norm phillips | BC Cancer Agency (original) (raw)

Papers by norm phillips

Research paper thumbnail of Risk of a second malignant neoplasm among 5-year survivors of cancer in childhood and adolescence in British Columbia, Canada

Pediatric Blood & Cancer, 2007

As a result of improvements in therapies for childhood and adolescent cancers in the last several... more As a result of improvements in therapies for childhood and adolescent cancers in the last several decades, survival rates are increasing. However, those same cancer therapies have been shown to increase risk of a subsequent cancer among survivors . Recent published reports suggest that the risk of developing a second malignancy in cohorts of 3-or 5-year survivors is 3 to 15 times greater than the incidence in the general population, and that the cumulative risk varies between 2% and12% at 20 years after the original diagnosis . Early studies of small, homogeneous, clinic-based cohorts with short follow-up periods reported somewhat higher incidence ratios, approaching 20-fold excess risks in comparison to the general population . The Childhood Cancer Survivor Study (CCSS), which followed a large multi-center cohort of childhood cancer patients with selected diagnoses in the US and Canada between 1970 and 1986, reported an SIR of observed-to-expected second cancers of 6.4 . Population-based cohorts from the UK and five Nordic countries have reported SIRs of 6.2 and 3.6 respectively , but these studies did not examine risk among survivors diagnosed during the 1990s. A populationbased cohort that followed patients diagnosed with an original cancer before the age of 25 years through the 1990s reported an SIR of 4.4 for second malignancies , whereas a small clinic-based study from Slovenia reported an SIR of 8 . Research also indicates that, while the major determinant of a second cancer is treatment (including high-dose radiation therapy and certain chemotherapy agents), risk may vary according to the patient's gender, age at diagnosis of the original cancer, and genetic predisposition to cancer . In order to address second cancer risk, more information is needed among the total population of survivors, with extensive follow-up, and on risks to cohorts diagnosed during different treatment eras.

Research paper thumbnail of Quality of life and oral function in patients treated with radiation therapy for head and neck cancer

Head and Neck-journal for The Sciences and Specialties of The Head and Neck, 2001

BackgroundMultiple oral complaints develop during radiation therapy for head and neck cancer, and... more BackgroundMultiple oral complaints develop during radiation therapy for head and neck cancer, and quality of life is affected after treatment. The purpose of this investigation was to assess the quality of life, oral function, and oral symptoms in a cohort of patients during and after radiation therapy.Multiple oral complaints develop during radiation therapy for head and neck cancer, and quality of life is affected after treatment. The purpose of this investigation was to assess the quality of life, oral function, and oral symptoms in a cohort of patients during and after radiation therapy.MethodsA general quality of life survey (the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ-C30), with an added oral symptom and function scale was administered to a consecutive series of patients who received radiation therapy for head and neck malignant disease. Patients completed surveys at the beginning of radiation therapy, immediately after, and 6 months after treatment.A general quality of life survey (the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ-C30), with an added oral symptom and function scale was administered to a consecutive series of patients who received radiation therapy for head and neck malignant disease. Patients completed surveys at the beginning of radiation therapy, immediately after, and 6 months after treatment.Results and DiscussionThe questionnaire used in this study provides increased information regarding the oral and dental function that is frequently affected by radiation therapy. Results of this study indicate the need to determine oral dysfunction after head and neck cancer therapy, so that the most predictable cure or best palliation of the malignancy with the least impact on oral function and quality of life is chosen.Oral complications during and after radiation therapy for head and neck cancer are common and affect quality of life. Oral QOL does not return to pretreatment levels by 6 months after radiation therapy. This study supports the use of a general function scale such as the EORTC questionnaire with the addition of disease/site-specific scales to provide data on outcomes of therapy and on the complications associated with therapy. The EORTC QLQ 30 questionnaire with the oral assessment addendum provides a measure of the quality of life and oral function in head and neck cancer patients and may provide useful outcome measures for assessment of oral care prevention and management strategies in these patient populations. The results show that the questionnaire is responsive to change throughout the course of radiation therapy for head and neck cancer. © 2001 John Wiley & Sons, Inc. Head Neck 23: 389–398, 2001.The questionnaire used in this study provides increased information regarding the oral and dental function that is frequently affected by radiation therapy. Results of this study indicate the need to determine oral dysfunction after head and neck cancer therapy, so that the most predictable cure or best palliation of the malignancy with the least impact on oral function and quality of life is chosen.Oral complications during and after radiation therapy for head and neck cancer are common and affect quality of life. Oral QOL does not return to pretreatment levels by 6 months after radiation therapy. This study supports the use of a general function scale such as the EORTC questionnaire with the addition of disease/site-specific scales to provide data on outcomes of therapy and on the complications associated with therapy. The EORTC QLQ 30 questionnaire with the oral assessment addendum provides a measure of the quality of life and oral function in head and neck cancer patients and may provide useful outcome measures for assessment of oral care prevention and management strategies in these patient populations. The results show that the questionnaire is responsive to change throughout the course of radiation therapy for head and neck cancer. © 2001 John Wiley & Sons, Inc. Head Neck 23: 389–398, 2001.

