Report: 15th Asian Pacific Cancer Conference

To promote a cancer prevention program at hospital, we started the hospital-based epidemiologic research program at ‍Aichi Cancer Center (HERPACC) in 1988. Because patients visiting hospitals are very concerned not only about their ‍own health condition but also practical way of disease prevention, we consider outpatients, especially those free of ‍cancer, as ideal targets to make a model program and a practical cancer prevention strategy for general people. To ‍confirm risk and protective effects of lifestyle factors like dietary habits, smoking and drinking, and exercise on cancer ‍in Japanese, we have been undertaking large-scale case-referent comparative studies of main cancer sites (stomach, ‍colorectal, lung, breast and uterine cancers) using the data generated by HERPACC. The risk of respiratory tract cancer ‍was definitely elevated by habitual smoking and that of upper digestive tract cancer by combined habitual smoking and ‍drinking. Frequent intake of raw vegetables and/or fruit in contrast reduced the risk of lung cancer among smokers. ‍Current obesity was positively associated with risk of post-menopausal breast cancer, recently on the increase in Japan. ‍However, all sites of cancer were linearly decreased with frequency of exercise in both males and females. Based on ‍these pieces of evidence and other main results obtained from the HERPACC studies, prevention trials with provision ‍of information about protective and risk factors for main sites of cancers to outpatients have been planned in parallel to ‍continuation of HERPACC.     

Gene-environment Interactions and Polymorphism Studies for Cancer Risk in Hospital-based Epidemiologic Research Program at Aichi Cancer Center II (HERPACC-II)

Genetic polymorphisms may modify the effects of environmental risk factors on cancer occurence. We have recentlylaunched a comprehensive epidemiologic project, HERPACC II (Hospital-based Epidemiologic Research Programat Aichi Cancer Center II), including both lifestyle and polymorphism data, following HERPACC-I which solelyconcentrated on lifestyle data. As of April 2001, about 3000 samples of DNA are being stored to conduct case-controlstudies. Genotyping of 46 polymorphisms has been conducted at the laboratory of the Division of Epidemiology andPrevention. Twelve case-control studies and two papers on a new PCR method, PCR-CTPP (polymerase chain reactionwith confronting two-pair primers), have been accepted for publication. Significant findings in Japanese were foundfor 1) gene-environment interaction for esophageal cancer between heavy drinking and aldehyde dehydrogenase 2(ALDH2), 2) malignant lymphoma risk with methylenetetrahydrofalate reductase (MTHFR) and methionine synthase(MS), 3) interactions between smoking and two polymorphisms, interleukin 1B (IL-1B) and myeloperoxidase (MPO)for Helicobacter pylori infection, and 4) smoking habits with dopamine receptor D2 (DRD2) and IL-1B. Furtherstudies on interactions with polymorphisms will continue to be conducted for Japanese, using larger sizes of samples.     

A Model Obesity Control Program Focusing on a Healthy Diet and Gentle Exercise in Aichi Cancer Center Hospital

With the change of nutrient intake after the Second World War, obesity is becoming one of the most serious healthproblems in Japan. From a practical viewpoint for prevention of lifestyle related diseases, we planned an intervention trialof weight control for obese women. After obtaining informed consent, we recruited patients over 30 years old with a BMIof 24 or more for the present program. Forty patients were randomly assigned into study groups A (28) and B (12). GroupA started the prevention program at the entry and group B started three months thereafter, according to the protocol. Thistrial was designed to evaluate effectiveness of intervention trial during the first 3 months by comparing values with thosefor the non- intervention subjects. At the baseline and after three and six months, participants were checked for body size,dietary intake and serum chemistry. They were stressed to make a record not only of food intake but also physical activityover the 3 months. Every weekend they returned their record diaries by mail and we provided appropriate comments bytelephone and/or mail after reviewing them.After follow up for 3 months, we observed significant improvement in BMI, waist and hip size. There was a 4.2 %decrease of initial body weight on average after intervention but a 0.3 % increase in the group without intervention, thedifference between the two groups being statistically significant. With regard to change in key biomarkers in group A,decreased serum triglycerides appeared related to the reduction of BMI, but no link was apparent for total cholesterol.     

