PurposeThe goal of this study was to synthesize evidence comparing cancer screening receipt between cancer survivors and non-cancer controls by conducting a systematic review and meta-analysis.MethodsWe searched PubMed, EMBASE, and CINAHL databases from inception through April 1, 2010 using search terms related to cancer, survivorship, and cancer screening. Studies were included if they reported a comparison of cancer screening receipt between cancer survivors and non-cancer controls. We performed a meta-analysis on the effect of cancer survivorship on breast, cervical, colorectal, and prostate cancer screening receipt.ResultsOur search strategy identified 1,778 titles, of which 20 met our inclusion/exclusion criteria. In our meta-analyses, cancer survivors were more likely to be screened for breast, cervical, colorectal, and prostate cancer than non-cancer controls (pooled odds ratio, 1.27; 95 % CI, 1.19–1.36). We observed significant heterogeneity between studies, most of which remained unexplained after subgroup and sensitivity analyses. Important contextual factors, such as how screening programs operate, were not reported in the primary literature. Many cancer survivors (along with non-cancer controls) still did not receive cancer screening.ConclusionCompared with non-cancer controls, cancer survivors receive more frequent screening for new primary breast, cervical, colorectal, and prostate cancers. Future research should seek to determine whether increased uptake of cancer screening is associated with improved outcomes during cancer survivorship.Implications for Cancer SurvivorsOur systematic review and meta-analysis demonstrated that cancer survivors received more frequent screening for second primary breast, cervical, colorectal, and prostate cancers than non-cancer controls. As many cancer survivors are at an increased risk of developing a second primary cancer, future research should seek to determine whether this increased uptake of cancer screening in cancer survivors leads to improved outcomes during cancer survivorship.
Purpose Reirradiation (re-RT) using external beam radiation therapy (EBRT) is a novel salvage strategy for local failure in prostate cancer. We performed a systematic review describing oncologic and toxicity outcomes for salvage EBRT/stereotactic radiation therapy (SBRT) re-RT. Methods and Materials A International Prospective Register of Systematic Reviews registered (#141466) systematic review, meta-analysis, and meta-regression was conducted using preferred reporting items for systematic reviews and meta-analyses guidelines. PubMed and EMBASE were searched from inception through September 2019. Outcome measures included local control (LC), biochemical relapse free survival (BRFS), and ≥grade 3 genitourinary (GU)/gastrointestinal (GI) toxicity. EBRT and SBRT data were collected separately. Meta-regression explored disease and toxicity outcomes as a function of equivalent dose in 2 Gy fractions (EQD2), length of follow-up, and partial versus whole prostate reirradiation. Results Nineteen studies representing 13 cohorts were included (428 patients). Weighted mean follow-up was 26.1 months. Median re-RT EQD2 was 77.1 Gy (α/β = 1.5), with 92% of patients receiving SBRT, 52.1% of patients receiving partial prostate re-RT, and 30.1% of patients receiving androgen deprivation therapy with re-RT. LC was 83.2% (95% confidence interval [CI], 75.5%-90.9%) and BRFS was 59.3% (47.9%-70.7%). Reported late toxicity ≥grade 3 was 3.4% (95% CI, 1.0%-5.8%) for GU and 2.0% (95% CI, 0.1%-4.0%) for GI. Meta-regression found higher LC, BRFS, and reported GU/GI toxicity with increasing EQD2, with partial prostate re-RT associated with less reported GU/GI toxicity and no detriment to LC and BRFS. Conclusions Salvage re-RT using EBRT, particularly with SBRT, is an emerging technique to treat isolated local failure of prostate cancer. With short-term follow-up, LC, BRFS, and reported toxicities appear reasonable, although further follow-up is required before definitive statements on late toxicities can be made. Our review is limited by incomplete reporting of androgen deprivation therapy use in the primary literature. Further prospective studies and longer follow-up are needed before considering re-RT as standard practice.
Purpose-Individuals diagnosed with cancer close to death have low access to enrollment in palliative care programs. The purpose of this literature review was to assess the usefulness of prediagnostic comorbidity and healthcare utilization as indicators of late-stage colorectal cancer (CRC) diagnosis, to help with early identification of individuals who may benefit from palliative care.Methods-A literature search was conducted in relevant databases using title/abstract terms which included "cancer," "stage," "diagnosis," "determinants," "predictors," and "associated." Included studies examined whether comorbidity and/or healthcare utilization had an impact on the CIHR Author ManuscriptCIHR Author Manuscript CIHR Author Manuscript stage at which CRC was diagnosed. A standardized data abstraction form was used to assess the eligibility of each study. Thirteen articles were included in the literature review. These studies were assessed and synthesized using qualitative methodology.Results-We found much heterogeneity among study variables. The findings of this literature review point to the presence of comorbidity and non-emergent healthcare utilization as having no association with late-stage diagnosis. Conversely, emergency room presentation (ERP) was associated with late-stage diagnosis.Conclusions-The results of this literature review did not find strong evidence to suggest that comorbidity and healthcare utilization are potential indicators of late-stage diagnosis. However, ERP may be useful as a flag for consideration of prompt referral to palliative care. Additional research is required to identify potential indicators of late-stage diagnosis that may be available in administrative databases, particularly in the area of healthcare utilization.
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