Research paper thumbnail of Quality of life and oral function following radiotherapy for head and neck cancer

Head and Neck-journal for The Sciences and Specialties of The Head and Neck, 1999

Multiple oral complaints occur following radiotherapy for oropharyngeal cancer, but the frequency... more Multiple oral complaints occur following radiotherapy for oropharyngeal cancer, but the frequency and severity of symptoms of dysfunction and discomfort are not well understood. The purpose of this investigation was to assess the quality of life, oral function, and oral symptoms following radiotherapy. A general quality of life survey (the European Organization for Research and Treatment of Cancer [EORTC] Quality of Life Questionnaire QLQ-C30), with an added oral symptom and function scale was mailed to 100 patients more than 6 months following radiotherapy. Sixty-five patients responded. Difficulty chewing or eating was reported by 43% of respondents. Dry mouth was reported by 91.8%, change in taste by 75.4%, dysphagia by 63.1%, altered speech by 50.8%, difficulty with dentures by 48.5%, and increased tooth decay by 38.5% of dentate patients. Pain was common (58.4%) and interfered with daily activities in 30.8%. Mood complaints were reported by approximately half the patients. Interference of the physical condition social activities was reported by 60%. The frequency of oral side effects correlated with radiation treatment fields and dose. Oral complications following radiotherapy for head and neck cancer are common and affect quality of life. Use of a general function scale such as the EORTC questionnaire with the addition of disease/site specific scales may provide useful data on outcome of therapy and upon the complications associated with therapy and impact upon the quality of life.

Research paper thumbnail of Quality of life and oral function following radiotherapy for head and neck cancer

Head and Neck-journal for The Sciences and Specialties of The Head and Neck, 1999

Multiple oral complaints occur following radiotherapy for oropharyngeal cancer, but the frequency... more Multiple oral complaints occur following radiotherapy for oropharyngeal cancer, but the frequency and severity of symptoms of dysfunction and discomfort are not well understood. The purpose of this investigation was to assess the quality of life, oral function, and oral symptoms following radiotherapy. A general quality of life survey (the European Organization for Research and Treatment of Cancer [EORTC] Quality of Life Questionnaire QLQ-C30), with an added oral symptom and function scale was mailed to 100 patients more than 6 months following radiotherapy. Sixty-five patients responded. Difficulty chewing or eating was reported by 43% of respondents. Dry mouth was reported by 91.8%, change in taste by 75.4%, dysphagia by 63.1%, altered speech by 50.8%, difficulty with dentures by 48.5%, and increased tooth decay by 38.5% of dentate patients. Pain was common (58.4%) and interfered with daily activities in 30.8%. Mood complaints were reported by approximately half the patients. Interference of the physical condition social activities was reported by 60%. The frequency of oral side effects correlated with radiation treatment fields and dose. Oral complications following radiotherapy for head and neck cancer are common and affect quality of life. Use of a general function scale such as the EORTC questionnaire with the addition of disease/site specific scales may provide useful data on outcome of therapy and upon the complications associated with therapy and impact upon the quality of life.

Research paper thumbnail of Effect of time interval between breast-conserving surgery and radiation therapy on ipsilateral breast recurrence

International Journal of Radiation Oncology Biology Physics, 2000

Methods and Materials: We reviewed interval and a number of prognostic and treatment factors amon... more Methods and Materials: We reviewed interval and a number of prognostic and treatment factors among 1,962 women treated with BCS and RT for invasive breast cancer diagnosed between January 1, 1989 and December 31, 1993 in British Columbia, Canada. Subjects were female, less than 90 years old at diagnosis, not treated with chemotherapy, not stage T4 or M1, and had survived more than 30 days from diagnosis. The cumulative incidence of IBR was estimated in four interval groups: 0 -5, 6 -8, 9 -12, and 13؉ weeks. Only 23 women had an interval of greater than 20 weeks between BCS and start of RT. To assess whether an imbalance of prognostic and treatment factors could be obscuring real differences between the interval groups, Cox proportional hazards regression analyses were conducted. Results: Median follow-up was 71 months. The crude incidence of IBR for the entire sample was 3.9%. The cumulative incidence of IBR in the 6 -8, 9 -12, and 13؉ week groups was not statistically significantly different from the cumulative incidence of IBR in the 0 -5 week group. Multivariate analyses demonstrated that patients not using tamoxifen (p ‫؍‬ 0.027) and those with grade 3 histology (p ‫؍‬ 0.003) were more likely to recur in the breast. Interval between BCS and RT was not a statistically significant predictor of breast recurrence when entered into a model incorporating tamoxifen use and tumor grade (0 -5 vs. 6 -8 weeks, p ‫؍‬ 0.872; 0 -5 vs. 9 -12 weeks, p ‫؍‬ 0.665; 0 -5 vs. 13؉ weeks, p ‫؍‬ 0.573). Conclusions: We found no univariate or multivariate difference in ipsilateral breast cancer recurrence between intervals of 0 to 20 weeks from breast conserving surgery to start of radiation therapy, in a population-based, low risk group of women not receiving adjuvant chemotherapy, after controlling for other factors important in predicting ipsilateral breast cancer recurrence.

