Explore the vast range of titles available.

To achieve this goal the institute divided its operation into four strands: two of the strands were the research areas - the study of advanced radiation therapy and biology, which worked separatively but cooperatively; a third was patient care; and the fourth element was leadership, provided by the clinical chiefs, the heads of the research divisions, and the administration, in particular the institute's first administrator, John Law. Together these strands helped create a philosophy that made the Ontario Cancer Institute unique and provided the basis for its national and international success. Essential to these successes was a new graduate department, Medical Biophysics, based in the University of Toronto School of Graduate Studies. This department, which provided an innovative, research-based doctoral and masters program, meant that the OCI could accurately be described as a centre for cancer treatment, research, and education. McCulloch describes how the first quantitative assay for stem cells played a major role in bringing OCI research to the international stage as well as influencing other science and much of the clinical thinking in the Institute. Other major advances that brought international recognition have been the identification of the mechanisms that allow cancer cells to resist death from the effects of a variety of different tumours and the isolation of the gene that encodes the T cell receptor, a critical part of the immune apparatus for dealing with foreign cells and viruses. McCulloch also details how lack of space to meet growing demands was a continuing source of frustration and disagreement, and how sometimes serious interpersonal problems hindered the forward thrust of development. Describing these events as well as institute's successes, he provides an insight into the history of Canada's premier cancer research centre.

ABSTRACTBackgroundCancer surveillance data are essential to help understand where gaps exist and progress is being made in cancer control. We sought to summarize the expected impact of cancer in Canada in 2024, with projections of new cancer cases and deaths from cancer by sex and province or territory for all ages combined. MethodsWe obtained data on new cancer cases (i.e., incidence, 1984–2019) and deaths from cancer (i.e., mortality, 1984–2020) from the Canadian Cancer Registry and Canadian Vital Statistics Death Database, respectively. We projected cancer incidence and mortality counts and rates to 2024 for 23 types of cancer, overall, by sex, and by province or territory. We calculated age-standardized rates using data from the 2011 Canadian standard population. ResultsIn 2024, the number of new cancer cases and deaths from cancer are expected to reach 247 100 and 88 100, respectively. The age-standardized incidence rate (ASIR) and mortality rate (ASMR) are projected to decrease slightly from previous years for both males and females, with higher rates among males (ASIR 562.2 per 100 000 and ASMR 209.6 per 100 000 among males; ASIR 495.9 per 100 000 and ASMR 152.8 per 100 000 among females). The ASIRs and ASMRs of several common cancers are projected to continue to decrease (i.e., lung, colorectal, and prostate cancer), while those of several others are projected to increase (i.e., liver and intrahepatic bile duct cancer, kidney cancer, melanoma, and non-Hodgkin lymphoma). InterpretationAlthough the overall incidence of cancer and associated mortality are declining, new cases and deaths in Canada are expected to increase in 2024, largely because of the growing and aging population. Efforts in prevention, screening, and treatment have reduced the impact of some cancers, but these short-term projections highlight the potential effect of cancer on people and health care systems in Canada.

