
| | - D.P. Saunders
- Northeast Cancer Centre of Health Sciences North, Northern Ontario School of Medicine, Sudbury, Canada
| | - N. Mittmann
- Canadian Agency for Drugs and Technologies in Health, Toronto, Canada
| | - R. Truscott
- Division of Prevention Policy and Stakeholder Engagement, Ontario Health (Cancer Care Ontario), Toronto, Canada
| | - G. Liu
- Division of Medical Oncology and Hematology, Department of Medicine, Princess Margaret Cancer Centre/University Health Network and University of Toronto, Toronto, Canada
| | - P.A. Bradbury
- Division of Medical Oncology and Hematology, Department of Medicine, Princess Margaret Cancer Centre/University Health Network and University of Toronto, Toronto, Canada
| | - W.K. Evans
- Department of Oncology, McMaster University, Hamilton, Canada
| | - J. Papadakos
- Cancer Education Program, Princess Margaret Cancer Centre, Toronto, Canada,Patient Education, Ontario Health (Cancer Care Ontario), Toronto, Canada
| | - M.E. Giuliani
- Cancer Education Program, Princess Margaret Cancer Centre, Toronto, Canada,Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Canada,Correspondence to: Prof M. Giuliani, Princess Margaret Cancer Centre, 610 University Avenue, Toronto, Ontario M5G 2M9, Canada. Tel: +1-416-946-2983; Fax: +1-416-946-6546
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McLaren S, Evans W, Galna B, Portas M, Weston M, Spears I. Fast reconstruction of centre of mass and foot kinematics during a single-legged horizontal jump: A point-cloud processing approach. J Biomech 2022; 135:111015. [DOI: 10.1016/j.jbiomech.2022.111015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 12/23/2021] [Accepted: 02/17/2022] [Indexed: 10/19/2022]
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Fields T, Patterson M, Bremova-Ertl T, Belcher G, Billington I, Churchill GC, Davis W, Evans W, Flint S, Galione A, Granzer U, Greenfield J, Karl R, Kay R, Lewi D, Mathieson T, Meyer T, Pangonis D, Platt FM, Tsang L, Verburg C, Factor M, Strupp M. A master protocol to investigate a novel therapy acetyl-L-leucine for three ultra-rare neurodegenerative diseases: Niemann-Pick type C, the GM2 gangliosidoses, and ataxia telangiectasia. Trials 2021; 22:84. [PMID: 33482890 PMCID: PMC7821839 DOI: 10.1186/s13063-020-05009-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 12/28/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The lack of approved treatments for the majority of rare diseases is reflective of the unique challenges of orphan drug development. Novel methodologies, including new functionally relevant endpoints, are needed to render the development process more feasible and appropriate for these rare populations and thereby expedite the approval of promising treatments to address patients' high unmet medical need. Here, we describe the development of an innovative master protocol and primary outcome assessment to investigate the modified amino acid N-acetyl-L-leucine (Sponsor Code: IB1001) in three separate, multinational, phase II trials for three ultra-rare, autosomal-recessive, neurodegenerative disorders: Niemann-Pick disease type C (NPC), GM2 gangliosidoses (Tay-Sachs and Sandhoff disease; "GM2"), and ataxia telangiectasia (A-T). METHODS/DESIGN The innovative IB1001 master protocol and novel CI-CS primary endpoints were developed through a close collaboration between the Industry Sponsor, Key Opinion Leaders, representatives of the Patient Communities, and National Regulatory Authorities. As a result, the open-label, rater-blinded study design is considerate of the practical limitations of recruitment and retention of subjects in these ultra-orphan populations. The novel primary endpoint, the Clinical Impression of Change in Severity© (CI-CS), accommodates the heterogenous clinical presentation of NPC, GM2, and A-T: at screening, the principal investigator appoints for each patient a primary anchor test (either the 8-m walk test (8MWT) or 9-hole peg test of the dominant hand (9HPT-D)) based on his/her unique clinical symptoms. The anchor tests are videoed in a standardized manner at each visit to capture all aspects related to the patient's functional performance. The CI-CS assessment is ultimately performed by independent, blinded raters who compare videos of the primary anchor test from three periods: baseline, the end of treatment, and the end of a post-treatment washout. Blinded to the time point of each video, the raters make an objective comparison scored on a 7-point Likert scale of the change in the severity of the patient's neurological signs and symptoms from video A to video B. To investigate both the symptomatic and disease-modifying effects of treatment, N-acetyl-L-leucine is assessed during two treatment sequences: a 6-week parent study and 1-year extension phase. DISCUSSION The novel CI-CS assessment, developed through a collaboration of all stakeholders, is advantageous in that it better ensures the primary endpoint is functionally relevant for each patient, is able to capture small but meaningful clinical changes critical to the patients' quality of life (fine-motor skills; gait), and blinds the primary outcome assessment. The results of these three trials will inform whether N-acetyl-L-leucine is an effective treatment for NPC, GM2, and A-T and can also serve as a new therapeutic paradigm for the development of future treatments for other orphan diseases. TRIAL REGISTRATION The three trials (IB1001-201 for Niemann-Pick disease type C (NPC), IB1001-202 for GM2 gangliosidoses (Tay-Sachs and Sandhoff), IB1001-203 for ataxia telangiectasia (A-T)) have been registered at www.clinicaltrials.gov (NCT03759639; NCT03759665; NCT03759678), www.clinicaltrialsregister.eu (EudraCT: 2018-004331-71; 2018-004406-25; 2018-004407-39), and https://www.germanctr.de (DR KS-ID: DRKS00016567; DRKS00017539; DRKS00020511).
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Affiliation(s)
- T. Fields
- IntraBio Ltd, Begbroke Science Park, Begbroke Hill, Woodstock Road, Oxford, OX5 1PF UK
| | - M. Patterson
- Mayo Clinic, 200 First Street SW, Rochester, MN 55905 USA
| | - T. Bremova-Ertl
- Department of Neurology, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
| | - G. Belcher
- PV Consultancy, 113 St Georges Square Mews, London, SW1V 3RZ UK
| | - I. Billington
- IntraBio Ltd, Begbroke Science Park, Begbroke Hill, Woodstock Road, Oxford, OX5 1PF UK
| | - G. C. Churchill
- Department of Pharmacology, University of Oxford, Mansfield Road, Oxford, OX1 3QT UK
| | - W. Davis
- Ataxia-Telangiectasia Society, Rothamsted Experimental Station West Common, Harpenden, AL5 2JQ UK
| | - W. Evans
- Niemann-Pick UK, Vermont House, Concord, Washington, Tyne and Wear NE37 2SQ UK
- Primary Care Stratified Medicine (PRISM) Division of Primary Care, University of Nottingham, Nottingham, UK
| | - S. Flint
- IntraBio Ltd, Begbroke Science Park, Begbroke Hill, Woodstock Road, Oxford, OX5 1PF UK
| | - A. Galione
- Department of Pharmacology, University of Oxford, Mansfield Road, Oxford, OX1 3QT UK
| | - U. Granzer
- Granzer Regulatory Consulting & Services, Kistlerhofstr. 172C, D-81379 Munich, Germany
| | | | - R. Karl
- Cure Tay-Sachs Foundation, 2409 E. Luke Avenue, Phoenix, AZ 85016 USA
| | - R. Kay
- RK Statistics, Brook House, Mesne Lane, Bakewell, DE45 1AL UK
| | - D. Lewi
- The Cure & Action for Tay-Sachs Foundation, 94 Milborough Crescent, Lee, London, SE12 0RW UK
| | - T. Mathieson
- International Niemann-Pick Disease Alliance, Vermont House, Concord, Washington, Tyne and Wear NE37 2SQ UK
| | - T. Meyer
- Granzer Regulatory Consulting & Services, Kistlerhofstr. 172C, D-81379 Munich, Germany
| | - D. Pangonis
- National Tay-Sachs and Allied Disease Foundation, 2001 Beacon Street, Suite 204, Boston, MA 02135 USA
| | - F. M. Platt
