Lung Cancer and COPD: Opportunities to Leverage Lung Cancer Screening Programs to Improve COPD Diagnostics.

Lung cancer and chronic obstructive pulmonary disease (COPD) have many shared risk factors and not surprisingly, the two diseases often coexist. This article highlights the burden of COPD among patients with lung cancer in Ontario and explores opportunities to enhance lung cancer screening programs. We propose pursuing integrated strategies that incorporate new advances in artificial intelligence to improve disease diagnostics and navigate the complexity of caring for people with coexisting lung diseases.

Molecular Expression Assays Improve the Prediction of Local and Invasive Local Recurrence After Breast-Conserving Surgery for Ductal Carcinoma In Situ.

Purpose: Ductal carcinoma in situ (DCIS) is routinely treated with adjuvant radiotherapy (RT) after breast-conserving surgery (BCS). The inability to accurately estimate an individual's risk of local recurrence (LR) and invasive LR using clinicopathologic factors (CPF) contributes to the overtreatment of DCIS. We examined the impact of the 12-gene DCIS Score (DS) and the 21-gene Recurrence Score (RS) on the accuracy of predicting LR and invasive LR.

BETTER LIFE- guidelines for chronic disease preventive care for people aged 18-39 years: a literature review.

Background: The original 'BETTER' (Building on Existing Tools To Improve Chronic Disease Prevention and Screening in Primary Care) approach consisted of a prevention-focused visit between participants aged 40-65 years and a "Prevention Practitioner" (PP), who empowered the participant to set achievable prevention and screening goals for cancers and chronic diseases. BETTER was successfully adapted for economically deprived communities (BETTER HEALTH) in Canada. Our objective was to conduct a review of guidelines in preparation for adapting the 'BETTER HEALTH' approach for younger adults aged 18-39 years living with lower income, a group known to have earlier mortality due to a higher prevalence of preventable chronic diseases than their peers with higher income.

Adaptation and qualitative evaluation of the BETTER intervention for chronic disease prevention and screening by public health nurses in low income neighbourhoods: views of community residents.

Background: The BETTER intervention is an effective comprehensive evidence-based program for chronic disease prevention and screening (CDPS) delivered by trained prevention practitioners (PPs), a new role in primary care. An adapted program, BETTER HEALTH, delivered by public health nurses as PPs for community residents in low income neighbourhoods, was recently shown to be effective in improving CDPS actions. To obtain a nuanced understanding about the CDPS needs of community residents and how the BETTER HEALTH intervention was perceived by residents, we studied how the intervention was adapted to a public health setting then conducted a post-visit qualitative evaluation by community residents through focus groups and interviews.

Personalizing the Treatment of Women with Ductal Carcinoma In Situ (DCIS) Using the DCIS Score: A Qualitative Study on Score Use.

Background: A twelve-gene molecular expression assay (DCIS score) may help guide radiation oncology treatment under specific circumstances. We undertook a study to examine radiation oncologist (RO), surgeon, and decision maker views on implementing the DCIS score in practice for women with low-risk DCIS.

Methods: We conducted a qualitative study involving telephone interviews that were audio-recorded and transcribed.

Impact of chronic obstructive pulmonary disease on lung cancer symptom burden: a population-based study in Ontario, Canada.

Background: Chronic obstructive pulmonary disease (COPD) and lung cancer commonly coexist and have significant symptom overlap. We sought to compare the symptom burden of lung cancer patients with COPD to those without COPD.

Methods: We conducted a retrospective, cross-sectional study of stage I-IV lung cancer patients in Ontario, Canada, who completed the Edmonton Symptom Assessment Scale (ESAS) within 90 days of diagnosis.

Palliative Care Among Lung Cancer Patients With and Without COPD: A Population-Based Cohort Study.

Context: Lung cancer patients with chronic obstructive pulmonary disease (COPD) may have greater palliative care needs due to poor prognosis and symptom burden.

Objectives: We sought to compare the provision of timely palliative care and symptom burden by COPD status.

Methods: We performed a retrospective, population-based cohort study of individuals diagnosed with lung cancer in Ontario, Canada (2009-2019) using health administrative databases and cancer registries.

Analysis of Time to Treatment and Survival Among Adults Younger Than 50 Years of Age With Colorectal Cancer in Canada.

Importance: Colorectal cancer (CRC) is uncommon in adults younger than 50 years of age, so this population may experience delays to treatment that contribute to advanced stage and poor survival.

Objective: To investigate whether there is an association between time from presentation to treatment and survival in younger adults with CRC.

Design, Setting, And Participants: This retrospective cohort study used linked population-based data in Ontario, Canada.

Association between COPD and Stage of Lung Cancer Diagnosis: A Population-Based Study.

Chronic obstructive pulmonary disease (COPD) is associated with an increased risk of lung cancer; however, the association between COPD and stage of lung cancer diagnosis is unclear. We conducted a population-based cross-sectional analysis of lung cancer patients (2008-2020) in Ontario, Canada. Using estimated propensity scores and inverse probability weighting, logistic regression models were developed to assess the association between COPD and lung cancer stage at diagnosis (early: I/II, advanced: III/IV), accounting for prior chest imaging.

Can Molecular Biomarkers Help Reduce the Overtreatment of DCIS?

Ductal carcinoma in situ (DCIS), especially in the era of mammographic screening, is a commonly diagnosed breast tumor. Despite the low breast cancer mortality risk, management with breast conserving surgery (BCS) and radiotherapy (RT) is the prevailing treatment approach in order to reduce the risk of local recurrence (LR), including invasive LR, which carries a subsequent risk of breast cancer mortality. However, reliable and accurate individual risk prediction remains elusive and RT continues to be standardly recommended for most women with DCIS.