A meta-analysis of multiple studies involving people aged 45-80 years showed that gFOBT reduced mortality from colorectal cancer (risk ratio [RR] 0.82, 95% confidence interval [CI] 0.73-0.92) and incidence of late-stage colorectal cancer (RR 0.92, 95% CI 0.85-0.99).11 The absolute reduction in death from colorectal cancer was 2.7 per 1000 screened, so the number needed to screen to prevent one death was 377 (95% CI 249-887) over a median follow-up period of 18.25 (9-30) years. Pooled analyses showed that flexible sigmoidoscopy reduced colorectal cancer mortality (RR 0.74, 95% CI 0.67-0.82) and incidence of late-stage colorectal cancer (RR 0.73, 95% CI 0.66-0.82) among people aged 55-74 years.11 For flexible sigmoidoscopy, the absolute reduction in death from colorectal cancer was 1.2 per 1000 screened, and the number needed to screen was 850 (95% CI 673-12052) over a shorter median follow-up period of 11.3 (7.0-11.9) years. No change was reported in allcause mortality with gFOBT (RR 1.00, 95% CI 1.00-1.01) or flexible sigmoidoscopy (RR 1.00, 95% CI 0.96-1.00).11 Two of the RCTs on gFOBT reported results by age.14,15 One of these found a significant reduction in mortality from colorectal cancer among patients aged 60-69 years (Table 1) but no reduction among patients under 60 years.14 The other found a significant benefit of screening in patients aged 60-69 years and in patients older than 70 years.15 One RCT on flexible sigmoidoscopy reported results by age.19 It found a reduction in colorectal cancer mortality with screening only among those aged 65-74 years (RR 0.65, 95% CI 0.52-0.82).19 It did not find a significant benefit of screening in the 55-64-year age group (RR 0.84, 95% CI 0.67- 1.06).19 However, both the gFOBT and flexible sigmoidoscopy RCTs were underpowered to detect an effect among those under 60 or over 70 years.11 There was no convincing evidence that the relative benefits of gFOBT and flexible sigmoidoscopy are lower among people aged 50-59 years, compared with older patients. However, assuming that the relative benefit is similar at all ages, the absolute benefit of screening must be lower among younger (50-59 yr) people than among those aged 60-74 years, owing to the rise in incidence with age; consequently, large numbers are needed to detect an effect in those under 60 years (Figure 1, Table 1). For flexible sigmoidoscopy, three of the four RCTs17,18,20 evaluated the effect of a one-time screen over a median follow-up period of 11 years but did not compare different screening intervals or evaluate the effect of repeated screening versus once-per-lifetime screening. The other RCT19 evaluated a strategy of flexible sigmoidoscopy at baseline and then again after three to five years of follow-up; the magnitude of the mortality benefit at a median of 11.9 years of follow-up was similar to that seen in the other three trials. The task force's recommendation of a 10-year screening interval is based on the following: follow-up data that show a reduction in both colorectal cancer mortality and incidence with screening with flexible sigmoidoscopy at least until 11 years of follow-up; Kaplan-Meier survival curves from the published RCTs, which show that the beneficial effects of screening with flexible sigmoidoscopy are maintained over the full duration of follow-up; and observational data21,29,30 suggesting that the mortality benefits of screening with flexible sigmoidoscopy last for at least 10-15 years.11 Additionally, as outlined in Table 1, the numbers needed to screen for colorectal cancer mortality by age group appear lower for flexible sigmoidoscopy. Consequently, the task force recommends a screening interval of 10 years by examiners who are trained in this technique. Patients without evidence of colorectal cancer or its precursor polyps following flexible sigmoidoscopy should not be screened again (by any method) for 10 years.

Background Immunotherapy in the presence of COVID-19 infections raises concerns because of potential overlapping clinical complications and immune system enhancement. Further investigation is warranted to establish its safety and to improve clinical decisions. Methods We conducted a retrospective cohort study using linked health administrative data from Ontario, Canada to assess 30-day mortality in patients with solid tumors who were treated with immunotherapy within 120 days before testing positive for COVID-19. A stepwise multivariable logistic regression model was used to identify clinical factors associated with 30-day mortality. Results Between January 2020 and April 2023, 281 patients tested positive for COVID-19 and were included in our study. The mean age was 68 (Standard Deviation: 10.3), 45% (127/281) were females and 58% (163/281) had lung cancer. 59% of patients (167/281) were treated with single agent immunotherapy, and almost 80% received at least one dose of COVID-19 vaccine. The 30-day mortality was 22% (63/281) and < 5% of patients were admitted to ICU or required ventilation. Factors associated with higher mortality were older age (Odds Ratio (OR) 1.60, 95% confidence interval (CI) 1.07–2.39), prior radiation therapy (OR 2.38, 95%CI 1.08–5.28), lower hemoglobin (< 10 g/dl) (OR 4.08, 95%CI 1.89–8.82) and higher leucocytes count (> 11,000/mm 3 ) (OR 3.63, 95%CI 1.55–8.52). Conclusions Immunotherapy does not seem to increase the risk of 30-day mortality in patients with COVID-19 infections compared to published outcomes of patients with cancer and COVID-19. Mortality was associated with certain clinical characteristics that need to be carefully examined when prescribing immunotherapy during future comparable pandemics.

With the declaration of the global pandemic, surgical slowdowns were instituted to conserve health care resources for anticipated surges in patients with COVID-19. The long-term implications on survival of these slowdowns for patients with cancer in Canada is unknown. We constructed a microsimulation model based on real-world population data on cancer care from Ontario, Canada, from 2019 and 2020. Our model estimated wait times for cancer surgery over a 6-month period during the pandemic by simulating a slowdown in operating room capacity (60% operating room resources in month 1, 70% in month 2, 85% in months 3–6), as compared with simulated prepandemic conditions with 100% resources. We used incremental differences in simulated wait times to model survival using per-day hazard ratios for risk of death. Primary outcomes included life-years lost per patient and per cancer population. We conducted scenario analyses to evaluate alternative, hypothetical scenarios of different levels of surgical slowdowns on risk of death. The simulated model population comprised 22 799 patients waiting for cancer surgery before the pandemic and 20 177 patients during the pandemic. Mean wait time to surgery prepandemic was 25 days and during the pandemic was 32 days. Excess wait time led to 0.01–0.07 life-years lost per patient across cancer sites, translating to 843 (95% credible interval 646–950) life-years lost among patients with cancer in Ontario. Pandemic-related slowdowns of cancer surgeries were projected to result in decreased long-term survival for many patients with cancer. Measures to preserve surgical resources and health care capacity for affected patients are critical to mitigate unintended consequences.