Alcohol, Smoking, and Dietary Status and Susceptibility to Malignant Lymphoma in Japan: Results of a Hospital-based Case-control Study at Aichi Cancer Center

Recent increase in the incidence of malignant lymphoma (ML) suggests possible involvement of lifestyle or environmental factors in its genesis. However, evidence for an effect of lifestyle factors, especially diet, on ML risk among Japanese is lacking. To explore the possibility that lifestyle factors exert an influence, we have conducted a hospital-based case-control study with 333 histo-logically confirmed ML cases and 55 904 non-cancer controls who first visited Aichi Cancer Center Hospital between 1988 and 1997. Multiple logistic regression analysis showed regular alcohol consumption to be associated with reduced risk of ML, whereas no risk change was observed for smoking. Some other factors including intake of vegetables (carrots and pumpkin), pork and fish showed partial associations, but their significance needs further clarification. From the previous study on genetic background for ML [Matsuo et al., Blood , 97, 3205–3209 (2001)], genetic variation combined with limited environmental factors should be targeted in future studies.     

Research questions concerning hepatitis C virus: Report from a workshop at the Harvard Center for Cancer Prevention

The Harvard Center for Cancer Prevention (HCCP) convened a symposium on April 23, 1999 in Boston, MA. The objectives of the meeting were to provide a broad overview of the natural history, pathogenesis, and treatment of hepatitis C virus (HCV) infection, to provide a forum for discussion of future research priorities, and to encourage the formation of a HCV working group among interested participants.     

Prevalence of Whole-Body Skin Self-Examination in a Population at High Risk for Skin Cancer (Australia)

OBJECTIVE: Whole-body skin self-examination (SSE) with presentation of suspicious lesions to a physician may improve early detection of melanoma. The aim of this study was to establish the prevalence and determinants of SSE in a high-risk population in preparation for a community-based randomised controlled trial of screening for melanoma. METHODS: A telephone survey reached 3110 residents older than 30 years (overall response rate of 66.9%) randomly selected from 18 regional communities in Queensland, Australia. RESULTS: Overall, 804 (25.9%) participants reported whole-body SSE within the past 12 months and 1055 (33.9%) within the past three years. Whole-body SSE was associated in multivariate logistic regression analysis with younger age (< 50 years); higher education; having received either a whole-body skin examination, recommendation or instruction on SSE by a primary care physicial; giving skin checks a high priority; concern about skin cancer and a personal history of skin cancer. CONCLUSION: Overall, the prevalence of SSE in the present study is among the highest yet observed in Australia, with about one-third of the adult population reporting whole-body SSE in the past three years. People over 50 years, who are at relatively higher risk for skin cancer, currently perform SSE less frequently than younger people.     

Information provision to cancer patients: a practical example of identifying the need for changes in practice from the Dorset Cancer Centre

The aim of this study was to produce a patient-centred information strategy based on the results of a local survey of cancer patients about the information they receive and their information needs. An anonymous patient survey was distributed at the Dorset Cancer Centre, Poole Hospital, the regional cancer centre for Dorset, in the South-west of England. All patients attending the Cancer Centre during 1 week in September 1999 were asked to complete a questionnaire on patient experience of the Cancer Centre, information sources, receipt and quality of Centre information, and perception of information requirements. Two hundred and eighty-two were returned. Most respondents had accessed information from a number of sources. Written Cancer Centre information had been given to most patients, and was generally perceived to be useful, understandable and timely. However, most patients had received information 'all at once', from a single professional group, and a notable proportion did not recall discussing it with staff. Furthermore, most patients indicated that information should also be provided to families and professionals. Seven items of information were selected as valuable by the majority of patients, with many others listed. There was a great deal of satisfaction with the current content of the patient information provided. However, the distribution system was shown to be in need of improvement. A new information strategy has been developed in the light of these findings.     

Electronic Risk Assessment System as an Appropriate Tool for the Prevention of Cancer: a Qualitative Study