Research paper thumbnail of Comparison of nonbreast cancer incidence, survival and mortality between breast screening program participants and nonparticipants

International Journal of Cancer, 2008

Comparisons of cancer mortality between users and nonusers of screening are potentially biased be... more Comparisons of cancer mortality between users and nonusers of screening are potentially biased because of the effects of self-selection. Previous studies of breast screening have found that individuals likely to participate have lower breast cancer mortality than those unlikely to participate. This study compares the incidence, survival and mortality for all cancer types other than breast between participants and nonparticipants in a service screening mammography program. British Columbian females having their first mammogram between the ages of 40 and 79 and the years 1988 and 2004 were identified as a cohort of “participants”. Person-years of follow-up of participants were aggregated by age and year. Nonparticipant person-years were obtained by subtraction from the total female population. Cancer diagnoses other than breast were identified for participants and nonparticipants. Age, calendar year, and income adjusted relative risks of cancer incidence were estimated from generalized additive models with Poisson errors. Hazard ratios were estimated by Cox regression. Observed cancer mortality in participants was compared with expected mortality generated from nonparticipant incidence and survival rates. Incidence rates of cancer showed a mixed relationship with some elevated, some decreased and others similar to nonparticipant rates. Cancer survival was higher among participants for most cancer types, with an overall hazard ratio of 0.76 (0.73–0.79). Observed mortality in participants was less than expected for most cancers, with an overall mortality ratio of 0.60 (0.58–0.62). The general cancer experience of screening program participants is different from that of the general population. © 2007 Wiley-Liss, Inc.

Research paper thumbnail of Impact of changing from annual to biennial mammographic screening on breast cancer outcomes in women aged 50-79 in British Columbia

Objectives The objective of this study was to compare breast cancer outcomes among women subject ... more Objectives The objective of this study was to compare breast cancer outcomes among women subject to different policies on mammography screening frequency. Setting Data were obtained for women participating in the Screening Mammography Programme of British Columbia (SMPBC) for 1988 -2005. The SMPBC changed its policy for women aged 50 -79 years from annual to biennial mammography in 1997, but retained an annual recommendation for women aged 40 -49 years. Methods Breast cancer outcomes were compared for women participating in the programme before and after 1997 for two groups: ages 40 -49 and 50-79 years. Results There were data on 658,151 women. Comparing pre-1997 and post-1997, the median interscreen interval increased by 11.1 months in women 50 -79 but by only 0.3 months in women aged 40-49. Excluding those detected at initial screen, 6291 breast cancers were identified. Comparing pre-1997 and post-1997: the relative rates (RR) of screen detected cancer increased in women aged 40 -49 (RR ¼ 1.32) and the rate of invasive cancers !20 mm at diagnosis decreased (RR ¼ 0.83); the rate of cancers with axillary node involvement increased in women aged 50 -79 (RR ¼ 1.23). Cancer survival improved after 1997 for women diagnosed at ages 40 -49 (hazard ratio ¼ 0.62), but was unchanged for women aged 50-79. Breast cancer mortality rates did not change between the periods in either age group. Conclusion The proximal cancer outcomes considered (staging and survival) improved in women aged 40-49 but this was offset in women aged 50-79 associated with the change in screen frequency. These changes did not result in alterations in breast cancer mortality rates in either age group.

Research paper thumbnail of Risk of invasive cervical cancer after pap smears: the protective effect of multiple negatives

