Cancer prevention & control : CPC = Prevention & controle en cancerologie : PCC最新文献

Objective: To describe the prevalence of sun exposure and protective behaviours among Canadian children 12 years of age or less, as reported by their parents.

Design: A random-digit-dialling telephone household survey of 4023 people 15 years of age or more was completed in 1996; 1051 parents responded to questions about their children's sun-related behaviours from June to August 1996.

Results: Most children (89%) had 30 minutes or more of daily sun exposure, and many of them (45%) had sunburns. The prevalence of sun protective actions ranged from 36% for avoiding the sun to 76% for using sunscreen. Parental reports on sun protection for children 5 years of age or less differed significantly from reports for children 6 to 12 years old.

Discussion: High levels of sun exposure among Canadian children suggests the need for protection. Use of multiple methods of sun protection should be emphasized to parents, school personnel, recreation staff and child-care workers.

Skin cancer is epidemic. Sun safety behaviours of skiers and snowboarders have not been investigated despite prolonged exposure at high altitudes. A sample of 156 adult alpine skiers and snowboarders at 14 high-altitude ski resorts in the western United States were interviewed during 1996-97 to ascertain their sun protective actions and exposure. Few of the adults said they received any messages over their entire lifespan regarding sun safety while skiing or snowboarding. Sun protective behaviour was variable: it was negatively associated with being male, younger, a snowboarder, exposed to prevention messages, and being in cold, windy and cloudy weather, and positively related to chair-lift elevation, skin sun sensitivity and prior sunburning while skiing or snowboarding. Prevention programs should target the young, males, novices and snowboarders, and advocate protection throughout the season and during inclement weather.

Guideline question: How effective is epirubicin compared with doxorubicin in the treatment of metastatic breast cancer?

Objective: To make recommendations about the use of epirubicin, particularly compared with doxorubicin, in women with metastatic breast cancer.

Outcomes: Outcomes of interest are response rate, survival and toxicity.

Perspective (values): Evidence was reviewed and summarized by a member of the Provincial Systemic Treatment Disease Site Group (DSG) of the Cancer Care Ontario Practice Guidelines Initiative. Drafts of the practice guideline were reviewed and discussed by the Breast Cancer DSG of the Cancer Care Ontario Practice Guidelines Initiative. The 2 DSGs comprise medical oncologists, radiation oncologists, surgeons, epidemiologists, pathologists, nurses, pharmacists, a medical sociologist and a community representative.

Quality of evidence: Thirteen randomized controlled trials (11 published reports and 2 reports in abstract form) were reviewed that compared epirubicin and doxorubicin at equal doses, epirubicin at a higher dose than that of doxorubicin, and epirubicin at escalating doses.

Benefits: No significant differences were observed in response rate or median survival in the 7 trials comparing equal doses of epirubicin and doxorubicin or in the 3 trials comparing epirubicin at a higher dose than that of doxorubicin. An increased response rate was observed with higher doses of epirubicin in the 3 trials that compared escalating doses; no difference in survival was observed.

Harms: Compared with doxorubicin, epirubicin was associated with less nausea and vomiting (risk ratio [RR] 0.76; 95% confidence interval [CI] 0.63 to 0.92; p = 0.0048), less neutropenia (RR 0.52; 95% CI 0.35 to 0.78; p = 0.0017) and less cardiotoxicity (RR 0.43; 95% CI 0.24 to 0.77; p = 0.0044), including a trend toward fewer episodes of congestive heart failure (RR 0.38; 95% CI 0.14 to 1.04; p = 0.059).

Practice guideline: For the treatment of metastatic breast cancer in which the goal of treatment is palliation, epirubicin (at doses equivalent to doxorubicin) has been shown to be equally efficacious and less toxic than doxorubicin. Doxorubicin, however, is an acceptable alternative. CLINICAL PRACTICE GUIDELINE DATE: Oct. 2, 1997.

Objective: To describe the prevalence of sun exposure and protective behaviours during leisure time among Canadian adults 25 years of age or more.

Design: A random-digit-dialling telephone household survey of 4023 people 15 years of age or more was completed; 3449 adults 25 years of age or more responded to questions about sun exposure and protective behaviours from June to August 1996.

Results: Many of the adults (51%) reported getting 30 minutes to 2 hours of daily sun exposure, and 26% reported getting more than 2 hours. Half (50%) reported having one or more sunburns during the study period; 21% said they actively spent time suntanning. Less than half reported taking adequate protective actions. Women, light-complexioned and adults 65 years or more were more likely than men, medium- or dark-complexioned adults and adults in younger groups to protect themselves. Nearly two-thirds (63%) of the adults said they forgot to take protective actions, 47% felt it was inconvenient to do so, and 29% were not concerned about sun exposure.

Discussion: Canadian adults, especially younger men, are exposed to significant amounts of sun during summer leisure time, but they do not always protect themselves adequately. Interventions should emphasize and facilitate convenient, effective sun protection strategies.

This article describes the methods used for the 1996 Canadian National Survey on Sun Exposure & Protective Behaviours. A 55-item random-digit-dialling telephone household survey of people 15 years of age or more was completed in 1996. Items assessed were daily sun exposure and protective behaviours, as well as other sun-related behaviours and attitudes. Data were collected regarding sun-related behaviours during leisure, work time and winter holidays, as well as for children 12 years of age or less (as reported by parents). To test for an effect on the survey response rate, a letter of introduction was sent to 40% of the households. The survey response rate was 69% (4023 successfully completed surveys out of 5847 households included in the sample). The response rate achieved in the subset that received the introductory letter was 75%. This survey is the first to establish national population estimates for sun exposure and protective behaviours in Canada.

