ESTRO 36 ________________________________________________________________________________________... more ESTRO 36 _______________________________________________________________________________________________ (36%) and retroperitoneal sarcomas (50%). With a median follow-up of 70 months (range 12-92), the median DSS was 54 months (range 28-80). The 5-year actuarial OS, LC and DSS were 71%, 68% and 44%, respectively. On univariate analysis margin status of resection significantly affected LC. For patient with resection R0, LC was 83% whereas no patient with R1 resection obtained local control (p<0,01). Toxicity presented in 11(27%) patients and pain was the most common side-effect (64%) followed by enteritis (18%). Conclusion IORT is an efficient method of salvage treatment to improve LC in selected patients with isolated locally recurrent tumors for recurrent pelvic or retroperitoneal tumors, with acceptable incidence of morbidity. EP-1414 Toxicity of concurrent stereotactic radiotherapy and targeted or immunotherapy: a systematic review
The need for an improved understanding of the rehabilitation services landscape in Ontario and fo... more The need for an improved understanding of the rehabilitation services landscape in Ontario and for promotion of Cancer Care Ontario’s newly developed Exercise for People with Cancer guideline brought Cancer Care Ontario’s Psychosocial Oncology and Survivorship Programs together to host a knowledge translation and exchange event. The primary objectives of the event were to understand recommendations from Cancer Care Ontario’s new exercise guideline, to discuss key considerations and determine strategies for the implementation of the guideline recommendations, and to explore the current state and future directions of cancer rehabilitation in Ontario. The event was attended by 124 stakeholders, including clinicians, allied health care professionals, administrators, patients, community partners, and academics representing each of the 13 regional cancer programs in Ontario. Attendees participated in two small-group activities that focused on determining the best approach for implementing...
Background This systematic review was completed by the Exercise for People with Cancer Guideline ... more Background This systematic review was completed by the Exercise for People with Cancer Guideline Development Group, a group organized by Cancer Care Ontario’s Program in Evidence-Based Care (pebc). It provides background and guidance for clinicians with respect to exercise for people living with cancer in active and post treatment. It focuses on the benefits of specific types of exercise, pre-screening requirements for new referrals, safety concerns, and delivery models.Methods Using the pebc’s standardized approach, medline and embase were systematically searched for existing guidelines, systematic reviews, and primary literature.Results The search identified two guidelines, eighteen systematic reviews, and twenty-nine randomized controlled trials with relevance to the topic. The present review provides conclusions about the duration, frequency, and intensity of exercise appropriate for people living with cancer.Conclusions The evidence shows that exercise is safe and provides bene...
Background: Development of this guideline was undertaken by the Exercise for People with Cancer G... more Background: Development of this guideline was undertaken by the Exercise for People with Cancer Guideline Development Group, a group organized by Cancer Care Ontario’s Program in Evidence-Based Care (pebc). The purpose of the guideline was to provide guidance for clinicians with respect to exercise for patients living with cancer, focusing on the benefits of specific types of exercise, recommendations about screening requirements for new referrals, and safety concerns. Methods: Consistent with the pebc’s standardized approach, a systematic search was conducted for existing guidelines, and systematic literature searches were performed in medline and embase for both systematic reviews and primary literature. Content and methodology experts performed an internal review, which was followed by an external review by targeted experts and intended users. Results: The search identified three guidelines, eighteen systematic reviews, and twenty-nine randomized controlled trials with relevance ...
Background: Sexual dysfunction in people with cancer is a significant problem. The present clinic... more Background: Sexual dysfunction in people with cancer is a significant problem. The present clinical practice guideline makes recommendations to improve sexual function in people with cancer. Methods: This guideline was undertaken by the Interventions to Address Sexual Problems in People with Cancer Expert Panel, a group organized by the Program in Evidence-Based Care (PEBC). Consistent with the PEBC standardized approach, a systematic search was conducted for existing guidelines, and the literature in MEDLINE and EMBASE for the years 2003–2015 was systematically searched for both systematic reviews and primary literature. Evidence found for men and for women was evaluated separately, and no restrictions were placed on cancer type or study design. Content and methodology experts performed an internal review of the resulting draft recommendations, which was followed by an external review by targeted experts and intended users. Results: The search identified 4 existing guidelines, 13 s...
