Windsor Regional Hospital

As cancer survival rates increase in Canada, a growing number of working-age individuals face challenges returning to work after treatment. This study examines the experiences of Canadian cancer survivors who remained in or returned to the workforce during the COVID-19 pandemic. Participants were cancer survivors aged 25-62 who had been employed prior to their diagnosis. They completed a brief online survey about their return-to-work (RTW) experiences and were invited to participate in a semi-structured interview. Seven participants took part in the interviews, which were transcribed and analyzed through inductive thematic analysis. Four overarching themes emerged: (1) The Perfect Storm of Systemic Challenges, highlighting healthcare barriers exacerbated by the pandemic; (2) You Are Not Alone, emphasizing the importance of social support in mitigating isolation; (3) One Size Does Not Fit All - Individual Journeys, reflecting the need for flexible workplace accommodations and patient self-advocacy; and (4) Creating a "New Normal," illustrating how survivors reassessed priorities, work identities, and personal well-being. Participants described delayed treatments, lack of fertility options, and limited support during appointments due to pandemic restrictions. Workplace accommodations varied, with some survivors feeling supported while others faced inflexibility. Findings emphasized the need for improved healthcare responsiveness, personalized RTW accommodations, and improved employer training to support cancer survivors. The study also reveals how the COVID-19 pandemic exacerbated existing systemic gaps, underscoring the importance of preparing healthcare and employment systems to better support vulnerable populations during times of crisis.

IntroductionColorectal Cancer (CrC) is a common cause of cancer-related death worldwide, but screening programs are highly effective at diagnosing early-stage disease, allowing effective treatment. During COVID-19, a decrease in screening participation was hypothesized due to limited access, leading to an increase in symptomatic presentations and stage at diagnosis.MethodsAll patients who met inclusion criteria were divided into two cohorts based on time of diagnosis (n = 373). The pre-COVID era was designated as December 2018 to February of 2020, with the COVID era running from then until March 2021. All patients were from the Windsor Regional Hospital Cancer Centre, located in Windsor, Canada.ResultsAcross time periods, 218 patients were diagnosed prior to, and only 144 during COVID. The number of Fecal Immunochemical Test (FIT) positive patients remained stable, while the number of procedural diagnoses decreased from 34.1% to 10.7%, with only 21.2% of patients overall being diagnosed with screening. When combining time periods, females presented symptomatically (85.0%) more often than males (74.4%). Patients with a positive family history were more likely to be diagnosed via procedural screening (42.9%) than those without (20.4%).ConclusionThere was no change to the proportion of symptomatic presentations across time groups, in contrast to our predicted outcome. There was a decrease in procedural screening during the COVID timeframe, with FIT testing rates remaining stable, likely representing patients being transferred to available methods. Female patients and patients with a family history demonstrated a particular need for increased screening participation based on our findings.

Triple-negative breast cancer (TNBC) is a heterogeneous cancer that lacks estrogen receptors (ER), progesterone receptors (PR), and human epidermal growth factor receptor 2 (HER2) proteins. Here, we investigated the prognostic value of grade in patients with TNBC. Methods: This retrospective study analyzed 780 TNBC patients from two large regional cancer programs in Canada. Patients seen between 1 January 2004 and 31 December 2022 were included. Patients with grade 1 tumors and stage IV disease were excluded from analysis. Demographic information regarding the patient, tumor, and treatment were collected. The primary outcomes, relapse-free survival (RFS) and overall survival (OS), were analyzed using the Cox proportional hazards model and max-combo test. Results: For patients with grade 2 TNBC, median RFS was 14.1 years (95% CI, 9.48 to not reached (NR)) while it was not reached for patients with grade 3 tumors. No difference for relapse was identified in the first five years. Beyond 5 years, 4.9% of the patients with grade 2 tumors and 1.6% of those with grade 3 tumors relapsed (p = 0.006). In that same study period, 10.4% of patients with grade 2 tumors and 5.7% of those with grade 3 tumors died (p = 0.03). Conclusion: Grade 2 TNBC was associated with a higher risk of relapse and death after the 5-year mark compared to grade 3 TNBC. This distinct pattern of relapse and survival in grade 2 TNBC, characterized by an increased risk of relapse and mortality after 5 years, warrants confirmatory investigations.

Abstract Purpose: Understanding real-world treatment patterns and their effectiveness in HR+ HER2- advanced breast cancer (aBC) in Canadian patients. Patient and Methods: This was an observational, prospective cohort study including men and pre-/peri-/postmenopausal women with HR+/HER2- aBC receiving endocrine therapy (ET) or ET+ targeted therapy (ET+TT). The primary objective was duration of treatment (DOT) with ET and ET+TT. Sequence of therapies, treatment patterns, and Overall Survival (OS) were also evaluated. Results: DOT was prolonged in patients receiving ET+TT compared to ET (median DOT: ET+TT 397 days vs ET 192 days; Log-Rank test p-value <.0001; HR=0.66; 95% CI; 0.52,0.85). An extended DOT was observed in ET+CDK4/6i subgroup when compared to ET (median DOT: ET+CDK4/6i 601 days vs ET 192 days; Log-Rank test p-value <.0001). This increase was statistically significant irrespective of line of therapy at baseline (1L: median DOT: ET+CDK4/6i: 649 days vs ET: 217 days, p-value= <.0001; 2L: median DOT: ET+CDK4/6i: 487 days vs ET: 203 days, p-value= 0.0013; 3L: median DOT: ET+CDK4/6i: 597 days vs ET: 143 days therapy: p-value= 0.0006). ET alone and ET + CDK4/6i were the most frequently administered therapies in both 1st (ET alone: 43.5% and ET+CDK4/6i: 43.3%) and 2nd line (ET alone: 36.3% and ET+CDK4/6i: 24.6%). Among patients who received at least one CDK4/6i in 1st, 2nd, or 3rd line, CDK4/6i were mostly administered in 1st line (61.9%) and 2nd line (38.5%). ClinicalTrials.gov ID: NCT02753686; Registration Date:20-04-2016 Conclusion: Results support current treatment recommendations of early introduction of CDK4/6i in HR+/HER2- aBC.

Non-contrast computed tomography (CT) is the gold-standard diagnostic test for urolithiasis. Little is published regarding which information needs to be included in the report for it to be most useful to the healthcare team for efficient triage and high-quality patient care. This study aimed to assess the quality and variability of CT scan reporting at a single Canadian tertiary academic medical center. We completed a retrospective review of 100 consecutive renal colic CT scans. Descriptive statistics were used to report the frequency with which specific elements commonly used by urologists to triage and treat patients were included in radiology reports. Our sample had a mean age of 51.4±13.1 years. Stone size was universally reported for obstructing stones but was less frequently reported for non-obstructing stones (100% vs. 86.8%). A similar trend was observed for the exact stone number (100% vs. 93.4%). Non-obstructing stones were more likely than obstructing stones to be reported in one dimension (77.5% vs. 47%). Obstructing stones were reported in three dimensions 27% of the time. CT reports commonly include the presence or absence of hydronephrosis status (98%) but are less likely to include renal size (32%) and periureteral stranding (16%). Hounsfield units (HU) were reported in 3% of the reports, but skin-to-stone distance (SSD) and radiation dose were never reported. Reports routinely included assessments of stone size, location, and number (although not uniformly). HU, SSD, and radiation dose were rarely reported. This provides insight into opportunities for standardized reporting to optimize knowledge transfer that may result in clinical efficiency and improved quality of patient care.