Journal of Medical Screening, 2005

Objective: To determine the relationship between the number of initial negative Pap smears and ri... more Objective: To determine the relationship between the number of initial negative Pap smears and risk of subsequent cervical cancer. Design: A cohort study was conducted using data from the British Columbia Cervical Cancer Screening Program and British Columbia Cancer Registry. The analysis used a random sample (1%) of women aged 20-69 with Pap smears and all cases of invasive cervical cancer diagnosed between 1994 and 1999. Each negative screen defined the beginning of a screening interval and intervals longer than five years were truncated. The following variables were created for each interval: age at the beginning of the interval, interval length, previous cytological abnormality, previous cervical procedure and number of preceding consecutive negative screens. The relationship between these variables and risk of squamous cervical cancer was determined using survival analysis methods. Results: A total of 388 cases of invasive cervical cancer (252 squamous) were included in the study from a study population of over 3.3 million Pap smears. The risk of invasive squamous cancer increased with time since the last negative screen, history of cytological abnormality and history of cervical therapeutic procedure. Risk was not significantly related to age (P ¼ 0.2) but was highest in women aged 30-49. Multiple consecutive negative pap smears were associated with reduced risk in women with a history of moderate atypia (Po0.0001), but not in women without a history (P ¼ 0.4). Conclusions: Multiple consecutive negative cytology was not associated with reduced risk of invasive cervical cancer in women with no history of cytological abnormality. 7 Ã Squamous ¼ ICDO 805-808. ÃÃ Mild glandular atypia added for this table entry only. ÃÃÃ Moderate or worse glandular atypia added for this table entry only. w Colposcopy, with or without biopsy, or endocervical curettage. z Laser therapy, cryotherapy, cone biopsy or LEEP. Ã P value is for significance of variable treated as unordered categorical. Invasive cervical cancer after pap smears 9 www.jmedscreen.com Journal of Medical Screening 2005 Volume 12 Number 1 Ã P value is for significance of variable treated as unordered categorical. All tests of second-order interaction were non-significant. ÃÃ Referent for preceding negative screens with or without history of moderate atypia variable. w Colposcopy, with or without biopsy, or endocervical curettage. z Laser therapy, cryotherapy, cone biopsy or LEEP 10 Coldman, Phillips, Kan, et al. Ã P value is for significance of variable treated as unordered categorical. All tests of second-order interaction were non-significant. ÃÃ Referent for preceding negative screens with or without history of moderate atypia variable. w Colposcopy, with or without biopsy, or endocervical curettage. z Laser therapy, cryotherapy, cone biopsy or LEEP 10 Coldman, Phillips, Kan, et al.

Research paper thumbnail of Population studies of the effectiveness of mammographic screening

Preventive Medicine, 2011

Objective. To examine population data to see whether survival from breast cancer has improved dif... more Objective. To examine population data to see whether survival from breast cancer has improved differentially in screened and unscreened women and examine published studies on mammographic screening to determine whether there is evidence that screening is no longer effective.

Research paper thumbnail of Breast cancer mortality after screening mammography in British Columbia women

International Journal of Cancer, 2007

Mammographic screening is a proven method for the early detection of breast cancer. The authors a... more Mammographic screening is a proven method for the early detection of breast cancer. The authors analyzed the impact of service mammographic screening on breast cancer mortality among British Columbia women who volunteered to be screened by the Screening Mammography Program of British Columbia. A cohort of women having at least one mammographic screen by Screening Mammography Program of British Columbia between the ages of 40 and 79 in the period 1988–2003 was identified. All cases and deaths from breast cancer occurring in British Columbia were identified from the British Columbia Cancer Registry and linked to the screening cohort. Expected deaths from breast cancer in the cohort were calculated using incidence and survival rates for British Columbia women not in the cohort. Adjustment was made for age and socioeconomic status of their area of residence at time of diagnosis. The breast cancer mortality ratio was calculated by dividing observed by expected breast cancer deaths. The mortality ratio (95% confidence interval) was 0.60 (0.55, 0.65) for all ages combined (p < 0.0001). The mortality ratio in women aged 40–49 at first screening was 0.61 (0.52, 0.71), similar to that in women over 50 (p = 0.90). Exclusion of mortality associated with breast cancers diagnosed after age 50 in women starting screening in their 40s increased the mortality ratio to 0.63 (0.52, 0.77), but it remained statistically significant. Correction for self-selection bias using estimates from the literature increased the mortality ratio for all ages to 0.76. Mammographic screening at all ages between 40 and 79 reduced subsequent mortality rates from breast cancer. © 2006 Wiley-Liss, Inc.

Research paper thumbnail of A retrospective study of the effect of participation in screening mammography on the use of chemotherapy and breast conserving surgery

International Journal of Cancer, 2007

A population sample was obtained from the British Columbia (BC) Cancer Registry of all women diag... more A population sample was obtained from the British Columbia (BC) Cancer Registry of all women diagnosed with a first breast cancer in 2002 who were resident in Greater Vancouver or Greater Victoria, BC. Information on treatment and prognostic factors were obtained from source records. The study group was linked to the records of the Screening Mammography Program of BC to identify screening histories on women prior to diagnosis. Logistic regression was used to determine the relationship between screening participation and treatment and to predict treatment use from prognostic factors. Fifteen hundred and eighty-nine women with breast cancer were included in the study and 1,071 (67%) had participated in screening prior to diagnosis: 786 (49%) had been screened within the 30 months prior to their diagnosis (regular participants). Breast conserving surgery (BCS) rates were higher (OR = 2.3, p < 0.001) and chemotherapy use lower (OR = 0.53, p < 0.001) among regular participants compared with nonparticipants after adjustment for age. A predictive model based on the distribution of prognostic factors between participants provided estimates of OR = 1.47 and OR = 0.54 for BCS and chemotherapy, respectively, and adjustment for self-selection changed the predicted values to OR = 1.16 and OR = 0.67, respectively. Participation in screening produced a considerable change in the use of chemotherapy but less on BCS use. © 2007 Wiley-Liss, Inc.