- Department of Pharmacology, University of Oxford, Mansfield Road, Oxford, OX1 3QT UK
| | - L. Tsang
- Arnold & Porter Kaye Scholer LLP, 25 Old Broad Street, London, EC2N 1HQ UK
| | - C. Verburg
- IntraBio Ltd, Begbroke Science Park, Begbroke Hill, Woodstock Road, Oxford, OX5 1PF UK
| | - M. Factor
- IntraBio Ltd, Begbroke Science Park, Begbroke Hill, Woodstock Road, Oxford, OX5 1PF UK
| | - M. Strupp
- Department of Neurology and German Center for Vertigo and Balance Disorders, University Hospital, Ludwig Maximilians University, Munich, Germany
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Giuliani M, Brual J, Cameron E, Chaiton M, Eng L, Haque M, Liu G, Mittmann N, Papadakos J, Saunders D, Truscott R, Evans W. Smoking Cessation in Cancer Care: Myths, Presumptions and Implications for Practice. Clin Oncol (R Coll Radiol) 2020; 32:400-406. [PMID: 32029357 DOI: 10.1016/j.clon.2020.01.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 11/26/2019] [Accepted: 12/04/2019] [Indexed: 10/25/2022]
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Rodriguez-Mañas L, Araujo de Carvalho I, Bhasin S, Bischoff-Ferrari HA, Cesari M, Evans W, Hare JM, Pahor M, Parini A, Rolland Y, Fielding RA, Walston J, Vellas B. ICFSR Task Force Perspective on Biomarkers for Sarcopenia and Frailty. J Frailty Aging 2020; 9:4-8. [PMID: 32150207 DOI: 10.14283/jfa.2019.32] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Biomarkers of frailty and sarcopenia are essential to advance the understanding of these conditions of aging and develop new diagnostic tools and effective treatments. The International Conference on Frailty and Sarcopenia Research (ICFSR) Task Force - a group of academic and industry scientists from around the world -- met in February 2019 to discuss the current state of biomarker development for frailty and sarcopenia. The D3Cr dilution method, which assesses creatinine excretion as a biochemical measure of muscle mass, was suggested as a more accurate measure of functional muscle mass than assessment by dual energy x-ray absorptiometry (DXA). Proposed biomarkers of frailty include markers of inflammation, the hypothalamic-pituitary-adrenal (HPA) axis response to stress, altered glucose insulin dynamics, endocrine dysregulation, aging, and others, acknowledging the complex multisystem etiology that contributes to frailty. Lack of clarity regarding a regulatory pathway for biomarker development has hindered progress; however, there are currently several international efforts to develop such biomarkers as tools to improve the treatment of individuals presenting these conditions.
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Eng L, Su J, Hueniken K, Brown M, Saunders D, de Almeida J, Hope A, Selby P, Spreafico A, Hansen A, Goldstein D, Xu W, Giuliani M, Evans W, Liu G, Chaiton M. Tobacco retail access and tobacco cessation among head and neck cancer (HNC) survivors. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz265.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Eng L, Su J, Hueniken K, Brown M, Hope A, Bezjak A, Sacher A, Bradbury P, Shepherd F, Leighl N, Pierre A, Selby P, Goldstein D, Xu W, Giuliani M, Evans W, Liu G, Chaiton M. P1.10-05 Tobacco Retail Availability and Tobacco Cessation Among Lung Cancer Survivors. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.1067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Smith E, Shankaran M, Hellerstein M, Brown K, Morris C, Ricotti V, Evans W. P.197Use of the D3-creatine dilution test as a non-invasive and accurate measurement of total body muscle mass in Duchenne muscular dystrophy. Neuromuscul Disord 2019. [DOI: 10.1016/j.nmd.2019.06.252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Cheema P, Evans W, Burkes R, Sangha R, Ho C, Wheatley-Price P, Boehm D, Venkatesh J, Walisser S, Grima D, Moldaver D, Hurry M. Estimating the cost and survival impact of new aNSCLC therapies in Canada with the iTEN model. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz260.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Evans W, Truscott R, Cameron E, Timmings C, Haque M, Halligan M, Rana S, Keen D, Rabeneck L. ES20.03 Tobacco Control Integration in Cancer Care: The Canadian Experience. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Cameron E, Haque M, Schwartz N, Khan S, Rana S, Truscott R, Evans W. OA09.07 Implementing an Opt-Out Approach to Smoking Cessation Referrals for Cancer Patients in Ontario, Canada. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Davies E, Wieboldt J, Stanley T, Maeda Y, Smyth M, Stanley S, Mcclean M, Evans W, Funston C, Millar BC, Goldsmith CE, Moore JE. Isolation and identification of ‘Mycobacterium angelicum’ from a patient with type II respiratory failure: suggested reporting guidelines to molecular clinical laboratories. Br J Biomed Sci 2019. [DOI: 10.1080/09674845.2012.12069140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- E. Davies
- Departments of Microbiology, Causeway Hospital, Coleraine, Co. Londonderry
| | - J. Wieboldt
- Departments of Respiratory Medicine, Causeway Hospital, Coleraine, Co. Londonderry
| | - T. Stanley
- Northern Ireland Mycobacterium Reference Laboratory, Department of Medical Microbiology, Royal Group of Hospitals
| | - Y. Maeda
- Northern Ireland Public Health Laboratory, Department of Bacteriology, Belfast City Hospital
| | - M. Smyth
- Northern Ireland Mycobacterium Reference Laboratory, Department of Medical Microbiology, Royal Group of Hospitals
| | - S. Stanley
- Northern Ireland Mycobacterium Reference Laboratory, Department of Medical Microbiology, Royal Group of Hospitals
| | - M. Mcclean
- Northern Ireland Mycobacterium Reference Laboratory, Department of Medical Microbiology, Royal Group of Hospitals
| | - W. Evans
- Department of Microbiology, Antrim Area Hospital, Co. Antrim
| | - C. Funston
- Department of Microbiology, Antrim Area Hospital, Co. Antrim
| | - B. C. Millar
- Northern Ireland Public Health Laboratory, Department of Bacteriology, Belfast City Hospital
| | - C. E. Goldsmith
- Northern Ireland Public Health Laboratory, Department of Bacteriology, Belfast City Hospital
| | - J. E. Moore
- Northern Ireland Public Health Laboratory, Department of Bacteriology, Belfast City Hospital
- School of Biomedical Sciences, University of Ulster, Coleraine, Northern Ireland, UK
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Abstract
Intermittent exercise might be an efficient means of exercise for improving bone strength and quality. The aim of our study was to examine the effect of intermittent running on bone turnover markers using altered exercise-to-rest intervals. Twelve males completed one control (no exercise), and three, 45-min intermittent protocols (5, 20, and 80 s intervals) matched for distance and speed. Fasted venous blood samples were collected at baseline, 1, 2 and 24 h post-exercise. Carboxyterminal crosslinked telopeptide (CTX-I) and procollagen type 1 amino-terminal propeptide (P1NP) were used as markers of bone resorption and formation. After adjustment for baseline, CTX-I concentration at 1 h was higher (very likely to most likely small) for 5 s (30.2%; ±90% confidence limits: 10%), 20 s (2.9.0%; ±10%) and 80 s (32.0%; ±10%) compared to control. The very likely small effect remained for 5 s at 2 h (30.2%; ±15%). The effect for 20 and 80 s was possibly trivial and possibly small/possibly trivial (∼14.5%; ±∼15%). Differences in P1NP concentrations were likely to very likely trivial (∼7.4%; ±∼7.6%). Circulating CTX-I concentration is affected acutely by intermittent running with short-interval (5 s) intermittent loading resulting in a prolonged attenuation in circadian rhythm of CTX-I up to 2 h that was not demonstrated as clearly by longer intervals despite matched internal and external training load.
