Willingness of patients with sarcoma to participate in cancer surveillance research: a cross-sectional patient survey

Oncologia ortopèdica; Sarcoma; Estadístiques i mètodes d'investigacióOncología ortopédica; Sarcoma; Estadísticas y métodos de investigaciónOrthopaedic oncology; Sarcoma; Statistics & research methodsObjectives To determine the proportion of patients with extremity sarcoma who would be willing to participate in a clinical trial in which they would be randomised to one of four different postoperative sarcoma surveillance regimens. Additionally, we assessed patients’ perspectives on the burden of cancer care, factors that influence comfort with randomisation and the importance of cancer research. Design Prospective, cross-sectional patient survey. Setting Outpatient sarcoma clinics in Canada, the USA and Spain between May 2017 and April 2020. Survey data were entered into a study-specific database. Participants Patients with extremity sarcoma who had completed definitive treatment from seven clinics across Canada, the USA and Spain. Main outcome measures The proportion of patients with extremity sarcoma who would be willing to participate in a randomised controlled trial (RCT) that evaluates varying postoperative cancer surveillance regimens. Results One hundred thirty complete surveys were obtained. Respondents reported a wide range of burdens related to clinical care and surveillance. The majority of patients (85.5%) responded that they would agree to participate in a cancer surveillance RCT if eligible. The most common reason to participate was that they wanted to help future patients. Those that would decline to participate most commonly reported that participating in research would be too much of a burden for them at a time when they are already feeling overwhelmed. However, most patients agreed that cancer research will help doctors better understand and treat cancer. Conclusions These results demonstrate that most participants would be willing to participate in an RCT that evaluates varying postoperative cancer surveillance regimens. Participants’ motivation for trial participation included altruistic reasons to help future patients and deterrents to trial participation included the overwhelming burden of a cancer diagnosis. These results will help inform the development of patient-centred RCT protocols in sarcoma surveillance research.The institution of the authors has received, during the study period, funding from the McMaster Surgical Associates (MSA) Innovation Grant

Published randomized controlled trials of surveillance in cancer patients - a systematic review

With solid tumor cancer survivorship increasing, the number of patients requiring post-treatment surveillance also continues to increase. This highlights the need for evidence-based cancer surveillance guidelines. Ideally, these guidelines would be based on combined high-quality data from randomized controlled trials (RCTs). We present a systematic review of published cancer surveillance RCTs in which we sought to determine the feasibility of data pooling for guideline development. We carried out a systematic search of medical databases for RCTs in which adult patients with solid tumors that had undergone surgical resection with curative intent and had no metastatic disease at presentation, were randomized to different surveillance regimens that assessed effectiveness on overall survival (OS). We extracted study characteristics and primary and secondary outcomes, and assessed risk of bias and validity of evidence with standardized checklist tools. Our search yielded 32,216 articles for review and 18 distinct RCTs were included in the systematic review. The 18 trials resulted in 23 comparisons of surveillance regimens. There was a highlevel of variation between RCTs, including the study populations evaluated, interventions assessed and follow-up periods for the primary outcome. Most studies evaluated colorectal cancer patients (11/18, [61%]). The risk of bias and validity of evidence were variable and inconsistent across studies. This review demonstrated that there is tremendous heterogeneity among RCTs that evaluate effectiveness of different postoperative surveillance regimens in cancer patients, rendering the consolidation of data to inform high-quality cancer surveillance guidelines unfeasible. Future RCTs in the field should focus on consistent methodology and primary outcome definition