Research paper thumbnail of Risk of a second malignant neoplasm among 5-year survivors of cancer in childhood and adolescence in British Columbia, Canada

Pediatric Blood & Cancer, 2007

As a result of improvements in therapies for childhood and adolescent cancers in the last several... more As a result of improvements in therapies for childhood and adolescent cancers in the last several decades, survival rates are increasing. However, those same cancer therapies have been shown to increase risk of a subsequent cancer among survivors . Recent published reports suggest that the risk of developing a second malignancy in cohorts of 3-or 5-year survivors is 3 to 15 times greater than the incidence in the general population, and that the cumulative risk varies between 2% and12% at 20 years after the original diagnosis . Early studies of small, homogeneous, clinic-based cohorts with short follow-up periods reported somewhat higher incidence ratios, approaching 20-fold excess risks in comparison to the general population . The Childhood Cancer Survivor Study (CCSS), which followed a large multi-center cohort of childhood cancer patients with selected diagnoses in the US and Canada between 1970 and 1986, reported an SIR of observed-to-expected second cancers of 6.4 . Population-based cohorts from the UK and five Nordic countries have reported SIRs of 6.2 and 3.6 respectively , but these studies did not examine risk among survivors diagnosed during the 1990s. A populationbased cohort that followed patients diagnosed with an original cancer before the age of 25 years through the 1990s reported an SIR of 4.4 for second malignancies , whereas a small clinic-based study from Slovenia reported an SIR of 8 . Research also indicates that, while the major determinant of a second cancer is treatment (including high-dose radiation therapy and certain chemotherapy agents), risk may vary according to the patient's gender, age at diagnosis of the original cancer, and genetic predisposition to cancer . In order to address second cancer risk, more information is needed among the total population of survivors, with extensive follow-up, and on risks to cohorts diagnosed during different treatment eras.

Research paper thumbnail of Quality of life and oral function in patients treated with radiation therapy for head and neck cancer

Head and Neck-journal for The Sciences and Specialties of The Head and Neck, 2001

BackgroundMultiple oral complaints develop during radiation therapy for head and neck cancer, and... more BackgroundMultiple oral complaints develop during radiation therapy for head and neck cancer, and quality of life is affected after treatment. The purpose of this investigation was to assess the quality of life, oral function, and oral symptoms in a cohort of patients during and after radiation therapy.Multiple oral complaints develop during radiation therapy for head and neck cancer, and quality of life is affected after treatment. The purpose of this investigation was to assess the quality of life, oral function, and oral symptoms in a cohort of patients during and after radiation therapy.MethodsA general quality of life survey (the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ-C30), with an added oral symptom and function scale was administered to a consecutive series of patients who received radiation therapy for head and neck malignant disease. Patients completed surveys at the beginning of radiation therapy, immediately after, and 6 months after treatment.A general quality of life survey (the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ-C30), with an added oral symptom and function scale was administered to a consecutive series of patients who received radiation therapy for head and neck malignant disease. Patients completed surveys at the beginning of radiation therapy, immediately after, and 6 months after treatment.Results and DiscussionThe questionnaire used in this study provides increased information regarding the oral and dental function that is frequently affected by radiation therapy. Results of this study indicate the need to determine oral dysfunction after head and neck cancer therapy, so that the most predictable cure or best palliation of the malignancy with the least impact on oral function and quality of life is chosen.Oral complications during and after radiation therapy for head and neck cancer are common and affect quality of life. Oral QOL does not return to pretreatment levels by 6 months after radiation therapy. This study supports the use of a general function scale such as the EORTC questionnaire with the addition of disease/site-specific scales to provide data on outcomes of therapy and on the complications associated with therapy. The EORTC QLQ 30 questionnaire with the oral assessment addendum provides a measure of the quality of life and oral function in head and neck cancer patients and may provide useful outcome measures for assessment of oral care prevention and management strategies in these patient populations. The results show that the questionnaire is responsive to change throughout the course of radiation therapy for head and neck cancer. © 2001 John Wiley & Sons, Inc. Head Neck 23: 389–398, 2001.The questionnaire used in this study provides increased information regarding the oral and dental function that is frequently affected by radiation therapy. Results of this study indicate the need to determine oral dysfunction after head and neck cancer therapy, so that the most predictable cure or best palliation of the malignancy with the least impact on oral function and quality of life is chosen.Oral complications during and after radiation therapy for head and neck cancer are common and affect quality of life. Oral QOL does not return to pretreatment levels by 6 months after radiation therapy. This study supports the use of a general function scale such as the EORTC questionnaire with the addition of disease/site-specific scales to provide data on outcomes of therapy and on the complications associated with therapy. The EORTC QLQ 30 questionnaire with the oral assessment addendum provides a measure of the quality of life and oral function in head and neck cancer patients and may provide useful outcome measures for assessment of oral care prevention and management strategies in these patient populations. The results show that the questionnaire is responsive to change throughout the course of radiation therapy for head and neck cancer. © 2001 John Wiley & Sons, Inc. Head Neck 23: 389–398, 2001.