Objective: To provide recommendations for preferred models of follow-up care for stage I-IV color... more Objective: To provide recommendations for preferred models of follow-up care for stage I-IV colorectal (CRC) cancer survivors in Ontario; to identify signs and symptoms of potential recurrence and when to investigate; and to evaluate patient information and support needs during the post-treatment survivorship period. Methods: Consistent with the Program in Evidence-Based Medicine’s standardized approach, MEDLINE, EMBASE, PubMed, Cochrane Library, and PROSPERO databases were systematically searched. The authors drafted recommendations and revised them based on the comments from internal and external reviewers. Results: Four guidelines, three systematic reviews, three randomized controlled trials, and three cohort studies provided evidence to develop recommendations. Conclusions: Colorectal cancer follow-up care is complex and requires multidisciplinary, coordinated care delivered by the cancer specialist, primary care provider, and allied health professionals. While there is limited ...
Background Patient engagement is a key quality component of cancer guideline development; however... more Background Patient engagement is a key quality component of cancer guideline development; however, the optimal strategy for engaging patients in guideline development remains unclear. The feasibility and efficacy of two patient engagement models was tested by Cancer Care Ontario’s cancer guideline development program, the Program in Evidence-Based Care (pebc).Methods In model 1, patients participated in the guideline development process as active members of a working group. In model 2, patients formed a separate consultation group to review project plans and recommendations generated by multiple working groups. Training included online resources (model 1) and an in-person orientation (model 2). The pebc’s standard patient engagement process acted as a control. The study was conducted for 1 year. Surveys measured the satisfaction of patients and members of the guideline working groups with the process and the outcome of each model.Results Three guideline projects used model 1 to enga...
Cancer may be associated with many symptoms, but pain is the one most feared by patients. Pain is... more Cancer may be associated with many symptoms, but pain is the one most feared by patients. Pain is experienced by one-third of patients receiving treatment for cancer and about two-thirds of those with advanced cancers. To aid in providing quality care and pain relief for cancer patients, Cancer Care Ontario&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s Cancer-related Pain Management Guideline Panel conducted a systematic review of guidelines to provide evidence-based and consensus recommendations for the management of cancer-related pain to guide the practice of healthcare providers. Published and unpublished cancer-related pain management guidelines were sought by conducting an Internet search, which included health organizations and the National Guidelines Clearinghouse, the Guideline International Network, and the McMillan Group. Also, MEDLINE searches were conducted for guidelines published between the years 2000 and May 2006. Twenty-five guidelines were found and the quality of each guideline was evaluated using the Appraisal of Guideline Research and Evaluation Instrument and the utility of the guideline for recommendations was assessed. Using these 2 criteria, 8 relevant and high-quality pain guidelines were identified. From these guidelines, the Panel articulated core principles of the management of cancer pain and selected or adapted specific recommendations through consensus to become a part of the cancer-related pain guide for practice. The domains on which recommendations were drafted include: assessment of pain; assessors of pain; time and frequency of assessment; components of pain assessment; assessment of pain in special populations; plan of care; pharmacologic intervention; nonpharmacologic intervention; documentation; education; and outcome measures of cancer-pain management.
Objective: To provide recommendations for a surveillance regimen that leads to the largest overal... more Objective: To provide recommendations for a surveillance regimen that leads to the largest overall survival benefit for patients after curative treatment for Stage I–IV colon and rectal cancer. Methods: Consistent with the Program in Evidence-Based Care’s standard approach, guideline databases, i.e., MEDLINE, EMBASE, PubMed, Cochrane Library, and PROSPERO, were systematically searched. Then, we drafted recommendations and methodology experts performed an internal review of the resulting draft recommendations, which was followed by an external review by targeted experts and intended users. Results: Four systematic reviews and two randomized controlled trials were identified that provided evidence for recommendations. Conclusions: For patients with stage I–III colon cancer, a medical history and physical examination should be performed every six months for three years; computed tomography (CT) of the chest-abdomen-pelvis (CT CAP) should be performed at one and three years, or one CT C...
Exercise is a safe, cost-effective means to prevent and manage secondary health complications and... more Exercise is a safe, cost-effective means to prevent and manage secondary health complications and enhance quality of life (QoL) among cancer survivors (CS). Published exercise recommendations for CS have been based on literature reviews and roundtable consensus and were not underpinned by a robust, standardized guideline development process using rigorous methodology (e.g., a systematic review of research evidence, extensive peer review). The objective of this study was to systematically develop evidence-informed exercise guidelines to improve aerobic and muscular fitness, and increase QOL, among CS. The Appraisal of Guidelines, Research and Evaluation II guideline development protocol was used as a methodological strategy. The evidence base for the guideline development process consisted of a systematic review and quality appraisal of research examining the effects of exercise on aerobic and muscular fitness and QoL among adults with cancer. A multidisciplinary working group reflec...