ABSTRACTBackgroundAdult survivors of childhood cancer are at elevated risk of morbidity and mortality compared to the general population, but their adherence to lifelong periodic surveillance is suboptimal. We aimed to examine adherence to surveillance guidelines for high-yield tests and identify risk factors for nonadherence in adult survivors of childhood cancer. MethodsIn this retrospective, population-based cohort study, we used health care administrative data from Ontario, Canada, to identify adult survivors of childhood cancer diagnosed between 1986 and 2014 who were at elevated risk of therapy-related colorectal cancer, breast cancer, or cardiomyopathy. Using a Poisson regression framework, we assessed longitudinal adherence and predictors of adherence to the Children’s Oncology Group surveillance guideline. ResultsAmong 3241 survivors, 327 (10%), 234 (7%), and 3205 (99%) were at elevated risk for colorectal cancer, breast cancer, and cardiomyopathy, respectively. Within these cohorts, only 13%, 6%, and 53% were adherent to recommended surveillance as of February 2020. During a median follow-up of 7.8 years, the proportion of time spent adherent was 14% among survivors at elevated risk for colorectal cancer, 10% for breast cancer, and 43% for cardiomyopathy. Significant predictors of adherence varied across the risk groups, but higher comorbidity was associated with adherence to recommended surveillance. InterpretationSurvivors of childhood cancer in Ontario are rarely up to date for recommended surveillance tests. Tailored interventions beyond specialized clinics are needed to improve surveillance adherence.

Validated biomarkers are needed to improve risk assessment and treatment decision-making for women with ductal carcinoma in situ (DCIS) of the breast. The Onco type DX ® DCIS Score (DS) was shown to predict the risk of local recurrence (LR) in individuals with low-risk DCIS treated by breast-conserving surgery (BCS) alone. Our objective was to confirm these results in a larger population-based cohort of individuals. We used an established population-based cohort of individuals diagnosed with DCIS treated with BCS alone from 1994 to 2003 with validation of treatment and outcomes. Central pathology assessment excluded cases with invasive cancer, DCIS < 2 mm or positive margins. Cox model was used to determine the relationship between independent covariates, the DS (hazard ratio (HR)/50 C p units (U)) and LR. Tumor blocks were collected for 828 patients. Final evaluable population includes 718 cases, of whom 571 had negative margins. Median follow-up was 9.6 years. 100 cases developed LR following BCS alone (DCIS, N  = 44; invasive, N  = 57). In the primary pre-specified analysis, the DS was associated with any LR (DCIS or invasive) in ER+ patients (HR 2.26; P  < 0.001) and in all patients regardless of ER status (HR 2.15; P  < 0.001). DCIS Score provided independent information on LR risk beyond clinical and pathologic variables including size, age, grade, necrosis, multifocality, and subtype (adjusted HR 1.68; P  = 0.02). DCIS was associated with invasive LR (HR 1.78; P  = 0.04) and DCIS LR (HR 2.43; P  = 0.005). The DCIS Score independently predicts and quantifies individualized recurrence risk in a population of patients with pure DCIS treated by BCS alone.

Background Survivors of head and neck cancer (HNC) experience long-term physical and psychosocial effects post-treatment, however, often receive fragmented survivorship care. Evidence-based survivorship guidelines exist, but implementation remains limited. Poor coordination, insufficient communication, and lack of tailored support contribute to unmet patient needs. Treatment Summary and Survivorship Care Plans (TSSP) and Motivational Interviewing (MI) may improve self-efficacy and adherence to survivorship care recommendations. This study aims to evaluate whether a personalized TSSP along with a one-time MI counselling session improves physician implementation of survivorship care recommendations, patient satisfaction with post-treatment care, and quality of life (QoL) among HNC survivors. Methods/design This study is a prospective, single-centre, two-arm, superiority randomized controlled trial (RCT) with a 1:1 allocation ratio. Outcomes will be evaluated at baseline, 3, 6, and 12 months post-baseline visit. A total of 252 HNC survivors (stage I–IVA, aged ≥ 18 years, 3–6 months post-definitive treatment, English-speaking, with no metastatic or residual disease) will be recruited by a trained research assistant through the Survivorship Clinic at Victoria Hospital in London, Canada. Recruitment began in May 2025. Participants will be randomized to either the intervention group (TSSP and MI session) or the control group (usual care only). The intervention consists of a 45-min MI session delivered by a trained nurse practitioner, focused on exploring the top 3 patient survivorship symptoms/concerns, providing resources and referrals, and goal-setting related to survivorship care recommendations. The primary outcome is the proportion of patient-identified survivorship symptoms/concerns addressed by primary care providers (PCP) at 12 months post-baseline between study groups, with secondary assessments at 3 and 6 months. Secondary outcomes include patient satisfaction with the TSSP and MI session, patient satisfaction with care and information, QoL, and PCP feedback on the utility of the TSSP. Descriptive statistics will be reported, and intention-to-treat analyses will be conducted using mixed-effects models to evaluate group differences over time. Discussion This study will contribute new evidence on the feasibility and effectiveness of integrating a scalable, combined TSSP and MI counselling intervention into routine HNC survivorship care. By promoting patient-centered communication, this approach may empower survivors to engage in self-management and improve long-term health outcomes. Findings will inform best practices for survivorship care planning and support the implementation of patient-tailored interventions across various oncology settings. Trial registration ClinicalTrials.gov NCT06127784. Registered on Nov. 6, 2023; https://www.clinicaltrials.gov/study/NCT06127784 .