Research paper thumbnail of Quality of life and oral function following radiotherapy for head and neck cancer

Head and Neck-journal for The Sciences and Specialties of The Head and Neck, 1999

Multiple oral complaints occur following radiotherapy for oropharyngeal cancer, but the frequency... more Multiple oral complaints occur following radiotherapy for oropharyngeal cancer, but the frequency and severity of symptoms of dysfunction and discomfort are not well understood. The purpose of this investigation was to assess the quality of life, oral function, and oral symptoms following radiotherapy. A general quality of life survey (the European Organization for Research and Treatment of Cancer [EORTC] Quality of Life Questionnaire QLQ-C30), with an added oral symptom and function scale was mailed to 100 patients more than 6 months following radiotherapy. Sixty-five patients responded. Difficulty chewing or eating was reported by 43% of respondents. Dry mouth was reported by 91.8%, change in taste by 75.4%, dysphagia by 63.1%, altered speech by 50.8%, difficulty with dentures by 48.5%, and increased tooth decay by 38.5% of dentate patients. Pain was common (58.4%) and interfered with daily activities in 30.8%. Mood complaints were reported by approximately half the patients. Interference of the physical condition social activities was reported by 60%. The frequency of oral side effects correlated with radiation treatment fields and dose. Oral complications following radiotherapy for head and neck cancer are common and affect quality of life. Use of a general function scale such as the EORTC questionnaire with the addition of disease/site specific scales may provide useful data on outcome of therapy and upon the complications associated with therapy and impact upon the quality of life.

Research paper thumbnail of Quality of life and oral function following radiotherapy for head and neck cancer

Head and Neck-journal for The Sciences and Specialties of The Head and Neck, 1999

Multiple oral complaints occur following radiotherapy for oropharyngeal cancer, but the frequency... more Multiple oral complaints occur following radiotherapy for oropharyngeal cancer, but the frequency and severity of symptoms of dysfunction and discomfort are not well understood. The purpose of this investigation was to assess the quality of life, oral function, and oral symptoms following radiotherapy. A general quality of life survey (the European Organization for Research and Treatment of Cancer [EORTC] Quality of Life Questionnaire QLQ-C30), with an added oral symptom and function scale was mailed to 100 patients more than 6 months following radiotherapy. Sixty-five patients responded. Difficulty chewing or eating was reported by 43% of respondents. Dry mouth was reported by 91.8%, change in taste by 75.4%, dysphagia by 63.1%, altered speech by 50.8%, difficulty with dentures by 48.5%, and increased tooth decay by 38.5% of dentate patients. Pain was common (58.4%) and interfered with daily activities in 30.8%. Mood complaints were reported by approximately half the patients. Interference of the physical condition social activities was reported by 60%. The frequency of oral side effects correlated with radiation treatment fields and dose. Oral complications following radiotherapy for head and neck cancer are common and affect quality of life. Use of a general function scale such as the EORTC questionnaire with the addition of disease/site specific scales may provide useful data on outcome of therapy and upon the complications associated with therapy and impact upon the quality of life.

Research paper thumbnail of Effect of time interval between breast-conserving surgery and radiation therapy on ipsilateral breast recurrence

International Journal of Radiation Oncology Biology Physics, 2000

Methods and Materials: We reviewed interval and a number of prognostic and treatment factors amon... more Methods and Materials: We reviewed interval and a number of prognostic and treatment factors among 1,962 women treated with BCS and RT for invasive breast cancer diagnosed between January 1, 1989 and December 31, 1993 in British Columbia, Canada. Subjects were female, less than 90 years old at diagnosis, not treated with chemotherapy, not stage T4 or M1, and had survived more than 30 days from diagnosis. The cumulative incidence of IBR was estimated in four interval groups: 0 -5, 6 -8, 9 -12, and 13؉ weeks. Only 23 women had an interval of greater than 20 weeks between BCS and start of RT. To assess whether an imbalance of prognostic and treatment factors could be obscuring real differences between the interval groups, Cox proportional hazards regression analyses were conducted. Results: Median follow-up was 71 months. The crude incidence of IBR for the entire sample was 3.9%. The cumulative incidence of IBR in the 6 -8, 9 -12, and 13؉ week groups was not statistically significantly different from the cumulative incidence of IBR in the 0 -5 week group. Multivariate analyses demonstrated that patients not using tamoxifen (p ‫؍‬ 0.027) and those with grade 3 histology (p ‫؍‬ 0.003) were more likely to recur in the breast. Interval between BCS and RT was not a statistically significant predictor of breast recurrence when entered into a model incorporating tamoxifen use and tumor grade (0 -5 vs. 6 -8 weeks, p ‫؍‬ 0.872; 0 -5 vs. 9 -12 weeks, p ‫؍‬ 0.665; 0 -5 vs. 13؉ weeks, p ‫؍‬ 0.573). Conclusions: We found no univariate or multivariate difference in ipsilateral breast cancer recurrence between intervals of 0 to 20 weeks from breast conserving surgery to start of radiation therapy, in a population-based, low risk group of women not receiving adjuvant chemotherapy, after controlling for other factors important in predicting ipsilateral breast cancer recurrence.