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Affiliation(s)
- W Evans
- Faculty of Health Sciences and Wellbeing, Sport and Exercise Sciences, University of Sunderland, Sunderland, UK
| | - A Nevill
- Faculty of Education, Health & Wellbeing, University of Wolverhampton, Wolverhampton, UK
| | - S J McLaren
- Institute for Sport, Physical Activity and Leisure, Leeds Beckett University, Leeds, UK.,The Rugby Football League, Leeds, UK
| | - M Ditroilo
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
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Montgomery G, Abt G, Dobson C, Smith T, Evans W, Ditroilo M. The mechanical loading and muscle activation of four common exercises used in osteoporosis prevention for early postmenopausal women. J Electromyogr Kinesiol 2018; 44:124-131. [PMID: 30611015 DOI: 10.1016/j.jelekin.2018.12.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 12/07/2018] [Accepted: 12/10/2018] [Indexed: 11/18/2022] Open
Abstract
High impact exercise can reduce postmenopausal bone loss, however stimulus frequency (loading cycles per second) can affect osteogenesis. We aimed to examine the effect of stimulus frequency on the mechanical loading of four common osteoporosis prevention exercises, measuring body acceleration and muscle activation with accelerometry and electromyography (EMG), respectively. Fourteen early postmenopausal women completed randomised countermovement jumps (CMJ), box-drops (BD), heel-drops (HD) and stamp (STP) exercises for continuous and intermittent stimulus frequencies. Sacrum accelerometry and surface electromyography (EMG) of four muscles were recorded. CMJ (mean ± SD: 10.7 ± 4.8 g & 10.0 ± 5.0 g), BD (9.6 ± 4.1 g & 9.5 ± 4.0 g) and HD (7.3 ± 3.8 g & 8.6 ± 4.4 g) conditions generated greater peak acceleration than STP (3.5 ± 1.4 g & 3.6 ± 1.7 g) across continuous and intermittent trials. CMJ and BD generated greater acceleration gradients than STP across continuous and intermittent trials. CMJ generated greater rectus femoris EMG than all other exercises, CMJ and BD generated greater semitendinosus and tibialis anterior EMG than HD across continuous and intermittent trials. CMJ and BD provide greater peak acceleration than STP and remain similar during different stimulus frequencies. CMJ, BD and HD may exceed STP in maintaining postmenopausal bone health.
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Affiliation(s)
- G Montgomery
- Musculoskeletal Science and Sports Medicine, Department of Sport and Exercise Sciences, Manchester Metropolitan University, Manchester, UK.
| | - G Abt
- School of Life Sciences, The University of Hull, Hull, UK
| | - C Dobson
- School of Engineering and Computer Science, The University of Hull, Hull, UK
| | - T Smith
- Faculty of Education, Health & Wellbeing, University of Wolverhampton, Wolverhampton, UK
| | - W Evans
- University of Sunderland, Faculty of Applied Sciences, Department of Sport and Exercise Sciences, Sunderland, UK
| | - M Ditroilo
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
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Eng L, Liu S, Farzanfar D, Smith E, McCartney A, Basgaran A, Balaratnam K, Yeung S, Brown M, Howell D, Jones J, Xu W, Goldstein D, Evans W, Selby P, Giuliani M, Liu G. Awareness of the cancer and non-cancer related harms of continued smoking in cancer survivors. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy300.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Gauvreau C, Fitzgerald N, Flanagan W, Memon S, Goffin J, Miller A, Evans W. Cost-Effectiveness of Smoking Cessation Within a Lung Cancer Screening Program in Canada. J Glob Oncol 2018. [DOI: 10.1200/jgo.18.26800] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Demonstrated lung cancer mortality reductions through low-dose computed tomography (LDCT) has encouraged some jurisdictions to consider implementing organized LDCT screening. A retrospective analysis of former smokers in the National Lung Screening Trial (NLST) suggested that abstention from smoking coupled with low-dose computed tomography (LDCT) screening realized more mortality benefits than abstinence alone or LDCT alone. Aim: We evaluated the potential costs and cost-effectiveness of lung cancer screening with integrated smoking cessation using OncoSim-Lung (version 2.5), a microsimulation model led by the Canadian Partnership Against Cancer, with model development by Statistics Canada. Methods: We compared organized LDCT screening without smoking cessation to various plausible scenarios of screening with cessation. Assumptions included: annual screening of 55-74 year-old individuals with a 30-pack-yr history; a 42% participation rate reached over 10 years; cessation therapy (nicotine replacement therapy + varenicline + 12 weeks' counseling) at a cost of $490; and up to 10 cessation attempts, with a permanent quit rate of 5% per attempt. Cost-effectiveness was estimated with a lifetime horizon, health system perspective and 1.5% discount rate. Costs are in 2016 CAD. Results: OncoSim-Lung projected that LDCT screening integrated with cessation would cost approximately $76 million annually (undiscounted) from 2017 to 2036 in Canada. About 110 fewer lung cancer (LC) cases and 50 fewer LC deaths would occur annually, compared with screening without cessation. Additionally, many other smoking-related deaths would be prevented. Using a lifetime horizon, smoking cessation would cost $14,000/QALYs gained. In one-way sensitivity analysis, with a 72% participation rate there would be 260 fewer deaths, at $24,000/QALY. With a 10% quit rate, cost-effectiveness would improve to $6,000/QALY. A 50% increase in the cost of the cessation intervention would decrease cost-effectiveness to $22,000/QALY. Conclusion: Robust smoking cessation efforts within a LDCT screening program could save lives and be relatively cost-effective. Cancer control planners should consider integrating smoking cessation when implementing a lung cancer screening initiative.
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Affiliation(s)
- C. Gauvreau
- Canadian Partnership Against Cancer, Toronto, Canada
| | - N. Fitzgerald
- Canadian Partnership Against Cancer, Toronto, Canada
| | - W. Flanagan
- Canadian Partnership Against Cancer, Toronto, Canada
| | - S. Memon
- Canadian Partnership Against Cancer, Toronto, Canada
| | - J. Goffin
- Canadian Partnership Against Cancer, Toronto, Canada
| | - A. Miller
- Canadian Partnership Against Cancer, Toronto, Canada
| | - W. Evans
- Canadian Partnership Against Cancer, Toronto, Canada
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Gauvreau C, Fitzgerald N, Hussain S, Memon S, Flanagan W, Miller A, Goffin J, Evans W. Lung Cancer–Related Clinical and Economic Impacts of Achieving a 5% Smoking Prevalence Rate by 2035 in Canada. J Glob Oncol 2018. [DOI: 10.1200/jgo.18.27500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Smoking is responsible for nearly 85% of lung cancer cases and 30% of all cancer-related deaths. Canada has set an ambitious target to reduce tobacco use to 5% by 2035 in alignment with a world-wide tobacco endgame initiative. Aim: We project the impact of achieving a national 5% smoking prevalence rate by 2035 on population-level lung cancer outcomes and costs. Methods: OncoSim-Lung (version 2.5), led by the Canadian Partnership Against Cancer with model development by Statistics Canada, is a microsimulation model that incorporates Canadian demographics, risk factors, registry data, resource utilization and other data to project clinical and economic impacts of cancer control measures. Smoking cessation parameters were modified to reduce the current average national smoking prevalence rate of 18% over time to 5% in 2035. Impacts were compared with those in a reference scenario, which maintained the current prevalence rate. Outputs of interest included lung cancer incidence, mortality, treatment costs, and quality-adjusted life-years (QALYs). Costs and QALYs are undiscounted and reported in 2016 CAD. Results: Achieving a 5% smoking rate by 2035 would result in a 2017-2035 cumulative total of 31,000 fewer lung cancer cases, 21,000 fewer lung cancer-related deaths, and 457,000 additional QALYs compared with projections based on a constant smoking prevalence rate of ∼20%. When stratified by sex, there would be 15,600 and 15,700 fewer lung cancer diagnoses and 11,000 and 10,000 fewer lung cancer-related deaths for males and females respectively. Furthermore, treatment-related costs would be reduced by $680 million dollars. On average there would be 4,500 fewer lung cancer cases, 3,500 fewer deaths, and $35 million in cost savings annually. If a 5% smoking rate is sustained until 2050, then there would be a 15% reduction in lung cancer cases and a 13% reduction in deaths from 2017-2050. Conclusion: Reducing Canada's smoking prevalence to 5% by 2035 could result in a significant reduction in lung cancer cases, deaths and treatment costs. Like Canada, other countries with relatively high smoking prevalence could use averted treatment costs to offset costs of aggressive smoking prevention and cessation programs or redirect them to other healthcare services.
