Credit Valley Hospital is a regional hospital located in Mississauga, Ontario. Officially opened on November 5, 1985, it is now part of the Trillium Health Partners hospital group and primarily serves the communities of north Mississauga: Streetsville, Meadowvale, Erin Mills and the surrounding area. In 2012, it was ranked as the best hospital in the Greater Toronto Area in a study conducted by the Canadian Institute for Health Information.
OBJECTIVE:Borderline ovarian tumors (BOTs) are heterogeneous primary epithelial lesions defined by atypical epithelial proliferation without stromal invasion, accounting for approximately 15% of primary ovarian neoplasms. Menopausal hormone therapy (MHT) treats vasomotor and genitourinary symptoms in postmenopausal women, yet its relationship with ovarian neoplasia, especially BOTs, remains uncertain. This systematic review evaluates the association between MHT and BOT outcomes. METHOD:Five databases were searched from inception to August 2025. Included studies were assessed for type of MHT, duration, and recurrences where reported. Risk of bias was assessed with the Newcastle-Ottawa Scale and certainty of evidence with GRADE. RESULTS:A search identified 469 studies; eleven met the inclusion criteria (four cohort, seven case-control). Six reported a statistically significant association between MHT and increased odds of BOTs; five did not. Combined estrogen-progestin therapy showed a stronger, more consistent positive association (odds ratio 1.426, 95% confidence interval 1.083-1.877), whereas estrogen-only therapy showed a nonsignificant association. Post-diagnosis evidence is extremely limited: no study addressed BOT recurrence, and only one observational study evaluated BOT survival, finding no adverse association. CONCLUSION:Evidence on the MHT-BOT association is heterogeneous and inconsistent. Although a statistical association was observed between combined MHT and increased odds of BOTs, postsurgical safety data are limited and overall certainty of evidence is very low; findings warrant considerable caution. Current literature is insufficient to confirm or exclude an association between MHT and BOT recurrence or survival. Indications for MHT after BOT surgery require individualized, multidisciplinary discussion involving oncology and menopause specialists, balancing quality-of-life benefits against unquantified theoretical risks.
Purpose/Aim Continued smoking during radiotherapy reduces treatment efficacy, increases toxicity, and decreases survival, while cessation after a cancer diagnosis significantly improves outcomes. A substantial proportion of patients undergoing radiotherapy are tobacco users and are motivated to quit during treatment, yet smoking cessation support is inconsistently delivered and not clearly owned by any single provider group. This project was initiated through the Ontario Health (Cancer Care Ontario) Radiation Therapy Community of Practice (RThCoP) to evaluate how smoking cessation is incorporated into radiation therapy practice across the province and to identify opportunities to strengthen RT involvement. Methods/Process A provincial survey was developed and distributed through the Ontario Health RThCoP. Responses were received from radiation therapists representing 14 cancer centres across Ontario, including academic, regional, and community programs. The survey included structured and open-ended questions addressing program integration, role clarity, training, workflow fit, resources, patient engagement, and program feedback. Data were analysed descriptively. Results or Benefits/Challenges All responding centres reported the existence of a smoking cessation program; however, only 79% indicated that RTs were involved, while 21% reported that programs existed without RT involvement. Smoking cessation discussions occurred most frequently at CT simulation (47%) or during treatment (40%), rather than at consult. Although 87% of RTs believed smoking cessation should be part of their professional role, only 27% reported having clearly defined responsibilities. Formal training was limited: 71% of respondents had received no formal smoking cessation training, and only 20% felt confident in counselling strategies, pharmacologic options, and referral pathways. Only 40% reported access to resources that fit into the planning and treatment workflow. Patient-level barriers most identified included nicotine addiction, stress, mental health challenges, and financial barriers. Only 40% of respondents felt that patients fully understood the impact of continued smoking on radiotherapy outcomes. Feedback on cessation effectiveness was uncommon, with 80% of RTs reporting that no outcome data or metrics are shared with RT teams. Conclusions/Impact Radiation therapists across Ontario recognize the importance of smoking cessation but are not consistently equipped or enabled to contribute effectively. Despite strong evidence that quitting smoking improves radiotherapy outcomes and survival, major gaps remain in training, role definition, workflow integration, and feedback. Leveraging RTs’ frequent patient contact through standardized education, embedded referral pathways, and performance feedback represents a high-value opportunity to strengthen smoking cessation delivery and improve cancer outcomes at a provincial level.
BACKGROUND:External beam radiation therapy (RT) involves many complex steps to safely and reliably treat patients. The radiation oncology community has adopted process maps and failure modes and effects analysis (FMEA) to analyze risk using the TG‑100 methodology, but the traditional TG‑100-endorsed risk priority number (RPN) has recognized limitations. An updated risk‑profile introduced by the automotive industry, action priority (AP), offers a severity‑weighted alternative that may better support risk‑based decision‑making in RT. PURPOSE:To compare the traditional RPN-based FMEA approach with the updated AP-based approach for identifying high-risk potential failure modes (PFMs) in a representative external beam RT workflow across multiple institutions, and to assess whether the AP framework provides additional value to the radiation oncology community. METHODS:Nine physicists from different cancer centers in Ontario, Canada collaboratively developed and refined a list of 63 PFMs associated with a generic RT workflow requiring data transfer. Each PFM was scored for occurrence (O), severity (S), and detectability (D) using TG‑100 recommendations. Three scoring scenarios were evaluated: average, worst‑case, and a severity‑focused score. High‑risk PFMs were identified using the traditional (top RPN quartile and/or S ≥ 8) and the updated (High or Medium AP categories) FMEA criteria. RESULTS:Seven high‑risk PFMs were selected using the updated FMEA, and an additional 23 were selected using the traditional FMEA. All PFMs identified by the updated FMEA approach were also selected by the traditional FMEA approach; however, the traditional FMEA approach identified many additional PFMs due to its quartile‑based and severity-threshold criteria. The updated AP approach appeared less affected by the scoring variability which may reduce the need for consensus discussion, it was generally easier to apply, showed more consistent behaviour across FMEA iterations and provided a clearer action guidance. CONCLUSIONS:The use of the updated AP approach in this study suggests a clearer, severity-driven, and more streamlined strategy to prioritize high-risk PFMs, potentially reducing the burden of multi‑institutional FMEA while maintaining consistent identification of critical risks.