The Gene Ontology knowledgebase in 2023

The Gene Ontology (GO) knowledgebase (http://geneontology.org) is a comprehensive resource concerning the functions of genes and gene products (proteins and noncoding RNAs). GO annotations cover genes from organisms across the tree of life as well as viruses, though most gene function knowledge currently derives from experiments carried out in a relatively small number of model organisms. Here, we provide an updated overview of the GO knowledgebase, as well as the efforts of the broad, international consortium of scientists that develops, maintains, and updates the GO knowledgebase. The GO knowledgebase consists of three components: (1) the GO-a computational knowledge structure describing the functional characteristics of genes; (2) GO annotations-evidence-supported statements asserting that a specific gene product has a particular functional characteristic; and (3) GO Causal Activity Models (GO-CAMs)-mechanistic models of molecular "pathways" (GO biological processes) created by linking multiple GO annotations using defined relations. Each of these components is continually expanded, revised, and updated in response to newly published discoveries and receives extensive QA checks, reviews, and user feedback. For each of these components, we provide a description of the current contents, recent developments to keep the knowledgebase up to date with new discoveries, and guidance on how users can best make use of the data that we provide. We conclude with future directions for the project

Orthopaedic Travelling Fellowship Programs: A Survey of Canadian Applicants and Participants

Background: Despite the well-documented benefits of travelling fellowships, there is a lack of female applicants to travelling fellowship programs. There is also a limited amount of research that has been conducted regarding travelling fellowships. Therefore, the aims of this study were fourfold: (1) to determine the number and gender of successful applicants for fellowship programs, (2) to determine any perceived barriers for both men and women to participating in travelling fellowship programs, (3) to explore possible support systems to address these barriers, and (4) to explore any differences among genders regarding perceived barriers to participating in travelling fellowship programs. Methods: A 41-item cross-sectional survey was distributed to all Canadian Orthopaedic Association (COA) members who applied for a COA travelling fellowship program between 2004 and 2019. There were 78 applicants of which 26 were women (33%). Up to 3 reminder emails were sent every two weeks after the initial invitations to encourage participation. Descriptive statistics were performed. Results: A total of 103 fellowship applications were submitted, 26% from female applicants. Thirty-one (39%) of the applications submitted by men were successful and 10 (33%) of the applications submitted by women were successful. Nineteen individuals completed the survey with a gender distribution equal to the non-responders. The most common perceived barriers were time constraints (65%) and family obligations (47%), with 24% of respondents identifying no perceived barriers at all. No respondent identified concerns for sexual or gender-based harassment. Eightyfive percent of individuals responded that the perceived barriers were not related to their gender. Most respondents (87%) suggested a mentorship program to increase the number of female applicants to COA travelling fellowship programs. Conclusions: Women are less likely to apply for orthopaedic travelling fellowships in Canada; however, the success rate of applications submitted by women is similar to that of applications submitted by men. When applying to COA travelling fellowship programs, the majority of applicants identified barriers including time constraints and family obligations. In general, these barriers were not perceived to be related to their gender. The findings of this study may encourage more women to apply to COA travelling fellowship programs

Use of fresh scotta whey as an additive for alfalfa silage

Scotta is a dairy industry waste obtained by ricotta cheese production. Because of its high availability and its high lactose content, scotta could be used as an additive to improve fermentation characteristics of alfalfa silage. Silage samples were obtained for 2 years from an alfalfa second cut, collecting the forage at three growth stages: mid bud (MB), early flowering (EF), and late flowering (LF). After wilting the forage at 38% dry matter (DM), four scotta doses were added (0, 75, 150, and 300 g/kg fresh forage) and the main chemical and microbiological characteristics were evaluated after 3, 13, and 90 days of ensiling (DOE). The lowest pH (4.3) was recorded in the EF and LF growth stages, after 90 DOE and with the highest scotta dose (300 g/kg fresh forage). After 90 DOE, the concentration of the main spoilage microorganisms and clostridial spore loads was always negligible. The addition of scotta decreased pH and fiber fractions, increased the relative feed value, and had no effect on the crude protein concentration or the total digestible nutrients. Therefore, the scotta can be successfully used as an additive to improve the fermentation characteristics of alfalfa silage

Limited evidence of fungicide-driven triazole resistant Aspergillus fumigatus in Hamilton, Canada