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Affiliation(s)
- C. Gauvreau
- Canadian Partnership Against Cancer, Toronto, Canada
| | - N. Fitzgerald
- Canadian Partnership Against Cancer, Toronto, Canada
| | - S. Hussain
- Canadian Partnership Against Cancer, Toronto, Canada
| | - S. Memon
- Canadian Partnership Against Cancer, Toronto, Canada
| | | | - A. Miller
- University of Toronto, Toronto, Canada
| | - J. Goffin
- McMaster University, Hamilton, Canada
| | - W. Evans
- McMaster University, Hamilton, Canada
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Eng L, Liu S, Farzanfar D, Alton D, Smith E, Mccartney A, Yeung S, Basgaran A, Balaratnam K, Mattina K, Harper C, Mohan R, Brown M, Hope A, Bradbury P, Sacher A, Leighl N, Shepherd F, Bezjak A, Howell D, Jones J, Xu W, Goldstein D, Evans W, Selby P, Giuliani M, Liu G. MA18.07 Awareness of the Harms of Continued Smoking Among Lung Cancer (LC) Survivors. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Seung S, Hurry M, Walton R, Evans W. P1.15-28 Real World Treatment Patterns and Survival of Stage IV Non-Small Cell Lung Cancer (NSCLC) in Ontario, Canada. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.961] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Seung S, Hurry M, Walton R, Evans W. P1.15-27 Patient Characteristics, Treatment Patterns and Survival for Unresectable Stage III NSCLC in Ontario, Canada. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Evans W, Flanagan W, Gauvreau C, Manivong P, Memon S, Fitzgerald N, Goffin J, Garner R, Khoo E, Mittmann N. MA18.03 How in the Real World Are Lung Cancer Patients Treated? The Ontario, Canada Experience. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Moldaver D, Hurry M, Tran D, Evans W, Cheema P, Sangha R, Burkes R, Melosky B, Orava E, Grima D. P2.15-09 The Impact of Treatment Evolution in NSCLC (iTEN) Model: Survival and Cost of Treating Patients with Advanced NSCLC in 2017. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.1450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Moldaver D, Hurry M, Tran D, Evans W, Cheema P, Sangha R, Burkes R, Melosky B, Orava E, Grima D. MA18.02 The Impact of Treatment Evolution in NSCLC (iTEN) Model: Development and Validation. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Cameron E, Haque M, Schwartz N, Khan S, Truscott R, Evans W. OA09.01 5As to 3As: Evolution of the Systematic Approach to Smoking Cessation in Ontario’s Regional Cancer Centres. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Evans W, Flanagan W, Gauvreau C, Manivong P, Memon S, Fitzgerald N, Goffin J, Garner R, Khoo E, Mittmann N. How advanced lung cancer patients are really treated at the population level? The Ontario, Canada experience. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy297.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Fitzgerald N, Gauvreau C, Memon S, Hussain S, Coldman A, Popadiuk C, Evans W, Wolfson M, Flanagan W, Nadeau C, Asakawa K, Garner R, Miller A. The OncoSim Cancer Simulation Platform: A Tool to Project the Population Effects of Cancer Control Interventions in Canada. J Glob Oncol 2018. [DOI: 10.1200/jgo.18.20300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Cancer control interventions exert their effects over multiple decades. To evaluate diverse and competing opportunities to reduce future cancer burden it is desirable to understand long-term effects prior to any new program implementation or significant change. Internationally, modeling is becoming an accepted source of planning information for decision-makers. Aim: We will describe the construction and use of the OncoSim microsimulation model, which was developed to evaluate cancer control strategies in Canada. Methods: OncoSim is a suite of models (cancers of the lung, colorectum, cervix and breast, plus a composite 32-cancer model) used to address key policy questions and support decision-making. It is led by the Canadian Partnership Against Cancer with model development by Statistics Canada. OncoSim incorporates risk factors, cancer natural history, screening, treatment, survival and end-of-life care. Wherever possible it is informed by Canadian data sources. Models are calibrated to reproduce a range of cancer-specific statistics, e.g., current and historical Canadian cancer-specific incidence and mortality, smoking patterns, and results of screening. The site-specific models have undergone further validation by replicating reported short-term effects of cancer prevention and screening interventions. Users may customize interventions through modifying input parameters. Outputs include incidence, mortality, costs, cost-effectiveness, and resource utilization. Users from the public sector have access at no cost to OncoSim and receive extensive support from a multidisciplinary technical team. The model is continually updated to incorporate emerging knowledge. Results: OncoSim has been used to support cancer control decision-making at the national and provincial/territorial levels. Applications include: national guidelines recommendations for colorectal and lung cancer screening; comparison of cytology vs. HPV based cervical cancer screening; and integration of smoking cessation into low-dose CT lung cancer screening. Conclusion: Validated simulation models such as OncoSim can be a versatile and efficient tool for cancer control planners to evaluate and prioritize cancer control strategies.
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Affiliation(s)
- N. Fitzgerald
- Canadian Partnership Against Cancer, Toronto, Canada
| | - C. Gauvreau
- Canadian Partnership Against Cancer, Toronto, Canada
| | - S. Memon
- Canadian Partnership Against Cancer, Toronto, Canada
| | - S. Hussain
- Canadian Partnership Against Cancer, Toronto, Canada
| | - A. Coldman
- Canadian Partnership Against Cancer, Toronto, Canada
| | - C. Popadiuk
- Canadian Partnership Against Cancer, Toronto, Canada
| | - W. Evans
- Canadian Partnership Against Cancer, Toronto, Canada
| | - M. Wolfson
- Canadian Partnership Against Cancer, Toronto, Canada
| | - W. Flanagan
- Canadian Partnership Against Cancer, Toronto, Canada
| | - C. Nadeau
- Canadian Partnership Against Cancer, Toronto, Canada
| | - K. Asakawa
- Canadian Partnership Against Cancer, Toronto, Canada
| | - R. Garner
- Canadian Partnership Against Cancer, Toronto, Canada
| | - A. Miller
- Canadian Partnership Against Cancer, Toronto, Canada
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Schwartz N, Haque M, Cameron E, Khan S, Truscott R, Peter A, Evans W. P2.10-02 Variations in Smoking Cessation Activities at Ontario’s Regional Cancer Centres. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.1331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Evans W, Darling G, Miller B, Cameron E, Yu M, Tammemagi M. OA09.02 Acceptance of Smoking Cessation Services in Cancer Care Ontario’s Lung Cancer Screening Pilot for People at High Risk. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.282] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Evans W, Cameron E, Haque M, Schwartz N, Khan S, Truscott R. A systematic approach to smoking cessation in regional cancer centres in Ontario, Canada. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy300.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Saint R, Evans W, Zhou Y, Barrett T, Fromhold TM, Saleh E, Maskery I, Tuck C, Wildman R, Oručević F, Krüger P. 3D-printed components for quantum devices. Sci Rep 2018; 8:8368. [PMID: 29849028 PMCID: PMC5976634 DOI: 10.1038/s41598-018-26455-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 05/09/2018] [Indexed: 11/18/2022] Open
Abstract
Recent advances in the preparation, control and measurement of atomic gases have led to new insights into the quantum world and unprecedented metrological sensitivities, e.g. in measuring gravitational forces and magnetic fields. The full potential of applying such capabilities to areas as diverse as biomedical imaging, non-invasive underground mapping, and GPS-free navigation can only be realised with the scalable production of efficient, robust and portable devices. We introduce additive manufacturing as a production technique of quantum device components with unrivalled design freedom and rapid prototyping. This provides a step change in efficiency, compactness and facilitates systems integration. As a demonstrator we present an ultrahigh vacuum compatible ultracold atom source dissipating less than ten milliwatts of electrical power during field generation to produce large samples of cold rubidium gases. This disruptive technology opens the door to drastically improved integrated structures, which will further reduce size and assembly complexity in scalable series manufacture of bespoke portable quantum devices.