Although advancements in systemic therapy have improved the outlook for pancreatic adenocarcinoma, it is not known if patients get access to these therapies. We aimed to examine the patterns and factors associated with access to specialized cancer consultations and subsequent receipt of cancer-directed therapy for patients with non-curative pancreatic adenocarcinoma. We conducted a population-based analysis of noncurative pancreatic adenocarcinoma diagnosed over 2005–2016 in Ontario by linking administrative health care data sets. Our primary outcomes were specialized cancer consultation and receipt of cancer-directed therapy (chemotherapy or a combination of chemo- and radiation therapy [chemoradiation therapy]). We examined specialized cancer consultation with hepato-pancreatico-biliary surgery, medical and radiation oncology. We used multivariable logistic regression to identify factors associated with medical oncology consultation and cancer-directed therapy. Of 10 881 patients, 64.9% had a consultation with specialists in medical oncology, 35.1% with hepatopancreatico-biliary surgery and 24.7% with radiation oncology. Sociodemographic characteristics were not associated with the likelihood of medical oncology consultation. Of these patients, 4144 received cancer-directed therapy, representing 38.1% of all patients and 58.6% of those who consulted with medical oncology. Of 6737 patients not receiving cancer-directed therapy, 2988 (44.4%) had a consultation with medical oncology. Older age and lowest income quintile were independently associated with lower likelihood of cancer-directed therapy. If the first specialized cancer consultation was with medical or radiation oncology, the likelihood of cancer-directed therapy was significantly higher compared with surgery. A considerable proportion of patients with noncurable pancreatic adenocarcinoma in Ontario did not have a specialized cancer consultation and most did not receive cancer-directed therapy. We identified disparities in specialized cancer consultation and receipt of systemic cancer-directed therapy that indicate potential gaps in assessment.

Patients with cancer have complex care requirements and frequently use the emergency department. The purpose of this study was to determine whether continuity of care, cancer expertise of an institution or both affect outcomes in patients with cancer in the emergency setting. We conducted a retrospective cohort study using administrative databases from Ontario, Canada, involving records of patients aged 20 years and older who received chemotherapy or radiation in the 30 days before a cancer-related visit to the emergency department between 2006 and 2011. Patients seen in an emergency department at an alternative hospital (not the site where cancer treatment was given) were matched based on propensity score to patients who visited their original hospital (site where cancer treatment was given). Next, patients seen at an alternative emergency department that was in a general hospital (i.e., not a cancer centre) were matched to patients who visited their original hospital or a cancer centre. Outcomes were admission to hospital at the index visit to the emergency department, 30-day mortality, having imaging with computed tomography and return visits to the emergency department. We found 42 820 patients who were eligible for our study. Patients seen in the emergency departments at alternative hospitals were less likely to be admitted to hospital (odds ratio [OR] 0.78, 95% confidence interval [CI] 0.74–0.83) and had higher hazards of return visits to the emergency department than matched patients at original hospitals (hazard ratio [HR] 1.06, 95% CI 1.03–1.11). In comparison, patients at alternative general hospitals also had lower odds of admission to hospital (OR 0.83, 95% CI 0.79–0.88) and higher hazards of return visits to the emergency department (HR 1.07, 95% CI 1.03–1.11) compared with matched counterparts; however, these patients had higher 30-day mortality (OR 1.13, 95% CI 1.05–1.22) and lower odds of having CT imaging (OR 0.74, 95% CI 0.69–0.80). Cancer expertise of an institution rather than continuity of care may be an important predictor of outcomes following emergency treatment of patients with cancer.