Aspergillus fumigatus is a ubiquitous opportunistic fungal pathogen that can cause aspergillosis in humans. Over the last decade there have been increasing global reports of treatment failure due to triazole resistance. An emerging hypothesis states that agricultural triazole fungicide use causes clinical triazole-resistance. Here we test this hypothesis in Hamilton, Ontario, Canada by examining a total of 195 agricultural, urban and clinical isolates using 9 highly polymorphic microsatellite markers. For each isolate, the in vitro susceptibilities to itraconazole and voriconazole, two triazole drugs commonly used in the management of patients, were also determined. Our analyses suggested frequent gene flows among the agricultural, urban environmental, and clinical populations of A. fumigatus and found evidence for widespread sexual recombination within and among the different populations. Interestingly, all 195 isolates analyzed in this study were susceptible to both triazoles tested. However, compared to the urban population, agricultural and clinical populations showed significantly reduced susceptibility to itraconazole and voriconazole, consistent with ecological niche-specific selective pressures on A. fumigatus populations in Hamilton. Frequent gene flow and genetic recombination among these populations suggest greater attention should be paid to monitor A. fumigatus populations in Hamilton and other similar jurisdictions.The accepted manuscript in pdf format is listed with the files at the bottom of this page. The presentation of the authors' names and (or) special characters in the title of the manuscript may differ slightly between what is listed on this page and what is listed in the pdf file of the accepted manuscript; that in the pdf file of the accepted manuscript is what was submitted by the author

Gender differences in Glenoid and Coracoid Dimensions evaluated through 3D Printed bone models in the context of Anterior Shoulder Instability Surgery – An exploratory study

Introduction: Nonrecognition of smaller bone anatomy in the context of the Latarjet procedure may increase the chance of complications and worsen it outcomes, and this should be addressed preoperatively by accurate measuring of bone anatomy. Measurement of bone dimension can be performed through 3d printed bone models nowadays and therefore we aimed to evaluate glenoid and coracoid process dimensions obtained in 3D printed bone models, assess differences between genders, and compare the results with previously published anatomical studies. We hypothesized that the values obtained in the 3D models would be similar to those previously reported in other anatomical studies and gender differences would also be present. Methods: We retrospectively retrieved shoulder computer tomography scans from 39 adult patients with uninjured scapula. Using the DICOM file of the CT, we performed three-dimensional reconstructions of the scapula, including the glenoid and coracoid. The resulting digital model was then printed in an FDM technology 3D printer. With the 3D Printed models, one of the authors measured the models using a digital caliper. The measurements collected on the Glenoid were Glenoid Superior-Inferior length (GlenSI); and Glenoid Antero-Inferior length (GlenAP) .On the coracoid, the measurements collected were the Coracoid Anterior-Posterior length (CoracAP), the Coracoid Medial-Lateral (CoracML) distance and the Coracoid Superior-Inferior (CoracSI) distance. Those measurements were summarized and underwent statistical comparison between genders. The results were compared with other anatomical studies in the same bone anatomy. Results: We recorded a mean glenoid length (GlenAP) of 28.03 mm (SD = 0.45) and mean glenoid height (GlenSI) of 37,18 mm (SD =0,55). The mean glenoid dimensions differ significantly between male and female gender (p=0,002 and p=0,001, respectively).The coracoid mean length was 22,35 mm (SD=0.47), mean coracoid width was 14,97 mm (SD=0,30), mean coracoid height was9,51 mm (SD=0,22), and those measures also differ significantly between genders. The observed mean values were similar to those previously reported in other anatomical studies. Discussion: We observed that coracoid and glenoid dimensions significantly vary between genders for all of the measurements performed. Measurements obtained in this series are comparable with other similar anatomic studies. Although some limitations exists in our study, we consider 3D-printed bone models in the setting of anatomical studies as a relevant option to traditional cadaveric studies. Conclusion: Gender differences in coracoid and glenoid dimensions were observed and must be considered for the Latarjet procedure. Our results suggest that 3d printed bone models may be used for such evaluation with a good degree of reproducibility of the measurements observed in already published anatomic studies