Background: Decision making modalities for screening for many cancer conditions and different stages have become increasingly complex. Computer-based risk assessment systems facilitate scheduling and decision making and support the delivery of cancer screening services. The aim of this article was to survey electronic risk assessment system as an appropriate tool for the prevention of cancer. Materials and Methods: A qualitative design was used involving 21 face-to-face interviews. Interviewing involved asking questions and getting answers from exclusive managers of cancer screening. Of the participants 6 were female and 15 were male, and ages ranged from 32 to 78 years. The study was based on a grounded theory approach and the tool was a semistructured interview. Results: Researchers studied 5 dimensions, comprising electronic guideline standards of colorectal cancer screening, work flow of clinical and genetic activities, pathways of colorectal cancer screening and functionality of computer based guidelines and barriers. Electronic guideline standards of colorectal cancer screening were described in the s3 categories of content standard, telecommunications and technical standards and nomenclature and classification standards. According to the participations’ views, workflow and genetic pathways of colorectal cancer screening were identified. Conclusions: The study demonstrated an effective role of computer-guided consultation for screening management. Electronic based systems facilitate real-time decision making during a clinical interaction. Electronic pathways have been applied for clinical and genetic decision support, workflow management, update recommendation and resource estimates. A suitable technical and clinical infrastructure is an integral part of clinical practice guidline of screening. As a conclusion, it is recommended to consider the necessity of architecture assessment and also integration standards.     

A Descriptive Retrospective Study of Bladder Cancer at a Hospital in Iran (1973-2003)

Background: Bladder cancer is the ninth most common cancer worldwide, and it is the fourth most commoncancer in males in Iran. The objective of this study was to collect, analyze, and discuss epidemiologic features ofbladder cancer using data from our University hospital. Methods: A review of medical records of 603 patientswith histologically confirmed primary malignant bladder tumors who were then referred and treated at theRadiation-Oncology Department during a time period 1973-2003 was performed. The topography and thehistology of cases were coded and classified according to the International Classification of Diseases for Oncology(ICD -O) and a frequency distribution of bladder tumors by age at diagnosis, gender, histology types, wascalculated. For age and cancer, mean, standard deviation, and 95% confidence intervals were presented. T testand Chi-squared test with p<0.05 were used depending on the variable analyzed, using the SPSS statisticalpackage. Results: Of the total, 85.2% were males and 15.0% were females (P<0.0001). The mean age of diagnosiswas not significantly different between the sexes and the frequency of bladder cancer increased with age in bothcases. Overall, two thirds of cases were between 50-74 years of age. For those aged 49 years and below the maleto female ratio were 3.6 while after this age the ratio rose to 6.1. The most common histological diagnosis in bothsexes among patients was transitional cell carcinoma. Conclusion: The frequency distribution and histologictypes of tumors were comparable with reported from other studies.     

Pediatric Nasopharyngeal Carcinoma: A Review of 27 Cases over 10 Years at Shaukat Khanum Memorial Cancer Hospital and Research Center,Pakistan

Purpose: This study aims to review the clinical features, treatment and outcome of pediatric nasopharyngealCarcinoma at Shaukat Khanum Memorial Cancer Hospital and Research Center (SKMCH&RC) over tenyears. Methods: Retrospective review of pediatric patients who were diagnosed with nasopharyngeal carcinomaand treated at SKMCH&RC from July 1996 to June 2006. Results: A total of 27 children with NPC wereincluded. The male to female ratio was 4.4:1. The mean age at diagnosis was 14 years (8-18 years). The mostcommon presenting symptom was neck swelling (81.5%, 22/27). The mean duration of symptoms before diagnosiswas 10.3 months (3-36 months). The majority of patients (70%, 19/27) presented at stage IV. All received acombination of chemotherapy and radiotherapy. Survival analysis was performed for 22 patients; of these 8patients died and 4 were lost to follow-up. The median follow-up time of the surviving patients was 53 months(5-116 months). At 5 years, the cumulative overall survival (OS) was 55% while the cumulative EFS was 54%with a flattening of the curve at 2 years. There was a significant difference in OS (p=0.001) and EFS (p=0.057) inpatients diagnosed with NPC under 14 years of age (n=11) and those between 14 and 18 years (n=11). Conclusion:In our institutional study, NPC presents late and in advanced stage. The outcome is better in younger children.Our survival rates, while comparable to developing countries, are less than those seen in the developed world.We feel a strong need for collaborative studies in view of small numbers in individual centres.     

The Continuing Umbrella of Research Experiences (CURE): A Model for Training Underserved Scientists in Cancer Research

Mentoring is a critical aspect of research and training; and the adoption of a successful mentoring model for guiding researchers through the educational pipeline is lacking. The Continuing Umbrella of Research Experiences (CURE) program was established in the Comprehensive Minority Biomedical Branch; which is part of the National Cancer Institute. This program offers unique training and career development opportunities to enhance diversity in cancer research. The CURE initiative focuses on broadening the cadre of underserved investigators engaging in cancer research. CURE begins with high school students and fosters scientific, academic and research excellence throughout the trainee’s educational progression. The program supports students throughout the entirety of their training career. During this period, the trainee matures into a competitive early stage investigator; capable of securing advanced research project funding in academic and industry workforces. Thus, the CURE program provides a comprehensive vehicle for training and reinforces the critical mass of underserved investigators conducting cancer research.     