Studies of emotion have provided occasional support for physiological differentiation of affectiv... more Studies of emotion have provided occasional support for physiological differentiation of affective states; however, the evidence has been inconsistent. The aims of the present study were to investigate cardiovascular changes associated with relived experiences of happiness, sadness, anger, fear, and disgust and to examine the utility of methods designed to optimize the induction of emotional responses. Thirty-four undergraduates who scored 0.5 sd above the mean on Larsen and Diener's Affect Intensity Measure described their most intense experiences of five emotions. These descriptions were then used to induce those emotions while blood pressure and other hemodynamic measures were monitored. Systolic blood pressure, diastolic blood pressure, and stroke volume differentiated among emotions. The results support the suggestion that cardiovascular activity differentiates emotional states and provide some insight into the physiological adjustments subserving such effects. The study demonstrates a method that may be applied to studies of discrete emotions.
This Practice Guideline Report was reviewed in Sept 2011 and ARCHIVED in 2012. The reviewed repor... more This Practice Guideline Report was reviewed in Sept 2011 and ARCHIVED in 2012. The reviewed report consists of: 1. Guideline Overview 2. Full Report and is available on the CCO website at: http://www.cancercare.on.ca Release
Canadian journal of gastroenterology = Journal canadien de gastroenterologie, 2007
Colorectal cancer (CRC) is the most common cause of non-tobacco-related cancer deaths in Canadian... more Colorectal cancer (CRC) is the most common cause of non-tobacco-related cancer deaths in Canadian men and women, accounting for 10% of all cancer deaths. An estimated 7800 men and women will be diagnosed with CRC, and 3250 will die from the disease in Ontario in 2007. Given that CRC incidence and mortality rates in Ontario are among the highest in the world, the best opportunity to reduce this burden of disease would be through screening. The present report describes the findings and recommendations of Cancer Care Ontario's Colonoscopy Standards Expert Panel, which was convened in March 2006 by the Program in Evidence-Based Care. The recommendations will form the basis of the quality assurance program for colonoscopy delivered in support of Ontario's CRC screening program.
ESTRO 36 ________________________________________________________________________________________... more ESTRO 36 _______________________________________________________________________________________________ (36%) and retroperitoneal sarcomas (50%). With a median follow-up of 70 months (range 12-92), the median DSS was 54 months (range 28-80). The 5-year actuarial OS, LC and DSS were 71%, 68% and 44%, respectively. On univariate analysis margin status of resection significantly affected LC. For patient with resection R0, LC was 83% whereas no patient with R1 resection obtained local control (p<0,01). Toxicity presented in 11(27%) patients and pain was the most common side-effect (64%) followed by enteritis (18%). Conclusion IORT is an efficient method of salvage treatment to improve LC in selected patients with isolated locally recurrent tumors for recurrent pelvic or retroperitoneal tumors, with acceptable incidence of morbidity. EP-1414 Toxicity of concurrent stereotactic radiotherapy and targeted or immunotherapy: a systematic review
The need for an improved understanding of the rehabilitation services landscape in Ontario and fo... more The need for an improved understanding of the rehabilitation services landscape in Ontario and for promotion of Cancer Care Ontario’s newly developed Exercise for People with Cancer guideline brought Cancer Care Ontario’s Psychosocial Oncology and Survivorship Programs together to host a knowledge translation and exchange event. The primary objectives of the event were to understand recommendations from Cancer Care Ontario’s new exercise guideline, to discuss key considerations and determine strategies for the implementation of the guideline recommendations, and to explore the current state and future directions of cancer rehabilitation in Ontario. The event was attended by 124 stakeholders, including clinicians, allied health care professionals, administrators, patients, community partners, and academics representing each of the 13 regional cancer programs in Ontario. Attendees participated in two small-group activities that focused on determining the best approach for implementing...
Background This systematic review was completed by the Exercise for People with Cancer Guideline ... more Background This systematic review was completed by the Exercise for People with Cancer Guideline Development Group, a group organized by Cancer Care Ontario’s Program in Evidence-Based Care (pebc). It provides background and guidance for clinicians with respect to exercise for people living with cancer in active and post treatment. It focuses on the benefits of specific types of exercise, pre-screening requirements for new referrals, safety concerns, and delivery models.Methods Using the pebc’s standardized approach, medline and embase were systematically searched for existing guidelines, systematic reviews, and primary literature.Results The search identified two guidelines, eighteen systematic reviews, and twenty-nine randomized controlled trials with relevance to the topic. The present review provides conclusions about the duration, frequency, and intensity of exercise appropriate for people living with cancer.Conclusions The evidence shows that exercise is safe and provides bene...