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Affiliation(s)
- R Saint
- School of Physics and Astronomy, The University of Nottingham, Nottingham, NG7 2RD, United Kingdom
- Department of Physics and Astronomy, University of Sussex, Brighton, BN1 9QH, United Kingdom
| | - W Evans
- School of Physics and Astronomy, The University of Nottingham, Nottingham, NG7 2RD, United Kingdom
- Department of Physics and Astronomy, University of Sussex, Brighton, BN1 9QH, United Kingdom
| | - Y Zhou
- School of Physics and Astronomy, The University of Nottingham, Nottingham, NG7 2RD, United Kingdom
| | - T Barrett
- School of Physics and Astronomy, The University of Nottingham, Nottingham, NG7 2RD, United Kingdom
- Department of Physics and Astronomy, University of Sussex, Brighton, BN1 9QH, United Kingdom
| | - T M Fromhold
- School of Physics and Astronomy, The University of Nottingham, Nottingham, NG7 2RD, United Kingdom
| | - E Saleh
- Faculty of Engineering, EPSRC Centre for Innovative Manufacturing in Additive Manufacturing, University of Nottingham, Nottingham, United Kingdom
| | - I Maskery
- Faculty of Engineering, EPSRC Centre for Innovative Manufacturing in Additive Manufacturing, University of Nottingham, Nottingham, United Kingdom
| | - C Tuck
- Faculty of Engineering, EPSRC Centre for Innovative Manufacturing in Additive Manufacturing, University of Nottingham, Nottingham, United Kingdom
| | - R Wildman
- Faculty of Engineering, EPSRC Centre for Innovative Manufacturing in Additive Manufacturing, University of Nottingham, Nottingham, United Kingdom
| | - F Oručević
- School of Physics and Astronomy, The University of Nottingham, Nottingham, NG7 2RD, United Kingdom
- Department of Physics and Astronomy, University of Sussex, Brighton, BN1 9QH, United Kingdom
| | - P Krüger
- School of Physics and Astronomy, The University of Nottingham, Nottingham, NG7 2RD, United Kingdom.
- Department of Physics and Astronomy, University of Sussex, Brighton, BN1 9QH, United Kingdom.
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Buehring B, Siglinsky E, Krueger D, Evans W, Hellerstein M, Yamada Y, Binkley N. Comparison of muscle/lean mass measurement methods: correlation with functional and biochemical testing. Osteoporos Int 2018; 29:675-683. [PMID: 29198074 DOI: 10.1007/s00198-017-4315-6] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 11/13/2017] [Indexed: 12/25/2022]
Abstract
UNLABELLED DXA-measured lean mass is often used to assess muscle mass but has limitations. Thus, we compared DXA lean mass with two novel methods-bioelectric impedance spectroscopy and creatine (methyl-d3) dilution. The examined methodologies did not measure lean mass similarly and the correlation with muscle biomarkers/function varied. INTRODUCTION Muscle function tests predict adverse health outcomes better than lean mass measurement. This may reflect limitations of current mass measurement methods. Newer approaches, e.g., bioelectric impedance spectroscopy (BIS) and creatine (methyl-d3) dilution (D3-C), may more accurately assess muscle mass. We hypothesized that BIS and D3-C measured muscle mass would better correlate with function and bone/muscle biomarkers than DXA measured lean mass. METHODS Evaluations of muscle/lean mass, function, and serum biomarkers were obtained in older community-dwelling adults. Mass was assessed by DXA, BIS, and orally administered D3-C. Grip strength, timed up and go, and jump power were examined. Potential muscle/bone serum biomarkers were measured. Mass measurements were compared with functional and serum data using regression analyses; differences between techniques were determined by paired t tests. RESULTS Mean (SD) age of the 112 (89F/23M) participants was 80.6 (6.0) years. The lean/muscle mass assessments were correlated (.57-.88) but differed (p < 0.0001) from one another with DXA total body less head being highest at 37.8 (7.3) kg, D3-C muscle mass at 21.1 (4.6) kg, and BIS total body intracellular water at 17.4 (3.5) kg. All mass assessment methods correlated with grip strength and jump power (R = 0.35-0.63, p < 0.0002), but not with gait speed or repeat chair rise. Lean mass measures were unrelated to the serum biomarkers measured. CONCLUSIONS These three methodologies do not similarly measure muscle/lean mass and should not be viewed as being equivalent. Functional tests assessing maximal muscle strength/power (grip strength and jump power) correlated with all mass measures whereas gait speed was not. None of the selected serum measures correlated with mass. Efforts to optimize muscle mass assessment and identify their relationships with health outcomes are needed.
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Affiliation(s)
- B Buehring
- University of Wisconsin Osteoporosis Clinical Research Program, 2870 University Avenue, Suite 100, Madison, WI, 53705, USA
| | - E Siglinsky
- University of Wisconsin Osteoporosis Clinical Research Program, 2870 University Avenue, Suite 100, Madison, WI, 53705, USA
| | - D Krueger
- University of Wisconsin Osteoporosis Clinical Research Program, 2870 University Avenue, Suite 100, Madison, WI, 53705, USA
| | - W Evans
- University of California, Berkeley, CA, USA
| | | | - Y Yamada
- National Institute of Health & Nutrition, Tokyo, Japan
| | - N Binkley
- University of Wisconsin Osteoporosis Clinical Research Program, 2870 University Avenue, Suite 100, Madison, WI, 53705, USA.
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Evans W, Peter A, Truscott R, Cameron E, Schwartz N, Haque M, Bassier-Paltoo M, Khan S, Giuliani M. MA 18.01 Driving Improvements in Cancer Care Ontario's Smoking Cessation Initiative for Cancer Patients in Ontario, Canada. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Evans W, Truscott R, Cameron E, Peter A, Reid R, Selby P, Smith P, Hay A. Lessons learned implementing a province-wide smoking cessation initiative in Ontario’s cancer centres. Curr Oncol 2017. [DOI: 10.3747/co.24.3506] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Purpose A large body of evidence clearly shows that cancer patients experience significant health benefits with smoking cessation. Cancer Care Ontario, the provincial agency responsible for the quality of cancer services in Ontario, has undertaken a province-wide smoking cessation initiative. The strategies used, the results achieved, and the lessons learned are the subject of the present article.Methods Evidence related to the health benefits of smoking cessation in cancer patients was reviewed. A steering committee developed a vision statement for the initiative, created a framework for implementation, and made recommendations for the key elements of the initiative and for smoking cessation best practices.Results New ambulatory cancer patients are being screened for their smoking status in each of Ontario’s 14 regional cancer centres. Current or recent smokers are advised of the benefits of cessation and are directed to smoking cessation resources as appropriate. Performance metrics are captured and used to drive improvement through quarterly performance reviews and provincial rankings of the regional cancer centres.Conclusions Regional smoking cessation champions, commitment from Cancer Care Ontario senior leadership, a provincial secretariat, and guidance from smoking cessation experts have been important enablers of early success. Data capture has been difficult because of the variety of information systems in use and non-standardized administrative and clinical processes. Numerous challenges remain, including increasing physician engagement; obtaining funding for key program elements, including in-house resources to support smoking cessation; and overcoming financial barriers to access nicotine replacement therapy. Future efforts will focus on standardizing processes to the extent possible, while tailoring the approaches to the populations served and the resources available within the individual regional cancer programs.
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Bagramian R, Abdullah F, Clarkson J, Cutress T, De Liefde B, Dooland M, Evans W, Hargreaves J, Horowitz H, Ish T, King N, Simmelink J, Skinner M, Woltgens J. Workshop on "Epidemiological indices of enamel defects". Adv Dent Res 2016. [DOI: 10.1177/08959374890030020101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Solomon T, Peake M, Butler J, Coleman M, Evans W, Jakobsen E, Boyer M, Johannesen T, Rachet B. Role of Treatment in International Differences in One-Year Mortality From Early Stage Non-Small Cell Lung Cancer: a Tentative Answer From the International Cancer Benchmarking Partnership Study. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv048.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Pakdaman A, Evans W, Howe E. Monitoring dental students' management of non-invasive intervention for dental caries. Aust Dent J 2014. [DOI: 10.1111/j.1834-7819.2007.tb06136.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Vellas B, Pahor M, Manini T, Rooks D, Guralnik JM, Morley J, Studenski S, Evans W, Asbrand C, Fariello R, Pereira S, Rolland Y, Abellan van Kan G, Cesari M, Chumlea WC, Fielding R. Designing pharmaceutical trials for sarcopenia in frail older adults: EU/US Task Force recommendations. J Nutr Health Aging 2013; 17:612-8. [PMID: 23933872 PMCID: PMC4077187 DOI: 10.1007/s12603-013-0362-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
An international task force of academic and industry leaders in sarcopenia research met on December 5, 2012 in Orlando, Florida to develop guidelines for designing and executing randomized clinical trials of sarcopenia treatments. The Task Force reviewed results from previous trials in related disease areas to extract lessons relevant to future sarcopenia trials, including practical issues regarding the design and conduct of trials in elderly populations, the definition of appropriate target populations, and the selection of screening tools, outcome measures, and biomarkers. They discussed regulatory issues, the challenges posed by trials of different types of interventions, and the need for standardization and harmonization. The Task Force concluded with recommendations for advancing the field toward better clinical trials.