Impact of non-adherence to endocrine therapy on recurrence risk in older women with stage I breast cancer after breast-conserving surgery.

Purpose: We examined the impact of non-adherence to adjuvant endocrine therapy (ET) on the risk and site of recurrence among older women with early stage, hormone receptor positive (HR+) breast cancer (EBC).

Methods: A population-based cohort of women age ≥ 65 years with T1N0 HR + EBC who were diagnosed between 2010 and 2016 and treated with breast-conserving surgery (BCS) + ET was identified. Treatment and outcomes were ascertained through linkage with administrative databases.

Residual Risk of Breast Cancer After Bariatric Surgery.

Importance: Excess adiposity confers higher risk of breast cancer for women. For women who have lost substantial weight, it is unclear whether previous obesity confers residual increased baseline risk of breast cancer compared with peers without obesity.

Objectives: To determine whether there is a residual risk of breast cancer due to prior obesity among patients who undergo bariatric surgery.

The Association Between Surgical Axillary Staging, Adjuvant Treatment Use and Survival in Older Women with Early Stage Breast Cancer: A Population-Based Study.

Background: Choosing Wisely guidelines recommend against surgical axillary staging (AS) in women ≥70 years with ER+/HER2- early stage breast cancer (BC). This study examined the impact of AS omission on survival in older patients with BC.

Methods: This was a population-based cohort study using health administrative data in Ontario, Canada.

Comparing Time to Diagnosis and Treatment Between Younger and Older Adults With Colorectal Cancer: A Population-Based Study.

Background & Aims: Younger adults (aged <50 years) with colorectal cancer (CRC) may have prolonged delays to diagnosis and treatment that are associated with adverse outcomes. We compared delay intervals by age for patients with CRC in a large population.

Methods: This was a population-based study of adults diagnosed with CRC in Ontario, Canada, from 2003 to 2018.

Clinical Delays and Comparative Outcomes in Younger and Older Adults with Colorectal Cancer: A Systematic Review.

Outcome disparities between adults <50 with colorectal cancer (CRC) and older adults may be explained by clinical delays. This study synthesized the literature comparing delays and outcomes between younger and older adults with CRC. Databases were searched until December 2021.

Measurement of clinical delay intervals among younger adults with colorectal cancer using health administrative data: a population-based analysis.

Background: Clinical delays may be important contributors to outcomes among younger adults (<50 years) with colorectal cancer (CRC). We aimed to describe delay intervals for younger adults with CRC using health administrative data to understand drivers of delay in this population.

Methods: This was a population-based study of adults <50 diagnosed with CRC in Ontario, Canada from 2003 to 2018.

Time to diagnosis and treatment in younger adults with colorectal cancer: A systematic review.

Background: The incidence of colorectal cancer is rising in adults <50 years of age. As a primarily unscreened population, they may have clinically important delays to diagnosis and treatment. This study aimed to review the literature on delay intervals in patients <50 years with colorectal cancer (CRC), and explore associations between longer intervals and outcomes.

Omission of Axillary Staging and Survival in Elderly Women With Early Stage Breast Cancer: A Population-Based Cohort Study.

Objectives: Determine if axillary staging is associated with survival in elderly women with breast cancer.

Background: Axillary staging in women ≥ 70 years with early-stage breast cancer is controversial. Older randomized evidence has not shown axillary staging improves survival, but recent observational studies have been mixed and widespread de-implementation of the practice has not occurred.

Uptake and Short-term Outcomes of High-risk Screening Colonoscopy Billing Codes: A Population-based Study Among Young Adults.

Background: Persons suspected or confirmed with familial colorectal cancer syndrome are recommended to have biennial colonoscopy from late adolescence or early adulthood. Persons without a syndrome but with one or more affected first-degree relatives are recommended to begin colonoscopy 10 years before the age at diagnosis of the youngest affected relative, and every 5 to 10 years. Ontario introduced colonoscopy billing codes for these two indications in 2011.

Effect of Chronic Comorbidities on Follow-up Colonoscopy After Positive Colorectal Cancer Screening Results: A Population-Based Cohort Study.

Introduction: Fecal occult blood tests (FOBTs) are colorectal cancer screening tests used to identify individuals requiring further investigation with colonoscopy. Delayed colonoscopy after positive FOBT (FOBT+) is associated with poorer cancer outcomes. We assessed the effect of comorbidity on colonoscopy receipt within 12 months after FOBT+.

Bariatric Surgery and Breast Cancer Incidence: a Population-Based, Matched Cohort Study.

Purpose: Obesity is associated with increased breast cancer risk in women. Bariatric surgery induces substantial weight loss. However, the effects of such weight loss on subsequent breast cancer risk in women with obesity are poorly understood.

Long-term outcomes of women with large DCIS lesions treated with breast-conserving therapy.

Purpose: The paucity of data on women with large (≥ 40 mm) DCIS tumors lead to uncertainty on the safety of breast-conserving surgery (BCS) for these patients. We evaluated the impact of large tumor size on local recurrence (LR) among women with DCIS treated with BCS ± radiotherapy (RT).

Methods: Treatment and outcomes were ascertained through administrative databases for all women with DCIS in Ontario from 1994 to 2003 treated with BCS ± RT with negative margins; 82% had pathology review.

Two randomized controlled trials for colorectal cancer screening invitations developed using a behavioral science approach.

The effectiveness of behaviorally informed, targeted invitations to standard invitations and to no invitation (control arm, primary analysis) were compared in the context of an organized colorectal cancer (CRC) screening program. Two multi-arm, pragmatic randomized controlled trials in men (arms: male-specific, unisex, standard invitation, or no invitation) and in women (arms: unisex, standard invitation, or no invitation), were conducted in Ontario, Canada. Eligible persons aged 50-74, due for CRC screening, were randomized.