UNE ORGANISATION CENTRÉE SUR LE PATIENT
TRAITEMENT DU CANCER COLORECTAL ET MISES À JOUR SUR LA RECHERCHE CLINIQUE
Month Ending July 15,, 2021
The following colorectal cancer treatment and research updates extend from June 26th, 2021 to July 15th, 2021, inclusive and are intended for informational purposes only.
Ce contenu n'est pas destiné à se substituer à un avis médical professionnel. Consultez toujours votre médecin traitant ou les conseils d'un professionnel de la santé qualifié pour toute question concernant votre santé ou un problème médical. Ne négligez jamais l'avis d'un professionnel de la santé et ne tardez jamais à le solliciter en raison d'un élément que vous avez lu sur ce site web.
CONTENU
1. Phase II LEAP Clinical Trial to Treat mCRC.
2. TRK Fusion Cancer and How to Test For It
3. Une étude de phase II, ouverte et multicentrique, d'un traitement immunothérapeutique pour la population présentant un cancer colorectal métastatique élevé
4. Étude de phase III au centre de cancérologie Odette comparant l'arfolitixorine et la leucovorine : toutes deux en association avec le 5FU, l'oxaliplatine et le bevacizumab chez des patients atteints d'un cancer colorectal avancé
5. The COC Protocol in CRC
6. Treatment of HER2+ CRC with Precision Cancer Medicines
7. Aspirin and Ibuprofen Use May Help Prevent CRC and Advanced Colorectal Adenoma Incidence
8. EC green Light for Opdivo Plus Yervoy in mCRC
9. Can KRAS Positive Colorectal and Lung Cancer Finally be Targeted?
10. Hepatic Artery Infusion Pump (HAIP) Chemotherapy Program – Sunnybrook Hospital
11. Living Donor Liver Transplantation pour les métastases hépatiques du cancer colorectal non résécable
12. Preoperative ctDNA Levels Are Detectable in the Majority of Patients with Resectable CRC
13.Étude Proposée Au Centre De Cancérologie D'odette Pour Traiter Les Cancers Rectaux Récurrents
14. Trends in the Incidence of Young-Onset CRC with a Focus on Years Approaching Screening Age
15. Cancer-detecting blood test accurate enough to be used as early screening tool: study
16. CRC Patients Diagnosed Before 50 Have Better Survival Odds
17. Olympus Supports New Recommendation to Begin CRC Screenings at Age 45
18. Young Adult CRC Clinic Available at Sunnybrook Hospital
19. Association of Cumulative Social Risk and Social Support with Receipt of Chemotherapy Among Patients with Advanced CRC
20. Are Antibiotics Linked to Early-Onset CRC?
21. Many Early Onset Colon Cancers are Caused by Genetic Mutations Through Families
22. CRC Survivors Ask: What Can I Do Now?
23. ’Mounting’ Data Link Red Meat Consumption to CRC Risk, Mortality
24. CRC Risk May Be Increased by Low Exposure to UVB Light
25. What to Know About the Coronavirus Lambda Variant
26. Pfizer to Ask Regulators to Authorize Covid-19 Vaccine Booster
27. Even with New Variants, Experts Say We May Not Need COVID-19 Booster Shots
28. COVID-19 Treatments: What’s In, What’s Out
29. Foire aux questions pour COVID-19
MÉDICAMENTS / THÉRAPIES SYSTÉMIQUES
- Essai clinique LEAP de phase II pour le CCRm (1er Mars 2020)
Le but de cette étude est de déterminer la sécurité et l'efficacité de la thérapie combinée avec le pembrolizumab (MK-3475) et la levantine (E7080/MK-7902) chez les patients atteints de cancer du sein triple négatif (TNBC), de cancer des ovaires, de cancer gastrique, de cancer colorectal (CCR), de glioblastome (GBM) ou de cancers des voies biliaires (BTC). Les participants seront inscrits dans des cohortes initiales spécifiques aux tumeurs, qui seront élargies si une efficacité adéquate est déterminée. L'essai est disponible au centre de cancérologie Odette et au centre de cancérologie Princess Margaret à Toronto ainsi que dans les centres suivants au Canada : Abbotsford, BC; Winnipeg, MB; CHU de Québec. Pour plus d'informations, consultez le lien ci-dessous.
2. TRK Fusion Cancer And How to Test For It (Feb.16/21)
https://www.bayer.ca/en/media/news/?dt=TmpBPQ==&st=1
3. A Phase 2, Open-label, Multicenter, Study of an Immunotherapeutic Treatment for the MSI High CRC Metastatic Population (Oct.01/20)
L'objectif de cette étude est d'examiner l'efficacité du vaccin DPX-Survivac en combinaison avec les médicaments cyclophosphamide et l'immunothérapie Pembrolizumab chez les patients atteints de cancers solides identifiés comme étant des IMS-E. Tous les patients recevront une thérapie combinée de DPX-Survivac, de cyclophosphamide et de pembrolizumab. Les patients participants sauront quel traitement ils reçoivent. L'essai est actuellement mené au centre de cancérologie Odette, et un nouveau site est en cours d'ouverture à l'hôpital Mont Sinaï.