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Affiliation(s)
- B Vellas
- University of Toulouse III, Toulouse, France
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Ung Y, Evans W, Assouad N, Sawka C. Lung Cancer Disease Pathway Management Initiative: A Novel Approach to Provincial Quality Improvement. Int J Radiat Oncol Biol Phys 2012. [DOI: 10.1016/j.ijrobp.2012.07.1446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Cooper C, Dere W, Evans W, Kanis JA, Rizzoli R, Sayer AA, Sieber CC, Kaufman JM, Abellan van Kan G, Boonen S, Adachi J, Mitlak B, Tsouderos Y, Rolland Y, Reginster JYL. Frailty and sarcopenia: definitions and outcome parameters. Osteoporos Int 2012; 23:1839-48. [PMID: 22290243 DOI: 10.1007/s00198-012-1913-1] [Citation(s) in RCA: 217] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2011] [Accepted: 12/13/2011] [Indexed: 12/15/2022]
Abstract
An operational definition of musculoskeletal decline in older people is needed to allow development of interventions for prevention or treatment, as was developed for the treatment of osteoporosis. Frailty and sarcopenia are linked, but distinct, correlates of musculoskeletal aging that have many causes, including age-related changes in body composition, inflammation, and hormonal imbalance. With the emergence of a number of exciting candidate therapies to retard the loss of muscle mass with aging, the derivation of a consensual definition of sarcopenia and physical frailty becomes an urgent priority. Although several consensual definitions have been proposed, these require clinical validation. An operational definition, which might provide a threshold for treatment/trial inclusion, should incorporate a loss of muscle mass as well as evidence of a decrease in muscle strength and/or physical activity. Evidence is required for a link between improvements in the measures of muscle strength and/or physical activity and clinical outcomes to allow development of interventions to improve clinical outcomes in frail older patients.
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Affiliation(s)
- C Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, England, UK.
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Davies E, Wieboldt J, Stanley T, Maeda Y, Smyth M, Stanley S, McClean M, Evans W, Funston C, Millar BC, Goldsmith CE, Moore JE. Isolation and identification of 'Mycobacterium angelicum' from a patient with type II respiratory failure: suggested reporting guidelines to molecular clinical laboratories. Br J Biomed Sci 2012; 69:134-136. [PMID: 23057162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- E Davies
- Department of Microbiology, Causeway Hospital, Coleraine, Co. Londonderry, Northern Ireland, UK
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Ung Y, Gu C, Cline K, Sun A, MacRae R, Wright J, Yu E, Evans W, Julian J, Levine M. An Ontario Clinical Oncology (OCOG) Randomized Trial (PET START) of FDG PET/CT in Stage 3 Non-small Cell Lung Cancer (NSCLC): Impact of PET on Survival. Int J Radiat Oncol Biol Phys 2011. [DOI: 10.1016/j.ijrobp.2011.06.282] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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Gomez-Iturriaga A, Crook J, Evans W, Parameswaran SE, Jezioranski J. 680 poster THE EFFICACY OF HYPERBARIC OXYGEN THERAPY IN THE TREATMENT OF MEDICALLY REFRACTORY SOFT TISSUE NECROSIS AFTER PENILE BRACHYTHERAPY. Radiother Oncol 2011. [DOI: 10.1016/s0167-8140(11)70802-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
The prevalence of type 2 diabetes is increasing continuously, especially in older people. Such a rapidly rising risk has been linked to physical inactivity and evolutionary changes in dietary patterns (mainly characterized by a greater intake in dietary fat). Increased physical activity in any age group is associated with a lower risk of developing type 2 diabetes. Epidemiological studies also reported a lower incidence of type 2 diabetes in individuals who consumed n-3 polyunsaturated fatty acids (PUFA), while intake of total, saturated and/or monounsaturated fat was associated with increased risk of type 2 diabetes in glucose-intolerant individuals. Furthermore, the beneficial effects of PUFA consumption on cardiovascular disease were mainly attributed to their effects on reducing triglyceride levels, increasing high density lipoprotein cholesterol, and improving endothelial function through anti-inflammatory mechanisms and reduced platelet aggregation. In addition to common diabetic complications such as dyslipidemia and cardiovascular disease, elderly people with type 2 diabetes are at greater risk of specific geriatric syndromes, such as cognitive decline and physical disability. The threats of physical disability, loss of independence and loss of cognitive performance which diminish quality of life may ultimately be the greatest concern for those with type 2 diabetes. In this review we will address: i) specific dietary fat intake patterns and the development of insulin resistance and type 2 diabetes, ii) the effects of PUFA supplementation on glucose metabolism, diabetic dyslipidemia and cardiovascular disease, iii) the potential advantages of PUFA supplementation on cognitive decline and physical disability in the elderly.
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Affiliation(s)
- A M Abbatecola
- Scientific Direction, Italian National Research Center on Aging (INRCA), Ancona, Italy
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Ung Y, Sun A, MacRae R, Gu C, Wright J, Yu E, Darling G, Leighl N, Evans W, Levine M. 30 PET START: THE FIRST RANDOMIZED CLINICAL TRIAL EVALUATING THE IMPACT OF POSITRON EMISSION TOMOGRAPHY IN STAGE III NON-SMALL CELL LUNG CANCER. Radiother Oncol 2009. [DOI: 10.1016/s0167-8140(12)72417-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Darling G, Maziak D, Inculet R, Gulenchyn K, Driedger A, Ung Y, Miller J, Gu C, Evans W, Levine M. PET-CT compared to invasive mediastinal staging in non-small cell lung cancer (NSCLC). J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.7575] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
7575 Background: In patients with NSCLC, preoperative staging tests including mediastinoscopy (M) are important in defining which patients are surgical candidates. 18FDG PET-CT is useful in identifying patients with mediastinal disease not evident by CT. Alternatively, M may not be required if PET-CT is negative. We have previously reported reduced rates of unnecessary thoracotomy (T) in the PET-CT arm of a trial which compared staging with PET-CT versus conventional imaging (bone scan and CT liver and adrenals) in patients with clinical stage I, II, or IIIA NSCLC being considered for surgery (J Clin Oncol 26 May 20 suppl: abstr 7502). Methods: In this analysis, we determined the accuracy of PET-CT in mediastinal staging compared to invasive surgical staging either by M alone or by M and T. Patients in the PET-CT arm had invasive mediastinal staging either by M or mediastinal nodal sampling at T. PET-CT was considered positive if N2 or N3 nodes exhibited increased 18FDG uptake. Results: M was performed in 81 of 143 patients in the PET-CT arm; the remainder had mediastinal nodal staging at T. Combining M with T, the sensitivity and specificity of PET-CT were 0.70 [95% CI: 0.48–0.85] and 0.94 [95%CI: 0.89–0.97], respectively. Of 21 patients with a positive PET-CT, 7 did not have tumor. The positive predictive value (PPV) and negative predictive value (NPV) were 0.67 [95% CI: 0.45–0.83] and 0.95 [95% CI: 0.90–0.98], respectively. The results for PET-CT versus M alone were: sensitivity, 1.0 [95% CI: 0.76–1.0]; specificity, 0.88 [95%CI: 0.79–0.94]; PPV, 0.60 [95%CI: 0.39–0.78]; NPV, 1.0 [95% CI: 0.94–1.0]. Based on PET-CT alone, 7 patients would have been denied T if PET-CT abnormalities had not been evaluated with invasive mediastinal staging. Conclusions: Mediastinal abnormalities on PET-CT should be confirmed by invasive mediastinal staging because of the risk of a false positive test. Patients should not be denied potentially curative therapy based on PET-CT alone. If PET-CT is negative in the mediastinum, the likelihood of occult metastatic disease in the mediastinum is very low and invasive staging may not be required depending on the clinical context. No significant financial relationships to disclose.