Research paper thumbnail of Comparison of nonbreast cancer incidence, survival and mortality between breast screening program participants and nonparticipants

International Journal of Cancer, 2008

Comparisons of cancer mortality between users and nonusers of screening are potentially biased be... more Comparisons of cancer mortality between users and nonusers of screening are potentially biased because of the effects of self-selection. Previous studies of breast screening have found that individuals likely to participate have lower breast cancer mortality than those unlikely to participate. This study compares the incidence, survival and mortality for all cancer types other than breast between participants and nonparticipants in a service screening mammography program. British Columbian females having their first mammogram between the ages of 40 and 79 and the years 1988 and 2004 were identified as a cohort of “participants”. Person-years of follow-up of participants were aggregated by age and year. Nonparticipant person-years were obtained by subtraction from the total female population. Cancer diagnoses other than breast were identified for participants and nonparticipants. Age, calendar year, and income adjusted relative risks of cancer incidence were estimated from generalized additive models with Poisson errors. Hazard ratios were estimated by Cox regression. Observed cancer mortality in participants was compared with expected mortality generated from nonparticipant incidence and survival rates. Incidence rates of cancer showed a mixed relationship with some elevated, some decreased and others similar to nonparticipant rates. Cancer survival was higher among participants for most cancer types, with an overall hazard ratio of 0.76 (0.73–0.79). Observed mortality in participants was less than expected for most cancers, with an overall mortality ratio of 0.60 (0.58–0.62). The general cancer experience of screening program participants is different from that of the general population. © 2007 Wiley-Liss, Inc.

Research paper thumbnail of Impact of changing from annual to biennial mammographic screening on breast cancer outcomes in women aged 50-79 in British Columbia

Objectives The objective of this study was to compare breast cancer outcomes among women subject ... more Objectives The objective of this study was to compare breast cancer outcomes among women subject to different policies on mammography screening frequency. Setting Data were obtained for women participating in the Screening Mammography Programme of British Columbia (SMPBC) for 1988 -2005. The SMPBC changed its policy for women aged 50 -79 years from annual to biennial mammography in 1997, but retained an annual recommendation for women aged 40 -49 years. Methods Breast cancer outcomes were compared for women participating in the programme before and after 1997 for two groups: ages 40 -49 and 50-79 years. Results There were data on 658,151 women. Comparing pre-1997 and post-1997, the median interscreen interval increased by 11.1 months in women 50 -79 but by only 0.3 months in women aged 40-49. Excluding those detected at initial screen, 6291 breast cancers were identified. Comparing pre-1997 and post-1997: the relative rates (RR) of screen detected cancer increased in women aged 40 -49 (RR ¼ 1.32) and the rate of invasive cancers !20 mm at diagnosis decreased (RR ¼ 0.83); the rate of cancers with axillary node involvement increased in women aged 50 -79 (RR ¼ 1.23). Cancer survival improved after 1997 for women diagnosed at ages 40 -49 (hazard ratio ¼ 0.62), but was unchanged for women aged 50-79. Breast cancer mortality rates did not change between the periods in either age group. Conclusion The proximal cancer outcomes considered (staging and survival) improved in women aged 40-49 but this was offset in women aged 50-79 associated with the change in screen frequency. These changes did not result in alterations in breast cancer mortality rates in either age group.

Research paper thumbnail of Risk of invasive cervical cancer after pap smears: the protective effect of multiple negatives