4. Phase III Study at the centre de cancérologie Odette Comparing Arfolitixorin vs. Leucovorin in Combination with 5FU, Oxaliplatin and Bevacizumab in Patients with Advanced CRC (Oct.01/20)
The purpose of this study is to look at the effectiveness of the drug Arfolitixorin in combination with 5-fluorouracil (5FU), oxaliplatin, and bevacizumab in patients with colorectal cancer (CRC). Patients with advanced/metastatic CRC who meet certain criteria may be able to participate. There will be two groups of patients participating in this study;
- un groupe recevra de l'arfolitixorine en combinaison avec du 5FU), de l'oxaliplatine et du bevacizumab,
- tandis que l'autre groupe recevra le médicament Leucovorin en combinaison avec le 5FU, l'oxaliplatine et le bevacizumab (norme de soins).
Le médecin et le personnel de l'étude ne sauront pas dans quel groupe se trouve un patient. Les patients seront répartis au hasard pour recevoir l'un ou l'autre traitement.
A propos d'Arfolitixorine:
L'arfolitixorine is Isofol’s proprietary drug candidate being developed to increase the efficacy of standard of care chemotherapy for advanced CRC. The drug candidate is currently being studied in a global Phase 3 clinical trial. As the key active metabolite of the widely used folate-based drugs, arfolitixorin can potentially benefit all patients with advanced CRC, as it does not require complicated metabolic activation to become effective.
Traiter les patients atteints de cancer avec de l'arfolitixorine - Les objectifs :
- When treating CRC, for example, arfolitixorin is administered in combination with 5-FU to increase cell mortality in circulating cancer cells and in cancerous tumours.
- Arfolitixorin is administered in conjunction with rescue therapy after high-dose treatment with the cytotoxic agent, methotrexate, in order to suppress the cytotoxic effect in surrounding healthy tissue. The treatment is used for certain types of cancer, such as osteosarcoma, a type of bone cancer. This involves administering arfolitixorin separately, 24 hours after the chemotherapy.
https://sunnybrook.ca/trials/item/?i=293&page=49335 et https://clinicaltrials.gov/ct2/show/NCT03750786
(https://isofolmedical.com/arfolitixorin/ )
5. The COC Protocol in CRC
The COC Protocol is a combination of four commonly prescribed medications (atorvastatin, metformin, mebendazole, and doxycycline) with the potential to target colorectal cancer (CRC) and help improve the effectiveness of standard anticancer therapies.
A number of observational studies in patients taking metformin or statins to treat diabetes or cardiovascular conditions have linked the use of these medications to improved outcomes in CRC. The strongest clinical evidence so far comes from a series of trials investigating the potential of metformin in patients who have either very early CRC, or a very high risk of developing CRC. In the first small pilot trial, just one month of low-dose metformin significantly reduced the number of potentially pre-cancerous cellular changes (called ‘aberrant crypt foci’) in patients, while patients who had no metformin treatment showed no change. A subsequent larger and better controlled Phase 3 trial in patients at high-risk of developing CRC who had recently had surgery to remove colorectal polyps found that metformin reduced the chance of polyps reoccurring within the year. Just 38.0% of patients who took metformin had polyps after 1 year, compared to 56.5% of patients who took placebo.
Numerous larger studies investigating the benefits of taking metformin alongside, or immediately following standard cancer treatments are now underway. More clinical trials are needed to investigate the individual and combined use of these medications in cancer.
https://careoncology.com/the-coc-protocol-in-colorectal-cancer/ref/2/
6. Treatment of HER2+ CRC with Precision Cancer Medicines (Jun.29/21)
Precision cancer medicines that target the HER2 receptor in breast, colon and other cancers represent an effective treatment option for individuals with HER2-positive (HER2+) disease. Researchers are evaluating various drug combinations that target the HER2 receptor in colorectal cancers (CRCs) because HER2 directed therapy is effective and can avoid the complications of chemotherapy.
Herceptin (trastuzumab) and Tykerb (lapatinib) are two precision cancer medicines that bind along the HER pathway at different points, both producing anti-cancer effects in HER2+ breast cancer. When evaluated in advanced HER2+ wild type KRAS patients with advanced colon cancer the combination is also active and well tolerated in treatment-refractory patients with HER2+ disease.