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Affiliation(s)
- G. Darling
- University of Toronto, Toronto General, UHN, Toronto, ON, Canada; University of Ottawa, The Ottawa Hospital, Ottawa, ON, Canada; University of Western Ontario, LHSC, London, ON, Canada; McMaster University, Hamilton Health Sciences, Hamilton, ON, Canada; University of Toronto, Sunnybrook Odette Cancer Center, Toronto, ON, Canada; McMaster University, St. Joseph's Healthcare, Hamilton, ON, Canada; McMaster University, OCOG, Hamilton, ON, Canada; McMaster University, Juravinski Cancer Center, HHS, Hamilton
| | - D. Maziak
- University of Toronto, Toronto General, UHN, Toronto, ON, Canada; University of Ottawa, The Ottawa Hospital, Ottawa, ON, Canada; University of Western Ontario, LHSC, London, ON, Canada; McMaster University, Hamilton Health Sciences, Hamilton, ON, Canada; University of Toronto, Sunnybrook Odette Cancer Center, Toronto, ON, Canada; McMaster University, St. Joseph's Healthcare, Hamilton, ON, Canada; McMaster University, OCOG, Hamilton, ON, Canada; McMaster University, Juravinski Cancer Center, HHS, Hamilton
| | - R. Inculet
- University of Toronto, Toronto General, UHN, Toronto, ON, Canada; University of Ottawa, The Ottawa Hospital, Ottawa, ON, Canada; University of Western Ontario, LHSC, London, ON, Canada; McMaster University, Hamilton Health Sciences, Hamilton, ON, Canada; University of Toronto, Sunnybrook Odette Cancer Center, Toronto, ON, Canada; McMaster University, St. Joseph's Healthcare, Hamilton, ON, Canada; McMaster University, OCOG, Hamilton, ON, Canada; McMaster University, Juravinski Cancer Center, HHS, Hamilton
| | - K. Gulenchyn
- University of Toronto, Toronto General, UHN, Toronto, ON, Canada; University of Ottawa, The Ottawa Hospital, Ottawa, ON, Canada; University of Western Ontario, LHSC, London, ON, Canada; McMaster University, Hamilton Health Sciences, Hamilton, ON, Canada; University of Toronto, Sunnybrook Odette Cancer Center, Toronto, ON, Canada; McMaster University, St. Joseph's Healthcare, Hamilton, ON, Canada; McMaster University, OCOG, Hamilton, ON, Canada; McMaster University, Juravinski Cancer Center, HHS, Hamilton
| | - A. Driedger
- University of Toronto, Toronto General, UHN, Toronto, ON, Canada; University of Ottawa, The Ottawa Hospital, Ottawa, ON, Canada; University of Western Ontario, LHSC, London, ON, Canada; McMaster University, Hamilton Health Sciences, Hamilton, ON, Canada; University of Toronto, Sunnybrook Odette Cancer Center, Toronto, ON, Canada; McMaster University, St. Joseph's Healthcare, Hamilton, ON, Canada; McMaster University, OCOG, Hamilton, ON, Canada; McMaster University, Juravinski Cancer Center, HHS, Hamilton
| | - Y. Ung
- University of Toronto, Toronto General, UHN, Toronto, ON, Canada; University of Ottawa, The Ottawa Hospital, Ottawa, ON, Canada; University of Western Ontario, LHSC, London, ON, Canada; McMaster University, Hamilton Health Sciences, Hamilton, ON, Canada; University of Toronto, Sunnybrook Odette Cancer Center, Toronto, ON, Canada; McMaster University, St. Joseph's Healthcare, Hamilton, ON, Canada; McMaster University, OCOG, Hamilton, ON, Canada; McMaster University, Juravinski Cancer Center, HHS, Hamilton
| | - J. Miller
- University of Toronto, Toronto General, UHN, Toronto, ON, Canada; University of Ottawa, The Ottawa Hospital, Ottawa, ON, Canada; University of Western Ontario, LHSC, London, ON, Canada; McMaster University, Hamilton Health Sciences, Hamilton, ON, Canada; University of Toronto, Sunnybrook Odette Cancer Center, Toronto, ON, Canada; McMaster University, St. Joseph's Healthcare, Hamilton, ON, Canada; McMaster University, OCOG, Hamilton, ON, Canada; McMaster University, Juravinski Cancer Center, HHS, Hamilton
| | - C. Gu
- University of Toronto, Toronto General, UHN, Toronto, ON, Canada; University of Ottawa, The Ottawa Hospital, Ottawa, ON, Canada; University of Western Ontario, LHSC, London, ON, Canada; McMaster University, Hamilton Health Sciences, Hamilton, ON, Canada; University of Toronto, Sunnybrook Odette Cancer Center, Toronto, ON, Canada; McMaster University, St. Joseph's Healthcare, Hamilton, ON, Canada; McMaster University, OCOG, Hamilton, ON, Canada; McMaster University, Juravinski Cancer Center, HHS, Hamilton
| | - W. Evans
- University of Toronto, Toronto General, UHN, Toronto, ON, Canada; University of Ottawa, The Ottawa Hospital, Ottawa, ON, Canada; University of Western Ontario, LHSC, London, ON, Canada; McMaster University, Hamilton Health Sciences, Hamilton, ON, Canada; University of Toronto, Sunnybrook Odette Cancer Center, Toronto, ON, Canada; McMaster University, St. Joseph's Healthcare, Hamilton, ON, Canada; McMaster University, OCOG, Hamilton, ON, Canada; McMaster University, Juravinski Cancer Center, HHS, Hamilton
| | - M. Levine
- University of Toronto, Toronto General, UHN, Toronto, ON, Canada; University of Ottawa, The Ottawa Hospital, Ottawa, ON, Canada; University of Western Ontario, LHSC, London, ON, Canada; McMaster University, Hamilton Health Sciences, Hamilton, ON, Canada; University of Toronto, Sunnybrook Odette Cancer Center, Toronto, ON, Canada; McMaster University, St. Joseph's Healthcare, Hamilton, ON, Canada; McMaster University, OCOG, Hamilton, ON, Canada; McMaster University, Juravinski Cancer Center, HHS, Hamilton
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Sussman J, Evans W, Whelan T, Bainbridge D, Schiff S, Hasler A. Integration between primary care providers and the cancer system: Gaps and opportunities. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.6584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
6584 Background: A number of reports suggest that family physicians (FPs) are poorly integrated with the cancer care system. The specific gaps in care integration are poorly understood. In this study we examine specific processes of care associated with integration between FPs and regional cancer programs. Methods: Cross sectional survey of all identified primary care providers within a representative health region in Ontario, Canada. The survey instrument was created specifically for this study with items generated from published literature and expert input and pilot tested in a representative sample. A modified dilman method was used. Results: 500 physicians responded (response rate 60%). Overall 90% of respondants reported confidence in the workup of a new cancer case for the major disease sites but only half (54%) knew the process of referring to the regional cancer program. Only 57% felt investigations necessary could be done in a timely manner and 44% indicated that coordination of care needs to be improved. Most indicated preferance for an active navigation structure for newly diagnosed patients. Despite over 80% of respondents indicating use of the internet only 10% reported accessing cancer program web portals for information on the regional cancer program (such as waiting times). The majority of respondants (75%) indicated ongoing involvement in care during the active treatment phase, mostly for non cancer related medical issues but 20% indicated that they were not properly infomed of patients’ health status by the oncology program and only 57% indicated that they felt their role was valued by the cancer program during this phase in the care trajectory. In the follow up phase, 35% were unclear of their role specific to monitoring and surveillance. 60% felt their current compensation model was inadequate to support care of cancer patients. This did not vary by compensation model reported. Factors associated with better integration included attendance at educational sessions and years in practice. Conclusions: Cancer systems need to be more responsive to the needs of FPs to better integrate them and support optimal quality of care for cancer patients. Policies to clarify and support roles and responsibilites are necessary to ensure that FPs are integrated team members. No significant financial relationships to disclose.
