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This article discusses the financial burden faced by individuals in Canada who are diagnosed with cancer. It highlights that people with low incomes are particularly at risk of experiencing financial toxicity, which includes both direct and indirect costs related to cancer treatment. While primary and hospital care are provided for free in Canada, many cancer-related costs, such as medications and home care services, are not publicly funded. The article suggests that efforts to address financial burdens related to cancer should involve the patient, care centers, and governments. It also emphasizes the need for comprehensive federal and provincial policies to reduce costs for home care and medical equipment, as well as improved benefit plans to provide financial assistance to those who need to take time off work for treatment. The article concludes by emphasizing the importance of recognizing and addressing the financial burden of cancer to ensure better health outcomes for patients and their families. [Extracted from the article]

Background: Patients with cancer have complex care requirements and frequently use the emergency department. The purpose of this study was to determine whether continuity of care, cancer expertise of an institution or both affect outcomes in patients with cancer in the emergency setting.Methods: We conducted a retrospective cohort study using administrative databases from Ontario, Canada, involving records of patients aged 20 years and older who received chemotherapy or radiation in the 30 days before a cancer-related visit to the emergency department between 2006 and 2011. Patients seen in an emergency department at an alternative hospital (not the site where cancer treatment was given) were matched based on propensity score to patients who visited their original hospital (site where cancer treatment was given). Next, patients seen at an alternative emergency department that was in a general hospital (i.e., not a cancer centre) were matched to patients who visited their original hospital or a cancer centre. Outcomes were admission to hospital at the index visit to the emergency department, 30-day mortality, having imaging with computed tomography and return visits to the emergency department.Results: We found 42 820 patients who were eligible for our study. Patients seen in the emergency departments at alternative hospitals were less likely to be admitted to hospital (odds ratio [OR] 0.78, 95% confidence interval [CI] 0.74-0.83) and had higher hazards of return visits to the emergency department than matched patients at original hospitals (hazard ratio [HR] 1.06, 95% CI 1.03-1.11). In comparison, patients at alternative general hospitals also had lower odds of admission to hospital (OR 0.83, 95% CI 0.79-0.88) and higher hazards of return visits to the emergency department (HR 1.07, 95% CI 1.03-1.11) compared with matched counterparts; however, these patients had higher 30-day mortality (OR 1.13, 95% CI 1.05-1.22) and lower odds of having CT imaging (OR 0.74, 95% CI 0.69-0.80).Interpretation: Cancer expertise of an institution rather than continuity of care may be an important predictor of outcomes following emergency treatment of patients with cancer. [ABSTRACT FROM AUTHOR]

The article offers information associated with proton beam therapy, which can effectively treat cancer while decreasing adverse effects by minimizing the volume of normal tissues exposed to radiation. It is evident that this therapy is most useful for pediatric cancers as well as for many head-and-neck and brain tumours. Topics discussed include details of proton beam therapy, eligibility for the therapy and its prospects in future.

Background: A principal objective of the Canadian Clinical Practice Guidelines for the Care and Treatment of Breast Cancer was to reduce the variation in the way that breast cancer was being treated. To evaluate whether this goal has been reached, we examined variations among surgeons for 4 measures of surgical care and tested for differences in province-wide rates and in variations among surgeons before and after the guidelines were released. Methods: We studied a population-based cohort of 7022 women living in Manitoba in whom breast cancer was diagnosed from 1995 to 2003 inclusive. Demographic, tumour and treatment information was obtained from the Manitoba Cancer Registry. We examined 4 measures of care: breastconserving surgery, axillary assessment in invasive disease, axillary node dissection in noninvasive disease and the adequacy of axillary node dissection. Generalized linear models were used to test for significant variations in care among surgeons and to test for differences in province-wide rates and variations in these rates among surgeons before and after introduction of the guidelines. Results: We found clinically significant variations in the province-wide rates of all 4 measures examined. These variations were statistically significant for all measures except axillary node dissection in noninvasive disease. No significant differences in either the province-wide rates or in variations in these rates among surgeons before and after introduction of the guidelines were found for any of the measures. Interpretation: Our results suggest that the Canadian breast cancer guidelines are not meeting their stated objective. New strategies for guideline dissemination and implementation may be required. [ABSTRACT FROM AUTHOR]