Background: Development of this guideline was undertaken by the Exercise for People with Cancer G... more Background: Development of this guideline was undertaken by the Exercise for People with Cancer Guideline Development Group, a group organized by Cancer Care Ontario’s Program in Evidence-Based Care (pebc). The purpose of the guideline was to provide guidance for clinicians with respect to exercise for patients living with cancer, focusing on the benefits of specific types of exercise, recommendations about screening requirements for new referrals, and safety concerns. Methods: Consistent with the pebc’s standardized approach, a systematic search was conducted for existing guidelines, and systematic literature searches were performed in medline and embase for both systematic reviews and primary literature. Content and methodology experts performed an internal review, which was followed by an external review by targeted experts and intended users. Results: The search identified three guidelines, eighteen systematic reviews, and twenty-nine randomized controlled trials with relevance ...
Background: Sexual dysfunction in people with cancer is a significant problem. The present clinic... more Background: Sexual dysfunction in people with cancer is a significant problem. The present clinical practice guideline makes recommendations to improve sexual function in people with cancer. Methods: This guideline was undertaken by the Interventions to Address Sexual Problems in People with Cancer Expert Panel, a group organized by the Program in Evidence-Based Care (PEBC). Consistent with the PEBC standardized approach, a systematic search was conducted for existing guidelines, and the literature in MEDLINE and EMBASE for the years 2003–2015 was systematically searched for both systematic reviews and primary literature. Evidence found for men and for women was evaluated separately, and no restrictions were placed on cancer type or study design. Content and methodology experts performed an internal review of the resulting draft recommendations, which was followed by an external review by targeted experts and intended users. Results: The search identified 4 existing guidelines, 13 s...
Objective: To provide recommendations for preferred models of follow-up care for stage I-IV color... more Objective: To provide recommendations for preferred models of follow-up care for stage I-IV colorectal (CRC) cancer survivors in Ontario; to identify signs and symptoms of potential recurrence and when to investigate; and to evaluate patient information and support needs during the post-treatment survivorship period. Methods: Consistent with the Program in Evidence-Based Medicine’s standardized approach, MEDLINE, EMBASE, PubMed, Cochrane Library, and PROSPERO databases were systematically searched. The authors drafted recommendations and revised them based on the comments from internal and external reviewers. Results: Four guidelines, three systematic reviews, three randomized controlled trials, and three cohort studies provided evidence to develop recommendations. Conclusions: Colorectal cancer follow-up care is complex and requires multidisciplinary, coordinated care delivered by the cancer specialist, primary care provider, and allied health professionals. While there is limited ...
Background Patient engagement is a key quality component of cancer guideline development; however... more Background Patient engagement is a key quality component of cancer guideline development; however, the optimal strategy for engaging patients in guideline development remains unclear. The feasibility and efficacy of two patient engagement models was tested by Cancer Care Ontario’s cancer guideline development program, the Program in Evidence-Based Care (pebc).Methods In model 1, patients participated in the guideline development process as active members of a working group. In model 2, patients formed a separate consultation group to review project plans and recommendations generated by multiple working groups. Training included online resources (model 1) and an in-person orientation (model 2). The pebc’s standard patient engagement process acted as a control. The study was conducted for 1 year. Surveys measured the satisfaction of patients and members of the guideline working groups with the process and the outcome of each model.Results Three guideline projects used model 1 to enga...
Cancer may be associated with many symptoms, but pain is the one most feared by patients. Pain is... more Cancer may be associated with many symptoms, but pain is the one most feared by patients. Pain is experienced by one-third of patients receiving treatment for cancer and about two-thirds of those with advanced cancers. To aid in providing quality care and pain relief for cancer patients, Cancer Care Ontario&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s Cancer-related Pain Management Guideline Panel conducted a systematic review of guidelines to provide evidence-based and consensus recommendations for the management of cancer-related pain to guide the practice of healthcare providers. Published and unpublished cancer-related pain management guidelines were sought by conducting an Internet search, which included health organizations and the National Guidelines Clearinghouse, the Guideline International Network, and the McMillan Group. Also, MEDLINE searches were conducted for guidelines published between the years 2000 and May 2006. Twenty-five guidelines were found and the quality of each guideline was evaluated using the Appraisal of Guideline Research and Evaluation Instrument and the utility of the guideline for recommendations was assessed. Using these 2 criteria, 8 relevant and high-quality pain guidelines were identified. From these guidelines, the Panel articulated core principles of the management of cancer pain and selected or adapted specific recommendations through consensus to become a part of the cancer-related pain guide for practice. The domains on which recommendations were drafted include: assessment of pain; assessors of pain; time and frequency of assessment; components of pain assessment; assessment of pain in special populations; plan of care; pharmacologic intervention; nonpharmacologic intervention; documentation; education; and outcome measures of cancer-pain management.
