Cancer population norms using a new value set for the SF-6Dv2 based on the preferences of patients with breast or colorectal cancer in Quebec.

BACKGROUND: Because health resources are limited, health programs should be compared to allow the most efficient ones to emerge. To that aim, health utility instruments have been developed to allow the calculation of quality-adjusted life-year (QALY). However, generic instruments, which can be used by any individual regardless of their health profile, typically consider the preferences of the general population when developing their value set. Consequently, they are often criticized for lacking sensitivity in certain domains, such as cancer. In response, the latest version of the Short Form 6-Dimension (SF-6Dv2) has been adapted to suit the preferences of patients with breast or colorectal cancer in the Canadian province of Quebec. By extension, our study's aim was to determine cancer population norms of utility among patients with breast or colorectal cancer in Quebec using the SF-6Dv2. METHOD: To determine the cancer population norms, we exploited the data that were used in the development of a new value set for the SF-6Dv2. This value set was developed considering the preferences of patients with breast or colorectal cancer. Stratification by time of data collection (i.e., T1 and T2), sociodemographic variables (i.e., age, sex, body mass index, and self-reported health problems affecting quality of life), and clinical aspects (i.e., cancer site, histopathological classification, cancer stage at diagnosis, modality, and treatment characteristics) was performed. RESULTS: In 353 observations, patients were more likely to have negative utility scores at T1 than at T2. Males had higher mean utility scores than females considering type of cancer and comorbidities. Considering the SF-6Dv2's dimensions, more females than males reported having health issues, most which concerned physical functioning. Significant differences by sex surfaced for all dimensions except "Role Limitation" and "Mental health." Patients with multifocal cancer had the highest mean and median utility values in all cancer sites considered. CONCLUSION: Cancer population norms can serve as a baseline for interpreting the scores obtained by a given population in comparison to the situation of another group. In this way, our results can assist in comparing utility scores among cancer patients with different sociodemographic groups to other patients/populations groups. To our knowledge, our identified utility norms are the first for patients with breast or colorectal cancer from Quebec.

A framework for role allocation in education, research and leadership services in Canadian academic divisions of general surgery: a modified Delphi consensus.

BACKGROUND: Moving toward a funding standard similar to that for clinical services for roles essential to the functioning of education, research and leadership services within divisions of general surgery is necessary to strengthen divisional resilience. We aimed to identify roles and underlying tasks in these services central to sustainable functioning of Canadian academic divisions of general surgery. METHODS: Between June 2018 and October 2020, we used a 4-step modified Delphi method (online survey, face-to-face nominal group technique [n = 12], semistructured telephone interview [n = 8] and nominal group technique [n = 12]) to achieve national consensus from an expert panel of all 17 heads of academic divisions of general surgery in Canada on the roles and accompanying tasks essential to education, research and leadership services within an academic division of general surgery. We used 70% agreement to determine consensus. RESULTS: The expert panel agreed that a framework for role allocation in education, research and leadership services was relevant and necessary. Consensus was reached for 7 roles within the educational service, 3 roles within the research service and 5 roles within the leadership service. CONCLUSION: Our framework represents a national consensus that defines role standards for education, research and leadership services in Canadian academic divisions of general surgery. The framework can help divisions build resiliency, and enable sustained and deliberate advances in these services.

Multitarget Stool mRNA Test for Detecting Colorectal Cancer Lesions Including Advanced Adenomas.

Current approved non-invasive screening methods for colorectal cancer (CRC) include FIT and DNA-FIT testing, but their efficacy for detecting precancerous lesions that are susceptible to progressing to CRC such as advanced adenomas (AA) remains limited, thus requiring further options to improve the detection of CRC lesions at earlier stages. One of these is host mRNA stool testing. The aims of the present study were to identify specific stool mRNA targets that can predict AA and to investigate their stability under a clinical-like setting. A panel of mRNA targets was tested on stool samples obtained from 102 patients including 78 CRC stage I-III and 24 AA as well as 32 healthy controls. Area under the receiver operating characteristic (ROC) curves were calculated to establish sensitivities and specificities for individual and combined targets. Stability experiments were performed on freshly obtained specimens. Six of the tested targets were found to be specifically increased in the stools of patients with CRC and three in the stools of both AA and CRC patients. After optimization for the choice of the 5 best markers for AA and CRC, ROC curve analysis revealed overall sensitivities of 75% and 89% for AA and CRC, respectively, for a ≥95% specificity, and up to 75% and 95% for AA and CRC, respectively, when combined with the FIT score. Targets were found to be stable in the stools up to 3 days at room temperature. In conclusion, these studies show that the detection of host mRNA in the stools is a valid approach for the screening of colorectal cancerous lesions at all stages and is applicable to a clinical-like setup.

Health utilities in cancer patients: A study protocol for a prospective, longitudinal cohort using online survey.