Background: A number of studies have examined time intervals between care steps in breast cancer diagnosis and treatment. The objective of this study was to document the elapsed time from first clinical or mammographic detection of breast abnormality to initiation of first adjuvant therapy in women with invasive breast cancer in Nova Scotia and to examine the effect of age, disease stage and place of residence on these intervals. Methods: All dates were abstracted from patient charts and the Oncology Patient Information System. Eligible women were those with invasive breast cancer detected by Sept. 1, 1999, who were referred to 1 of 2 provincial cancer treatment centres by Sept. 1, 2000. All time intervals were calculated in days, and only patients experiencing both care events defining an interval were included in the analysis of time to event for that interval. We used proportional hazards regression analysis to evaluate the influence of patient age, disease stage and place of residence on times between care events. Results: A total of 776 new diagnoses of breast cancer were reported to the Nova Scotia Cancer Registry over the study period. Of the 776, 467 met the inclusion criteria, and 364 patients were eligible for analysis. The overall median time from clinical or mammographic detection of breast cancer to initiation of first adjuvant therapy was 91 days (interquartile range 72-123 days). Disease stage was the strongest predictor of elapsed time: the median interval from disease detection to initiation of first adjuvant therapy for patients with stage I disease was 118 days, as compared with 85 days for those with stage II disease and 75 days for those with stage III disease (adjusted hazard ratio [HR] 2.1, 95% confidence interval [CI] 1.6-2.8). Patients aged 70 years or more at diagnosis experienced longer elapsed times (median interval 98 days) than did younger patients (93 days for those aged 5069 years and 82 days for those aged 49 years or less)... [ABSTRACT FROM AUTHOR]

Clark Noble was one of the first members of the University of Toronto insulin team and came within a coin toss of replacing Charles Best as Frederick Banting's assistant during the summer of 1921. Noble performed important early studies helping to characterize insulin's action, and he co-authored many of the original papers describing insulin. Because mass production of insulin from livestock pancreata had proved elusive throughout 1922, J.J.R. Macleod hired Noble during the summer of 1923 to help him test and develop a new method for producing commercial quantities of insulin that Macleod believed would revolutionize insulin production. However, commercial production of insulin from fish proved impractical and was dropped by 1924, as methods to produce large quantities of mammalian insulin had improved very rapidly. Noble later played a small but critical role in the most important Canadian contribution to cancer chemotherapy research: the discovery of vinca alkaloids by his brother Robert Laing Noble. Although one might expect that a physician involved in 2 of Canada's most important medical discoveries during the 20th century must be famous, such was not Clark Noble's fate. He died without so much as an obituary in CMAJ. INSET: From our files. [ABSTRACT FROM AUTHOR]

Many of the patients with cancer seen by surgeons affiliated with regional cancer centres in Ontario may be experiencing significant delays in the assessment and treatment of their cancer. [ABSTRACT FROM AUTHOR]

Reports on a study to assess the time interval to surgery from diagnosis among Quebec women with breast cancer and to examine the influence on waiting time of age, pattern of care and cancer stage. Methods; Results; Interpretation.

Studies variations in the treatment of early-stage breast cancer in Quebec between 1998 and 1994. Variations of therapies according to hospital caseload; Care of patients; Prevalence of breast-conserving surgery and systemic adjuvant therapy; Adoption of innovative therapeutic modalities.

Presents a study that assesses the degree to which Nova Scotia cancer patients, who may need palliative care, are being referred to the comprehensive Halifax-based Palliative Care Program (PCP). Methods of the experiment, including data sources and analysis; Results; Interpretations.

The article discusses the key role of the whole genome sequencing in the clinical setting. Topics mentioned include the use of whole genome sequencing, whole exome sequencing and targeted sequencing in the diagnosis of genetic disorders and the treatment of cancers, the release of open-source database, called the Personal Genome Project Canada, and the need to address the ethical issues behind the role of whole genome sequencing in empowering patients and doctors.

Editorial. Discusses the need to bring oncology and palliative care together. The different roots and paths of palliative care and oncology; The difficulty of communication between oncologists and physicians; The sense of territoriality that contributes to the division between oncologists and palliative care professionals; Advantages in linking oncology and palliative care; How oncologist burnout is linked to patient suffering; The support of cancer centers by provinces in Canada.

The article reports on the aim of the Northwest Territories (NWT) to implement a comprehensive electronic medical record (EMR) system. Topics discussed include the call for a nationwide health information system in Canada to support medical decision-making, an improvement in diabetes and colorectal cancer management as a result of electronic health (e-health) advances implemented by NWT, and funding from the federal government to support e-health systems.

The article reports on the call for physicians to collaborate with traditional healers and to respect their practices in Canada as of March 2015. Topics discussed include the move of Ontario doctors to legally compel cancer treatment for a Mohawk girl with leukemia, the right of the girl's substitute decision-maker to practice traditional medicine, and the increasing view that a blend of treatments is possible. Also mentioned is the need to acknowledge the patient's contribution to healing.