Objective: To provide recommendations for a surveillance regimen that leads to the largest overal... more Objective: To provide recommendations for a surveillance regimen that leads to the largest overall survival benefit for patients after curative treatment for Stage I–IV colon and rectal cancer. Methods: Consistent with the Program in Evidence-Based Care’s standard approach, guideline databases, i.e., MEDLINE, EMBASE, PubMed, Cochrane Library, and PROSPERO, were systematically searched. Then, we drafted recommendations and methodology experts performed an internal review of the resulting draft recommendations, which was followed by an external review by targeted experts and intended users. Results: Four systematic reviews and two randomized controlled trials were identified that provided evidence for recommendations. Conclusions: For patients with stage I–III colon cancer, a medical history and physical examination should be performed every six months for three years; computed tomography (CT) of the chest-abdomen-pelvis (CT CAP) should be performed at one and three years, or one CT C...
Exercise is a safe, cost-effective means to prevent and manage secondary health complications and... more Exercise is a safe, cost-effective means to prevent and manage secondary health complications and enhance quality of life (QoL) among cancer survivors (CS). Published exercise recommendations for CS have been based on literature reviews and roundtable consensus and were not underpinned by a robust, standardized guideline development process using rigorous methodology (e.g., a systematic review of research evidence, extensive peer review). The objective of this study was to systematically develop evidence-informed exercise guidelines to improve aerobic and muscular fitness, and increase QOL, among CS. The Appraisal of Guidelines, Research and Evaluation II guideline development protocol was used as a methodological strategy. The evidence base for the guideline development process consisted of a systematic review and quality appraisal of research examining the effects of exercise on aerobic and muscular fitness and QoL among adults with cancer. A multidisciplinary working group reflec...
Studies of emotion have provided occasional support for physiological differentiation of affectiv... more Studies of emotion have provided occasional support for physiological differentiation of affective states; however, the evidence has been inconsistent. The aims of the present study were to investigate cardiovascular changes associated with relived experiences of happiness, sadness, anger, fear, and disgust and to examine the utility of methods designed to optimize the induction of emotional responses. Thirty-four undergraduates who scored 0.5 sd above the mean on Larsen and Diener's Affect Intensity Measure described their most intense experiences of five emotions. These descriptions were then used to induce those emotions while blood pressure and other hemodynamic measures were monitored. Systolic blood pressure, diastolic blood pressure, and stroke volume differentiated among emotions. The results support the suggestion that cardiovascular activity differentiates emotional states and provide some insight into the physiological adjustments subserving such effects. The study demonstrates a method that may be applied to studies of discrete emotions.
This Practice Guideline Report was reviewed in Sept 2011 and ARCHIVED in 2012. The reviewed repor... more This Practice Guideline Report was reviewed in Sept 2011 and ARCHIVED in 2012. The reviewed report consists of: 1. Guideline Overview 2. Full Report and is available on the CCO website at: http://www.cancercare.on.ca Release
Canadian journal of gastroenterology = Journal canadien de gastroenterologie, 2007
Colorectal cancer (CRC) is the most common cause of non-tobacco-related cancer deaths in Canadian... more Colorectal cancer (CRC) is the most common cause of non-tobacco-related cancer deaths in Canadian men and women, accounting for 10% of all cancer deaths. An estimated 7800 men and women will be diagnosed with CRC, and 3250 will die from the disease in Ontario in 2007. Given that CRC incidence and mortality rates in Ontario are among the highest in the world, the best opportunity to reduce this burden of disease would be through screening. The present report describes the findings and recommendations of Cancer Care Ontario's Colonoscopy Standards Expert Panel, which was convened in March 2006 by the Program in Evidence-Based Care. The recommendations will form the basis of the quality assurance program for colonoscopy delivered in support of Ontario's CRC screening program.
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