The value of routine follow-up programs for patients with early stage breast cancer remains an area of controversy. In recent years, the cost-effectiveness of routine investigations has been questioned, and 2 prospective randomized clinical trials have shown no survival advantage to more intensive diagnostic follow-up approaches. Under the auspices of the Ottawa Regional Cancer Centre, a national survey of the practice patterns of Canadian surgical, radiation and medical oncologists was undertaken to measure current Canadian standards of care and to determine average costs of 5-year follow-up for patients completing primary treatment for stage I and II breast cancer. Standardized questionnaires were sent out to 130 surgeons, 59 radiation oncologists and 89 medical oncologists. The overall response rate was 44%. Based on the frequency of follow-up visits and investigations recommended by respondents, an average cost per patient for a 5-year follow-up plan was derived for each subspecialist group: $791, $911 and $904 for surgeons, radiation oncologists and medical oncologists respectively. Use of a less interventionist follow-up program was estimated to result in a cost saving of $300 per patient over 5 years. The results indicate that, for the most part, Canadian oncologists have been influenced by the available literature concerning follow-up practices and are ordering fewer routine tests. Further cost savings to the Canadian health care system could be achieved with the adoption of even less interventionist follow-up programs.

Eight focus groups involving women with metastatic breast cancer were held across Ontario over approximately 6 months in 1996-97. Prevalent themes identified during the sessions are reported under 2 broad dimensions: the women's expressed desire for information in specific content areas, and issues related to whether information can be either beneficial or harmful, depending on how it is provided. The women reported high needs for information, especially that which would relate to their situation. Perceived adequacy of information is closely linked to health professional engagement and care. Although the provision of information is important, the needs of these women for maintenance of hope and provision of interpersonal support and comfort are also critical.

Purpose: To evaluate the effect of megestrol acetate at a lower dose than previously investigated on the symptoms of cachexia in patients with advanced cancer.

Methods: A total of 84 patients with advanced, solid tumours not responsive to hormone therapy were enrolled in this double-blind, crossover study. During phase 1, patients were randomly assigned to receive megestrol acetate (160 mg 3 times daily) for 10 days or placebo. During phase 2, after a 2-day washout period, patients received the alternate treatment for 10 days. Patients underwent daily assessments of activity, nausea, appetite and well-being by means of a visual analogue scale (VAS). In addition, nutritional status (weight, tricep skinfold measure, arm muscle circumference), energy intake, fatigue (Piper Fatigue Scale) and quality of life (Functional Living Index-Cancer [FLIC]) were assessed.

Results: Among the 53 evaluable patients megestrol acetate resulted in a significant improvement in appetite (p = 0.005), activity (p = 0.007) and well-being (p = 0.03). There was no significant change in the intensity of nausea, nutritional parameters, energy intake or FLIC scores. There was a significant improvement in 2 of the 3 factors measured by the Piper Fatigue Scale and in the overall fatigue score. Upon completion of the study, while still blind to the treatment condition, 30 patients indicated that they felt better overall after megestrol, 15 said they felt better after placebo, and 10 indicated no preference (p = 0.001).

Conclusion: Treatment with megestrol acetate results in rapid and significant improvement of symptoms in terminally ill patients at lower doses than previously reported. The effects are not secondary to nutritional changes. The FLIC quality-of-life questionnaire was unable to detect these changes.

Guideline question: What is the role of strontium-89 in effective palliative care of patients with stage D endocrine-refractory prostate cancer and multiple sites of painful bone metastases?

Objective: To make recommendations about the routine use of 89Sr in this clinical setting.

Outcomes: Effective palliation is the primary outcome of interest. Patient survival and toxic effects of treatment are also considered.

Perspective (values): Evidence was selected and reviewed by 3 members of the Genitourinary Cancer Disease Site Group (Genitourinary Cancer DSG) of the Cancer Care Ontario Practice Guidelines Initiative. Earlier drafts of the guideline were circulated and reviewed by members of the DSG. The Genitourinary Cancer DSG comprises medical oncologists, radiation oncologists, urologists, a pathologist and a community representative. Guideline approval requires input from community representatives.

Quality of evidence: Three randomized controlled trials (RCTs) were available for evaluation. Two compared 89Sr with placebo, and one RCT compared 89Sr with conventional radiation (either hemibody or involved-field radiotherapy, as determined before randomization).

Benefits: One of the 2 studies comparing 89Sr with placebo demonstrated the palliative efficacy of the intervention (p < 0.01); the other showed no benefit. The third study, comparing 89Sr with conventional radiation, concluded that all treatments provided equally effective pain relief and that improvement was sustained for at least 3 months in similar proportions of patients. The difference in the median duration of patient survival between groups in this study was neither clinically nor statistically significant.

Harms: The use of 89Sr may cause bone marrow suppression, but clinically significant sequelae are uncommon. The use of 89Sr may preclude further systemic chemotherapy or eligibility for clinical trials of systemic therapy. Symptoms other than those due to bone marrow suppression are rare.

Practice guideline: 89Sr is recommended for use in patients with endocrine-refractory prostate cancer who have multiple uncontrolled painful sites of bone metastases on both sides of the diaphragm not adequately controlled with conventional analgesic therapy, and in whom the use of multiple single fields of external beam radiation is not possible. 89Sr has proven to be efficacious in the palliation of hormone-refractory painful bone metastases from prostate cancer. It has not been shown to lengthen the average duration of patient survival. There is limited evidence on the relative efficacy of 89Sr compared with wide-field radiotherapy. 89Sr is the treatment of choice given all the following specific indications: Established diagnosis of prostate cancer metastatic to bone. Metastatic disease refractory to hormone therap