The article discusses the results of a study which showed that orally administered molecularly targeted agents are important treatment opportunities for Canadian Inuits with lung cancer. Topics discussed include the barriers to accessing diagnostic and treatment services by cancer patients, molecularly targeted agents as standard of care across tumour sites and the potential relevance of targeted cancer therapy for Canadian Inuit.

The article focuses on the guidelines issued by the Canadian Task Force on Preventive Heath Care in 2011 against the screening of women under the age of 50 for breast cancer. It says that the benefits of the routine screening were overlooked by the task force as the fact that women need less chemotherapy mastectomies when they found a cancer earlier. However, critics have argued that the analysis was compromised by including the data from the Canadian National Breast Cancer Screening Study.

The article focuses on the pan-Canadian Oncology Drug Review (pCODR), which offers advice for provincial governments in Canada whether to fund new cancer drugs. PCODR executive director Mona Sabharwal says that pCODR evaluates health benefits and cost effectiveness of drugs before making advice. It adds that pCODR review process will quicken availability of new cancer drugs and will benefit both manufacturers and clinicians due to its clearer standards and consistent and comprehensive reviews.

The article reports on the pan-Canadian Oncology Drug Review (pDOCR) of cancer drugs in Canada. It states that the review process will be launched in 2010 in all provinces of Canada to provide common recommendations on clinical and cost-effectiveness of cancer drugs. It says that the clinical, pharmacoeconomic, and guideline evidence for oncology drug submissions and recommendations will be evaluated by an expert committee. It adds that the review is expected to be completed within five months.

The article offers information on the use of black salves and silver bullets for treating cancer and other diseases, as reported by some web sites in Canada. It mentions that black salve can be used as a healing agent for cancer, yeast infections and plaque. Adam Zimmerman, competition law officer with the Competition Bureau of Canada, which regulates false and misleading advertising, considers these as quack medicines and says that these are not approved for sale.

The author reflects on the effectiveness of Canadian Practice Guidelines for the care and treatment of breast cancer supported by Health Canada. The author highlights a study by Steven Latosinsky and colleagues on the effectiveness of these guidelines on surgical practices. The author also discusses the importance of disseminating and increasing the resources for guidelines.

Reports on the decision of some Canadian provinces to pay for the extended use of trastuzumab or Herceptin in breast cancer treatment in 2005. Percentage of newly diagnosed breast cancer cases who are human epidermal growth factor receptor 2 positive; Number of provinces that have expanded funding for trastuzumab as of July 22, 2005; Comments from Sharon Batt, a breast cancer survivor and a Canadian Institutes of Health Research trainee in the ethics of health research and policy.

Provides a summary of changes made by Health Canada's Steering Committee on Clinical Practice Guidelines for the Care and Treatment of Breast Cancer to the 1998 article 'Clinical practice guidelines for the care and treatment of breast cancer: 10. The management of chronic pain in patients with breast cancer.'

Provides a summary of changes made by Health Canada to its clinical practice guidelines for the care and treatment of breast cancer, with focus on the management of ductal carcinoma in situ, as of 2001. Additional evidence to support the original recommendations which were published in 1998; Guidelines regarding surgery, radiotherapy and drug treatment, including tamoxifen therapy.

Describes advances in the treatment of prostate cancer in Canadian men, as of December 15, 1997. Prevalence of prostate cancer in Canadian men; Use of prostate-specific antigen (PSA) for diagnosis and treatment; Radiation therapy; Adjuvant hormonal therapy and its timing; Combination therapies; Levels of androgens after surgical castration with bilateral orchidectomy; Total androgen blockade.

The article reports that Canada deserves a B grade for the extent to which it has reduced wait times for treatment in five designated priority areas including cancer, heart, and joint replacement, targeted for reduction under the 2004 Health Accord, the Wait Times Alliance (WTA).

Reports on a breakthrough made by researchers at the British Columbia Cancer Agency (BCCA) in the discovery of an agent that is capable of inhibiting tumor cell growth. How integrin-linked kinase (ILK) prevents tumor cell death; How ILK is suppressed by the gene PTEN in non-cancerous cells; How the absence of PTEN in cancerous cells leads to the spread and growth of tumors; Study methods; Results; Discussion of the finding that ILK-inhibiting compounds prevent both the growth and spread of tumor cells.

Reports that brachytherapy for prostate cancer patients is available at the British Columbia Cancer Agency. Comment of Dr. W. James Morris, a radiation treatment specialist; Brief description of the process in brachytherapy.

Focuses on Dr. John Collins, chief urologist at the Ottawa Hospital's Civic campus. His development of Ottawa Hospital Prostate Centre, a center where men with prostate cancer can get support and services; List of benefits of the center; Comparison to the Women's Breast Health Centre at Ottawa Hospital's Civic campus.