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

Guideline questions: 1) Should breast irradiation be given to women with early stage invasive breast cancer (stage I and II) following breast conservation surgery (lumpectomy with clear resection margins and axillary dissection)? 2) Is there an optimal schedule for breast irradiation? 3) What is a reasonable interval between definitive surgery and the start of breast irradiation? 4) Are there patients who can be spared breast irradiation after lumpectomy?

Objective: To make recommendations about the use of breast irradiation in women with early stage invasive breast cancer following breast conservation surgery.

Outcomes: Local control is the primary endpoint of interest. Survival, quality of life (addressed through the adverse effects of radiotherapy) and cosmesis are also considered.

Perspective (values): Evidence was selected and reviewed by 6 members of the Breast Disease Site Group (Breast DSG) of the Ontario Cancer Treatment Practice Guidelines Initiative. Earlier drafts of the evidence-based recommendation were reviewed, discussed and approved by the Breast DSG, which comprises medical oncologists, radiation oncologists, surgeons, epidemiologists, pathologists and a medical sociologist. There was no participation by a community representative in the development of this guideline.

Quality of evidence: There are 5 randomized controlled trials (RCTs) and 1 meta-analysis comparing breast irradiation with no breast irradiation following breast conservation surgery; 6 randomized trials comparing breast conservation surgery plus breast irradiation with mastectomy are also included, as well as several retrospective studies.

Benefits: All of the 5 RCTs showed a significant decrease in local recurrence rates among patients receiving radiotherapy. In the 4 trials with a median follow-up of 5 years or longer, the relative risk reduction with breast irradiation ranged from 69% to 88%. The absolute differences ranged from 16% (p < 0.001) to 25% (p < 0.001). Despite the effect on local recurrence, no difference in survival was detected in any of the 5 trials. Most of the patients with local recurrence in these trials underwent mastectomy.

Harms: Major adverse effects of breast irradiation occur very infrequently.

Practice guideline: Women with early stage invasive breast cancer (stage I and II) who have undergone breast conservation surgery should be offered postoperative breast irradiation. The optimal fractionation schedule for breast irradiation has not been established, and the role of boost irradiation is unclear. Outside of a clinical trial, 2 commonly used fractionation schedules are suggested: 50 Gy in 25 fractions to the whole breast, or 40 Gy in 16 fractions to the whole breast with a local boost to the primary site of 12.5 Gy in 5 fractions. Shorter schedules (e.g.,

Six focus groups of 58 individuals (30 women and 28 men) were held in 3 Canadian cities to help develop a survey instrument to be implemented nationally to identify cancer patients' experiences with cancer: treatment, symptoms and symptom management. Patient participants had different cancer diagnoses, but their experience with cancer had been within the year preceding the study. Our intent was to identify as many themes as possible to allow for comparison of different experiences in a national survey. This paper reports on what was learned substantively from these focus groups and discusses the methodological contribution of focus groups in developing survey tools.

The purpose of this study was to explore the usefulness of Reiki as an adjuvant to opioid therapy in the management of pain. Since no studies in this area could be found, a pilot study was carried out involving 20 volunteers experiencing pain at 55 sites for a variety of reasons, including cancer. All Reiki treatments were provided by a certified second-degree Reiki therapist. Pain was measured using both a visual analogue scale (VAS) and a Likert scale immediately before and after the Reiki treatment. Both instruments showed a highly significant (p < 0.0001) reduction in pain following the Reiki treatment.

Purpose: Although the care of inpatients is an important aspect of radiation oncology practice in many countries, it has never been studied in detail. The goal of this study was to describe the admissions to a radiation oncology inpatient service over a 1-year period with respect to patient characteristics, primary malignancies, common nonmalignant diagnoses, use of radiotherapy and outcome of admission.

Method: Using computerized hospital databases, we analysed the utilization of 11 radiation oncology beds in a 424-bed teaching hospital from March 31, 1991, to April 1, 1992.

Results: There were 342 admissions of 277 patients. The median age was 66.5 years; the male:female ratio was 1:1. The commonest primary neoplastic diagnoses were lung (42%), gynecological (15%), genitourinary (14%) and breast (8%) cancers. Only 17% of the patients had cancer as the sole diagnosis; most patients had multiple medical diagnoses. Infections (22%), neurological (20%), cardiovascular (13%) and endocrine (9%) conditions were the commonest. Mean length of stay was 11.25 days. Most of the admissions (71%) resulted in discharge to the patient's home; few patients (15%) died. Only half of admissions involved radiotherapy, indicating that the focus of patient care was the medical treatment of cancer complications or other active medical problems.

Conclusion: These data show that radiation oncology inpatients have complicated medical problems, and they support the training of radiation oncologists in the comprehensive medical care of patients.