Cancer Trial Impact: Understanding Implementation of the Short Course Oncology Treatment (SCOT) Trial Findings in colorectal cancer at a National Level

AimsThe Short Course Oncology Treatment (SCOT) trial indicated that 3 months of adjuvant doublet chemotherapy was non-inferior to 6 months of treatment for patients with colorectal cancer, with considerably less toxicity. The SCOT trial results were disseminated in June 2017. The aim of this study was to understand if SCOT trial findings were implemented in Scotland.Materials and methodsA retrospective analysis was carried out on a dataset derived from a source population of 5.4 million people. Eligible patients were those with stage II or III colorectal cancer who received adjuvant chemotherapy. Logistic regression was applied to understand the extent of practice change to a 3-month adjuvant chemotherapy duration after the SCOT trial results were disseminated. Interrupted time series analysis was used to visualise differences in prescribing trends before and after June 2017 for the overall cohort, and by SCOT trial eligibility.ResultsIn total, 2310 patients were included in the study; 1957 and 353 treated pre- and post-June 2017, respectively. The median treatment duration decreased from 21 weeks (interquartile range 14–24) prior to June 2017 to 12 weeks (interquartile range 12–21 weeks) after June 2017 (P < 0.001). The proportion of patients receiving over 3 months of adjuvant treatment decreased from 75% to 42% (P < 0.001). This change was most noticeable for patients who met the SCOT trial eligibility criteria, and specifically for those with low-risk stage III disease and those treated with capecitabine and oxaliplatin (CAPOX). Although practice change occurred in all locations, there were differences between regions that could be explained by pre-SCOT trial prescribing trends.DiscussionA significant change in chemotherapy prescribing occurred after dissemination of the SCOT trial results. National, real-world data can be used to capture the extent of implementation of clinical trial results. In this case, implementation was aligned with clinical trial subgroup findings. This type of analysis could be conducted to evaluate the impact of other clinical trials.     

Esthesioneuroblastoma (Olfactory Neuroblastoma) with Ectopic ACTH Syndrome: A Multidisciplinary Case Presentation from the Joan Karnell Cancer Center of Pennsylvania Hospital

The case of a patient with recurrent esthesioneuroblastoma complicated by ectopic adrenocorticotropic hormone production is presented, including the workup and management of this uncommon complication of an uncommon disease.     

Prognostic factors and a scoring system for survival after radiotherapy for metastases to the spinal column: a review of 544 patients at Shizuoka Cancer Center Hospital

BACKGROUND: To optimize selection of a radiotherapy schedule for patients with spinal metastases, the authors analyzed prognostic factors and developed a scoring system to predict survival in such patients. METHODS: Five-hundred forty-four patients with spinal metastases received radiotherapy at Shizuoka Cancer Center Hospital between September 2002 and November 2006. Prognostic factors for survival were studied using a Cox proportional hazards model, and a scoring system was developed based on regression coefficients: Three points were given for an unfavorable tumor type and bad performance status (> or =3); 2 points were given for hypercalcemia, visceral metastases, and previous chemotherapy; and 1 point was given for multiple bone metastases and age > or =71 years. RESULTS: The overall survival rates after 6 months, 12 months, and 24 months were 49%, 32%, and 19%, respectively, and the median survival was 5.9 months (95% confidence interval, 4.9-6.8 months). In total, 503 patients (93%) were followed for > or =12 months or until death. These patients were separated into Groups A, B, and C based on scores of 0 to 4, 5 to 9, and 10 to 14, respectively. These groups included 24%, 57%, and 19% of patients, respectively; and the mean median survival for Groups A, B, and C was 27.1 months, 5.4 months, and 1.8 months, respectively. Overall survival rates after 6 months, 12 months, and 24 months were 89%, 77%, and 54% in Group A; 46%, 22%, and 9% in Group B; and 7%, 4%, and 0% in Group C, respectively (P < .001). CONCLUSIONS: The scoring system was able to predict the survival of patients with spinal metastases and may be useful for selecting an optimal radiotherapy schedule.