BACKGROUND: Cost-utility analysis (CUA) is becoming more commonly used in healthcare decision-making. CUA uses the quality-adjusted life-years (QALY) metric, which combines the length of life with the health-related quality of life (HRQoL). Most QALY-measuring instruments were validated for general populations. For patients with cancer, the perception of their health state is different and may vary by the type of cancer considered. In Quebec, no preference weights for QALY have been developed, neither for the general population nor particular subpopulations. METHODS/DESIGN: This survey is a prospective, longitudinal cohort study. The study objectives are: to assess the extent of difference in health utilities between the general population and patients with breast or colorectal cancer; to develop a QALY preference weights dataset for patients with cancer; and to perform "mapping" with different HRQoL questionnaires by correlating the SF-6Dv2 with the EQ-5D-5L, European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30, and functional assessment of cancer therapy - general questionnaires. Data will be collected via a self-administered online survey. Patients' health utilities will be measured within 2 days before the beginning of a chemotherapy treatment cycle and about 8 days after the start of the chemotherapy. Health utilities will be measured by a hybrid method using the time-trade-off and discrete choice experiment methods. ETHICS AND DISSEMINATION: The proposed research was reviewed and approved by the Institutional Research Ethics Review Boards of the CHUS. We will disseminate our study findings through peer-reviewed publications and conference presentations.

International validation of the EORTC QLQ-PRT20 module for assessment of quality of life symptoms relating to radiation proctitis: a phase IV study.

BACKGROUND: Although patients experience radiation proctitis post radiotherapy no internationally tested instruments exist to measure these symptoms. This Phase IV study tested the scale structure, reliability and validity and cross-cultural applicability of the EORTC proctitis module (QLQ-PRT23) in patients who were receiving pelvic radiotherapy. METHODS: Patients (n = 358) from six countries completed the EORTC QLQ-C30, QLQ-PRT23 and EORTC Quality of Life Group debriefing questions. Clinicians completed the EORTC Radiation Therapy Oncology Group scale. Questionnaires were completed at four time-points. The module's scale structure was examined and validated using standard psychometric analysis techniques. RESULTS: Three items were dropped from the module (QLQ-PRT23 → QLQ-PRT20). Factor analysis identified five factors in the module: bowel control; bloating and gas; emotional function/lifestyle; pain; and leakage. Inter-item correlations were within r = 0.3-0.7. Test-Retest reliability was high. All multi-item scales discriminated between patients showing symptoms and those without symptomology. The module discriminated symptoms from the clinician completed scoring and for age, gender and comorbidities. CONCLUSION: The EORTC QLQ-PRT20 is designed to be used in addition to the EORTC QLQ-C30 to measure quality of life in patients who receive pelvic radiotherapy. The EORTC QLQ-PRT20 is quick to complete, acceptable to patients, has good content validity and high reliability. TRIAL REGISTRATION: Australian and New Zealand Clinical Trials Registry (ANZCTR) ACTRN12609000972224 .

Periumbilical vs transumbilical laparoscopic incision: A patients' satisfaction-centered randomised trial.

BACKGROUND: While studies suggested that transumbilical incisions (TUI) incur better postoperative cosmetic satisfaction scores (CSS) and shorter operative time (OT) than periumbilical incisions (PUI) during general surgery laparoscopic interventions, others did not. Concerns have been raised toward the potential negative impact of TUI on the incidence of surgical site infection (SSI) but this issue is under documented. METHODS: A controlled trial was conducted between August 2014 and August 2015 in our hospital. Individuals aged 18-70 undergoing a laparoscopic rectopexy, cholecystectomy, appendectomy or proctocolectomy were considered. Patients were randomized in two groups (PUI or TUI) following a 1:1 allocation ratio. Participants with a body mass index >40, with a history of abdominal surgery, undergoing co-operations, requesting a specific incision or converted to open surgery were excluded. RESULTS: Among the 56 randomized patients, 50 (27 PUI vs 23 PUI) produced analyzable data. There were no significant difference between the characteristics of both groups. CSS evolution (pre-op vs 1 month post-op), SSI incidence and OT were also comparable. Only 28% of participants valued the appearance of their umbilicus prior to intervention. Those who did had a significantly worst CSS evolution (OR -1.7; IC95-2.6/-0.72, p = 0.001). Higher preoperative CSS was also a predictor of postoperative CSS decline (OR -0.4; IC95-0.6/-0.2, p = 0.001). CONCLUSIONS: SUI and TUI were similar for all tested outcomes. Among the participants, the minority of patients who valued the appearance of their umbilicus and those with a high preoperative CSS were particularly prone to postoperative CSS decline.

Neurostimulation for fecal incontinence after correction of repair of imperforate anus.