The effect of surveillance intensity on long-term survival following curative surgical treatment for solid cancers: A systematic review and meta-analysis

Background The number of cancer survivors continues to increase due to advancements in cancer treatment. Consequently, the number of patients requiring post-operative surveillance protocols have increased, highlighting the need to develop post-operative surveillance protocols that increase survival benefit while remaining both cost- and resource-effective. Methods We carried out a comprehensive and systematic literature search of medical databases for randomized controlled trials (RCTs) in which patients with solid tumors 18 years of age or older that had undergone surgical resection with curative intent and had no metastatic disease at presentation, were randomized to different surveillance regimens to assess the effect on overall survival (OS). According to a priori definitions, surveillance programs were classified as (1) biological test, (2) frequency, (3) imaging, or (4) practitioner type. We carried out a pooled effect size estimate on risk ratios (RR) to evaluate the effect of more intensive versus less intensive surveillance strategies in each of the surveillance program categories on overall survival (OS). Results Our search yielded a total of 32,216 articles for review. Following all screening stages, 18 distinct RCTs were included in the systematic review. Most studies evaluated colorectal cancer patients (11/18, [61%]). Twenty-one comparisons from the 18 trials were included in the meta-analysis, with no significant difference in OS for any of the more intensive surveillance program categories analysed. One comparison evaluated biological test interventions and therefore, a meta-analysis was not conducted. Six comparisons were classified as frequency interventions with a combined RR of 0.96 (95% CI: 0.79-1.16). Eleven comparisons were classified as imaging interventions with a combined RR of 0.99 (95% CI: 0.91-1.08). Two comparisons were classified as practitioner type interventions with a combined RR of 1.106 (95% CI: 0.64-1.91). No difference in OS was observed in any of the cancer type subgroup analyses. Conclusion The cost of cancer care is steadily rising due to the growing number of cancer survivors, leading to questions in the ability of healthcare systems to meet the needs of patients. This study demonstrated that there is currently no evidence to support any kind of more intensive surveillance in solid cancers after treatment when considering OS as the primary outcome. However, due to persistent clinical equipoise and advancements in surveillance options, further large RCTs are required to evaluate the most optimal surveillance protocol for individual cancer types

Willingness of patients with sarcoma to participate in cancer surveillance research: a cross-sectional patient survey

Objectives To determine the proportion of patients with extremity sarcoma who would be willing to participate in a clinical trial in which they would be randomised to one of four different postoperative sarcoma surveillance regimens. Additionally, we assessed patients’ perspectives on the burden of cancer care, factors that influence comfort with randomisation and the importance of cancer research.Design Prospective, cross-sectional patient survey.Setting Outpatient sarcoma clinics in Canada, the USA and Spain between May 2017 and April 2020. Survey data were entered into a study-specific database.Participants Patients with extremity sarcoma who had completed definitive treatment from seven clinics across Canada, the USA and Spain.Main outcome measures The proportion of patients with extremity sarcoma who would be willing to participate in a randomised controlled trial (RCT) that evaluates varying postoperative cancer surveillance regimens.Results One hundred thirty complete surveys were obtained. Respondents reported a wide range of burdens related to clinical care and surveillance. The majority of patients (85.5%) responded that they would agree to participate in a cancer surveillance RCT if eligible. The most common reason to participate was that they wanted to help future patients. Those that would decline to participate most commonly reported that participating in research would be too much of a burden for them at a time when they are already feeling overwhelmed. However, most patients agreed that cancer research will help doctors better understand and treat cancer.Conclusions These results demonstrate that most participants would be willing to participate in an RCT that evaluates varying postoperative cancer surveillance regimens. Participants’ motivation for trial participation included altruistic reasons to help future patients and deterrents to trial participation included the overwhelming burden of a cancer diagnosis. These results will help inform the development of patient-centred RCT protocols in sarcoma surveillance research.Level of evidence V