Journal of Medical Screening, 2005

Objective: To determine the relationship between the number of initial negative Pap smears and ri... more Objective: To determine the relationship between the number of initial negative Pap smears and risk of subsequent cervical cancer. Design: A cohort study was conducted using data from the British Columbia Cervical Cancer Screening Program and British Columbia Cancer Registry. The analysis used a random sample (1%) of women aged 20-69 with Pap smears and all cases of invasive cervical cancer diagnosed between 1994 and 1999. Each negative screen defined the beginning of a screening interval and intervals longer than five years were truncated. The following variables were created for each interval: age at the beginning of the interval, interval length, previous cytological abnormality, previous cervical procedure and number of preceding consecutive negative screens. The relationship between these variables and risk of squamous cervical cancer was determined using survival analysis methods. Results: A total of 388 cases of invasive cervical cancer (252 squamous) were included in the study from a study population of over 3.3 million Pap smears. The risk of invasive squamous cancer increased with time since the last negative screen, history of cytological abnormality and history of cervical therapeutic procedure. Risk was not significantly related to age (P ¼ 0.2) but was highest in women aged 30-49. Multiple consecutive negative pap smears were associated with reduced risk in women with a history of moderate atypia (Po0.0001), but not in women without a history (P ¼ 0.4). Conclusions: Multiple consecutive negative cytology was not associated with reduced risk of invasive cervical cancer in women with no history of cytological abnormality. 7 Ã Squamous ¼ ICDO 805-808. ÃÃ Mild glandular atypia added for this table entry only. ÃÃÃ Moderate or worse glandular atypia added for this table entry only. w Colposcopy, with or without biopsy, or endocervical curettage. z Laser therapy, cryotherapy, cone biopsy or LEEP. Ã P value is for significance of variable treated as unordered categorical. Invasive cervical cancer after pap smears 9 www.jmedscreen.com Journal of Medical Screening 2005 Volume 12 Number 1 Ã P value is for significance of variable treated as unordered categorical. All tests of second-order interaction were non-significant. ÃÃ Referent for preceding negative screens with or without history of moderate atypia variable. w Colposcopy, with or without biopsy, or endocervical curettage. z Laser therapy, cryotherapy, cone biopsy or LEEP 10 Coldman, Phillips, Kan, et al. Ã P value is for significance of variable treated as unordered categorical. All tests of second-order interaction were non-significant. ÃÃ Referent for preceding negative screens with or without history of moderate atypia variable. w Colposcopy, with or without biopsy, or endocervical curettage. z Laser therapy, cryotherapy, cone biopsy or LEEP 10 Coldman, Phillips, Kan, et al.

Research paper thumbnail of Population studies of the effectiveness of mammographic screening

Preventive Medicine, 2011

Objective. To examine population data to see whether survival from breast cancer has improved dif... more Objective. To examine population data to see whether survival from breast cancer has improved differentially in screened and unscreened women and examine published studies on mammographic screening to determine whether there is evidence that screening is no longer effective.

Research paper thumbnail of Breast cancer mortality after screening mammography in British Columbia women

International Journal of Cancer, 2007

Mammographic screening is a proven method for the early detection of breast cancer. The authors a... more Mammographic screening is a proven method for the early detection of breast cancer. The authors analyzed the impact of service mammographic screening on breast cancer mortality among British Columbia women who volunteered to be screened by the Screening Mammography Program of British Columbia. A cohort of women having at least one mammographic screen by Screening Mammography Program of British Columbia between the ages of 40 and 79 in the period 1988–2003 was identified. All cases and deaths from breast cancer occurring in British Columbia were identified from the British Columbia Cancer Registry and linked to the screening cohort. Expected deaths from breast cancer in the cohort were calculated using incidence and survival rates for British Columbia women not in the cohort. Adjustment was made for age and socioeconomic status of their area of residence at time of diagnosis. The breast cancer mortality ratio was calculated by dividing observed by expected breast cancer deaths. The mortality ratio (95% confidence interval) was 0.60 (0.55, 0.65) for all ages combined (p < 0.0001). The mortality ratio in women aged 40–49 at first screening was 0.61 (0.52, 0.71), similar to that in women over 50 (p = 0.90). Exclusion of mortality associated with breast cancers diagnosed after age 50 in women starting screening in their 40s increased the mortality ratio to 0.63 (0.52, 0.77), but it remained statistically significant. Correction for self-selection bias using estimates from the literature increased the mortality ratio for all ages to 0.76. Mammographic screening at all ages between 40 and 79 reduced subsequent mortality rates from breast cancer. © 2006 Wiley-Liss, Inc.

Research paper thumbnail of A retrospective study of the effect of participation in screening mammography on the use of chemotherapy and breast conserving surgery

International Journal of Cancer, 2007

A population sample was obtained from the British Columbia (BC) Cancer Registry of all women diag... more A population sample was obtained from the British Columbia (BC) Cancer Registry of all women diagnosed with a first breast cancer in 2002 who were resident in Greater Vancouver or Greater Victoria, BC. Information on treatment and prognostic factors were obtained from source records. The study group was linked to the records of the Screening Mammography Program of BC to identify screening histories on women prior to diagnosis. Logistic regression was used to determine the relationship between screening participation and treatment and to predict treatment use from prognostic factors. Fifteen hundred and eighty-nine women with breast cancer were included in the study and 1,071 (67%) had participated in screening prior to diagnosis: 786 (49%) had been screened within the 30 months prior to their diagnosis (regular participants). Breast conserving surgery (BCS) rates were higher (OR = 2.3, p < 0.001) and chemotherapy use lower (OR = 0.53, p < 0.001) among regular participants compared with nonparticipants after adjustment for age. A predictive model based on the distribution of prognostic factors between participants provided estimates of OR = 1.47 and OR = 0.54 for BCS and chemotherapy, respectively, and adjustment for self-selection changed the predicted values to OR = 1.16 and OR = 0.67, respectively. Participation in screening produced a considerable change in the use of chemotherapy but less on BCS use. © 2007 Wiley-Liss, Inc.