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Affiliation(s)
- J. Sussman
- Juravinski Cancer Centre, Hamilton, ON, Canada
| | - W. Evans
- Juravinski Cancer Centre, Hamilton, ON, Canada
| | - T. Whelan
- Juravinski Cancer Centre, Hamilton, ON, Canada
| | | | - S. Schiff
- Juravinski Cancer Centre, Hamilton, ON, Canada
| | - A. Hasler
- Juravinski Cancer Centre, Hamilton, ON, Canada
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Ung Y, Sun A, MacRae R, Gu C, Wright J, Yu E, Darling G, Leighl N, Evans W, Levine M. Impact of positron emission tomography (PET) in stage III non-small cell lung cancer (NSCLC): A prospective randomized trial (PET START). J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.7548] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
7548 Background: Patients with stage III NSCLC are potentially curable using combined modality therapy (CMT) with chemotherapy and radical radiation (RT). The use of PET-CT rather than conventional imaging (CI) may better identify patients for CMT by enhanced tumor staging and improved definition of RT treatment volumes. Methods: Patients with stage III NSCLC (based on histology/cytology, brain CT/MRI, CT thorax, CT/US abdomen, and bone scan) who were considered candidates for CMT were randomized to either PET-CT or CT for RT treatment planning. The primary outcome was the proportion of patients who did not receive CMT because their tumor was upstaged to Stage 4 or their intrathoracic tumor was too extensive for radical RT. Overall survival (OS) and alteration of RT treatment planning volume were secondary outcomes. Target sample size was 400 patients based on a hazard rate reduction of 30% in OS at 2 years in favor of PET-CT with 2-sided alpha = 0.05 and 80% power. We also postulated that 200 patients would be required to detect a 20% difference between arms for the primary endpoint. 5 centers in Ontario participated. Results: The trial commenced in August 2004. In November 2008 after a planned interim analysis for the primary outcome, the Data Safety Monitoring Board recommended stopping recruitment because of superior efficacy with PET-CT. 304 patients were randomized and 289 had analyzable data. 25 patients were unsuitable for CMT: 21 in the PET-CT arm (16 upstaged to Stage 4 and 5 unsuitable for radical RT) and 4 in the CT arm (unsuitable for radical RT). Thus, 21 of 140 (15%) patients in the PET-CT arm achieved the primary outcome compared with 4 of 149 (2.7%) in the CT arm, P= 0.0002. Conclusions: This is the first randomized trial in stage III NSCLC showing that PET-CT is superior to CT planning alone in selecting appropriate patients for CMT. Longer patient follow-up will determine potential impact on OS. No significant financial relationships to disclose.
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Affiliation(s)
- Y. Ung
- University of Toronto, Sunnybrook Odette Cancer Center, Toronto, ON, Canada; University of Toronto, PMH, UHN, Toronto, ON, Canada; University of Ottawa, The Ottawa Hospital, Ottawa, ON, Canada; McMaster University, OCOG, Hamilton, ON, Canada; McMaster University, Juravinski Cancer Center, Hamilton, ON, Canada; University of Western Ontario, LHSC, London, ON, Canada; University of Toronto, Toronto General, UHN, Toronto, ON, Canada
| | - A. Sun
- University of Toronto, Sunnybrook Odette Cancer Center, Toronto, ON, Canada; University of Toronto, PMH, UHN, Toronto, ON, Canada; University of Ottawa, The Ottawa Hospital, Ottawa, ON, Canada; McMaster University, OCOG, Hamilton, ON, Canada; McMaster University, Juravinski Cancer Center, Hamilton, ON, Canada; University of Western Ontario, LHSC, London, ON, Canada; University of Toronto, Toronto General, UHN, Toronto, ON, Canada
| | - R. MacRae
- University of Toronto, Sunnybrook Odette Cancer Center, Toronto, ON, Canada; University of Toronto, PMH, UHN, Toronto, ON, Canada; University of Ottawa, The Ottawa Hospital, Ottawa, ON, Canada; McMaster University, OCOG, Hamilton, ON, Canada; McMaster University, Juravinski Cancer Center, Hamilton, ON, Canada; University of Western Ontario, LHSC, London, ON, Canada; University of Toronto, Toronto General, UHN, Toronto, ON, Canada
| | - C. Gu
- University of Toronto, Sunnybrook Odette Cancer Center, Toronto, ON, Canada; University of Toronto, PMH, UHN, Toronto, ON, Canada; University of Ottawa, The Ottawa Hospital, Ottawa, ON, Canada; McMaster University, OCOG, Hamilton, ON, Canada; McMaster University, Juravinski Cancer Center, Hamilton, ON, Canada; University of Western Ontario, LHSC, London, ON, Canada; University of Toronto, Toronto General, UHN, Toronto, ON, Canada
| | - J. Wright
- University of Toronto, Sunnybrook Odette Cancer Center, Toronto, ON, Canada; University of Toronto, PMH, UHN, Toronto, ON, Canada; University of Ottawa, The Ottawa Hospital, Ottawa, ON, Canada; McMaster University, OCOG, Hamilton, ON, Canada; McMaster University, Juravinski Cancer Center, Hamilton, ON, Canada; University of Western Ontario, LHSC, London, ON, Canada; University of Toronto, Toronto General, UHN, Toronto, ON, Canada
| | - E. Yu
- University of Toronto, Sunnybrook Odette Cancer Center, Toronto, ON, Canada; University of Toronto, PMH, UHN, Toronto, ON, Canada; University of Ottawa, The Ottawa Hospital, Ottawa, ON, Canada; McMaster University, OCOG, Hamilton, ON, Canada; McMaster University, Juravinski Cancer Center, Hamilton, ON, Canada; University of Western Ontario, LHSC, London, ON, Canada; University of Toronto, Toronto General, UHN, Toronto, ON, Canada
| | - G. Darling
- University of Toronto, Sunnybrook Odette Cancer Center, Toronto, ON, Canada; University of Toronto, PMH, UHN, Toronto, ON, Canada; University of Ottawa, The Ottawa Hospital, Ottawa, ON, Canada; McMaster University, OCOG, Hamilton, ON, Canada; McMaster University, Juravinski Cancer Center, Hamilton, ON, Canada; University of Western Ontario, LHSC, London, ON, Canada; University of Toronto, Toronto General, UHN, Toronto, ON, Canada
| | - N. Leighl
- University of Toronto, Sunnybrook Odette Cancer Center, Toronto, ON, Canada; University of Toronto, PMH, UHN, Toronto, ON, Canada; University of Ottawa, The Ottawa Hospital, Ottawa, ON, Canada; McMaster University, OCOG, Hamilton, ON, Canada; McMaster University, Juravinski Cancer Center, Hamilton, ON, Canada; University of Western Ontario, LHSC, London, ON, Canada; University of Toronto, Toronto General, UHN, Toronto, ON, Canada
| | - W. Evans
- University of Toronto, Sunnybrook Odette Cancer Center, Toronto, ON, Canada; University of Toronto, PMH, UHN, Toronto, ON, Canada; University of Ottawa, The Ottawa Hospital, Ottawa, ON, Canada; McMaster University, OCOG, Hamilton, ON, Canada; McMaster University, Juravinski Cancer Center, Hamilton, ON, Canada; University of Western Ontario, LHSC, London, ON, Canada; University of Toronto, Toronto General, UHN, Toronto, ON, Canada
| | - M. Levine
- University of Toronto, Sunnybrook Odette Cancer Center, Toronto, ON, Canada; University of Toronto, PMH, UHN, Toronto, ON, Canada; University of Ottawa, The Ottawa Hospital, Ottawa, ON, Canada; McMaster University, OCOG, Hamilton, ON, Canada; McMaster University, Juravinski Cancer Center, Hamilton, ON, Canada; University of Western Ontario, LHSC, London, ON, Canada; University of Toronto, Toronto General, UHN, Toronto, ON, Canada
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Affiliation(s)
- W Evans
- Cardiac Department of the London Hospital
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