We are reporting the case of a 32-year-old female who had suffered from fecal incontinence (FI). She was born with an imperforate anus and a recto-vaginal fistula; she underwent repair at 6 mo of age. At 29 years of age, she was still fecally incontinent despite extensive pelvic floor reeducation. A magnetic resonance imaging and an anal electromyography were performed. Because her symptoms were considered to be probably due to extra-sphincteric implantation of the neo-anus, a redo was performed of the recto-neo-anal intra-sphincteric anastomosis. A neurostimulator device was subsequently implanted for persistent incontinence. Solid and liquid FI resolved, and her quality of life improved markedly. Combining surgery to correct the position of the neo-anus within the anal sphincter complex and neurostimulation could thus become a new approach in cases of refractory FI for patients with imperforate anus as a newborn. Follow-up into adulthood after pediatric imperforate anus surgery should be recommended for adult patients with persistent FI.

Risk factors for mortality following emergency colectomy for fulminant Clostridium difficile infection.

PURPOSE: This study evaluated risk factors for mortality after emergency colectomy for fulminant Clostridium difficile infection. METHODS: Retrospective study of 130 cases of Clostridium difficile infection that required a colectomy between 1994 and 2007 in four hospitals of Quebec, Canada. Primary outcome was 30-day mortality. RESULTS: Twenty-five cases underwent colectomy in 1994 to 2002, 41 in 2003, 40 in 2004, and 24 in 2005 to 2007. Common indications were septic shock (41 percent) and nonresponse to medical treatment (39 percent). Overall, 30-day mortality was 37 percent. Mortality increased with age but was not influenced by comorbidities burden. Mortality correlated with preoperative lactate (< or =2.1 mmol/L: 26 percent; 2.2-4.9 mmol/L: 52 percent; > or =5.0 mmol/L: 75 percent, P < 0.001), leukocytosis (<20.0 x 10(9)/L: 32 percent; 20.0-49.9 x 10(9)/L: 33 percent; > or =50.0 x 10(9)/L: 73 percent, P = 0.008), albumin (> or =25 g/L: 19 percent; 15-24 g/L: 38 percent; <15 g/L: 52 percent, P = 0.04) and renal failure. In multivariate analysis, risk factors for mortality were age (per year, adjusted odds ratio: 1.03, 95 percent confidence interval: 1.00-1.06), preoperative lactate greater than or equal to 5.0 mmol/L (adjusted odds ratio: 10.32, 95 percent confidence interval: 2.59-41.1), leukocytosis greater than or equal to 50.0 x10(9)/L (adjusted odds ratio: 3.68, 95 percent confidence interval: 0.92-14.8) and albumin less than 15 g/L (adjusted odds ratio, 6.57, 95 percent confidence interval: 1.31-33.1). CONCLUSIONS: Incidence of Clostridium difficile infection-related emergency colectomies increased 20-fold during the epidemic. Postoperative mortality can be predicted by simple laboratory parameters. Three-fourths of patients with leukocytosis greater or equal to 50.0 x10(9)/L or lactate greater or equal to 5.0 mmol/L died. When possible, emergency colectomy should be performed earlier.

Late clinically silent perforation of intestinal non-Hodgkin's lymphoma.

The combined positron emission tomography/computed tomography scan is ideal in the initial staging of lymphomas and for evaluating the response to treatment. In posttreatment studies, the presence of a residual, metabolically active mass at the site of initially documented lymphoma is not expected to be anything other than residual active disease. We describe a case of intestinal non-Hodgkin's lymphoma that responded to chemotherapy but with a residual metabolically active mass at the site of initial disease. This mass was revealed to be a clinically silent closed intestinal perforation with abscess formation. Similar conditions should be kept in mind during the interpretation of posttreatment combined positron emission tomography/computed tomography scan and before exposing the patient to additional chemotherapy.

Seat-belt injuries in children involved in motor vehicle crashes.

BACKGROUND: The efficacy of seat belts in reducing deaths from motor vehicle crashes is well documented. A unique association of injuries has emerged in adults and children with the use of seat belts. The "seat-belt syndrome" refers to the spectrum of injuries associated with lap-belt restraints, particularly flexion-distraction injuries to the spine (Chance fractures). METHODS: We describe the injuries sustained by 8 children, including 2 sets of twins, in 3 different motor vehicle crashes. RESULTS: All children were rear seat passengers wearing lap or 3-point restraints. All had abdominal lap-belt ecchymosis and multiple abdominal injuries due to the common mechanism of seat-belt compression with hyperflexion and distraction during deceleration. Five of the children had lumbar spine fractures and 4 remained permanently paraplegic. CONCLUSIONS: These incidents illustrate the need for acute awareness of the complete spectrum of intra-abdominal and spinal injuries in restrained pediatric passengers in motor vehicle crashes and for rear seat restraints that include shoulder belts with the ability to adjust them to fit smaller passengers, including older children.