Tukysa (tucatinib) is a tyrosine kinase inhibitor drug that is highly selective for HER2 without significant inhibition of EGFR (epidermal growth factor receptor). EGFR inhibition is associated with significant side effects including skin rash and diarrhea. The MOUNTAINEER clinical trial evaluated the effectiveness of combination HER2 therapy with Herceptin combined with Tukysa in HER2+ advanced CRC in 26 patients with HER2+ RAS wild-type metastatic CRC (mCRC) after treatment with first- and second-line standard-of-care therapies. The combined regimen demonstrated encouraging activity and was well tolerated. Overall, 52% of patients responded to treatment with a median duration of response of 10.4 months and an average overall survival of 18.7 months.
The combination of Herceptin-Perjeta also has demonstrated promising activity in patients with metastatic CRC with RAS wild-type and HER2 amplification in the TRIUMPH clinical trial. Overall ~35% of 19 patients with RAS wild-type and HER2-amplified metastatic CRC that were refractory to standard chemotherapy responded to treatment.
7. Aspirin and Ibuprofen Use May Help Prevent CRC and Advanced Colorectal Adenoma Incidence (Jul.02/21)
As colorectal cancer (CRC) continues to be the second highest cause of cancer-related deaths in the U.S., researchers have had a growing interest in prevention strategies. One potential preventative strategy may be the use of nonsteroidal anti-inflammatory drugs (NSAIDs) and ibuprofen, which were associated with reduced risk of advanced recurrent adenoma (a benign tumor that could progress to cancer) and CRC. “Chronic inflammation has been implicated in the process of colorectal tumorigenesis, and NSAIDs have been identified in preclinical and clinical studies to have a protective effect against colorectal tumors,” the study authors wrote.
Although prior studies have shown reduction in colorectal cancer risk with aspirin use, few evaluated non-aspirin NSAIDs such as ibuprofen and most have grouped all NSAIDs together, the authors noted. The long-term benefit has also been unclear. Researchers of this study saw a decrease in the overall risk of CRC incidence with increased use of aspirin, ibuprofen and combined use of both. There was a significant inverse association between both aspirin use alone and combined use of aspirin and ibuprofen with cancers in the proximal and distal colon. Ibuprofen use alone was associated with a decreased risk of cancer in the proximal colon but not the distal colon. To conclude, authors noted that further research is necessary to balance the potential for medication-related side effects and life expectancy when assessing the use of NSAIDs for chemoprevention recommendations.
8. EC green Light For Opdivo Plus Yervoy in mCRC (Jun.30/21)
The European Commission (EC) has cleared Opdivo (nivolumab) plus Yervoy (ipilimumab) for the treatment of adult patients with mismatch repair deficient (MMR-D) or microsatellite instability-high (MSI-high) metastatic colorectal cancer (mCRC), after prior fluoropyrimidine-based combination chemotherapy.
The approval is based on the positive results from BMS’ Phase II CheckMate-142 trial, which demonstrated a clinically meaningful improvement in objective response rate (ORR) for MSI-high/MMR-D mCRC patients who had received prior treatment with fluoropyridine, oxaliplatin and irinotecan. Specifically, 64.7% of patients responded to treatment with Opdivo plus Yervoy, with 12.6% achieving a complete response.
“With this approval, patients in the EU with MMR-D or MSI-high mCRC will now have the first dual immunotherapy treatment available to them, and we look forward to working with stakeholders to advance this rational combination,” said Ian Waxman, development lead, gastrointestinal cancers, BMS.
9. Can KRAS Positive Colorectal and Lung Cancer Finally be Targeted? (Mar.26/21)
The investigational KRAS G12C inhibitor drug Adagrasib (MRTX849) yielded clinical responses in patients with non-small cell lung cancer (NSCLC) and colorectal cancer (CRC), and other solid tumors harboring KRAS G12C mutations, according to the results from the phase I – II Krystal clinical trials.
Adagrasib is an investigational, orally available small molecule that is designed to potently and selectively inhibit a form of KRAS which harbors a substitution mutation (G12C). Adagrasib works by irreversibly and selectively binding to KRAS G12C in its inactive state, blocking its signaling to other cells and preventing cancer cell growth and proliferation; this leads to cancer cell death.
The phase 1/2 KRYSTAL-1 clinical trial evaluated adagrasib in 18 CRC patients. Three (17%) had a confirmed objective response and two of them continue to receive treatment. Disease control was seen in 17 of the patients (94%) and 12 of these patients continue to be treated. Side effects included nausea (54%), diarrhea (51%), vomiting (35%), fatigue (32%) and increased levels of an enzyme that indicates minor liver irritation (20%). The only serious adverse side effect to occur in more than one patient was low sodium in the blood.
LES THÉRAPIES CHIRURGICALES
10. Hepatic Artery Infusion Pump (HAIP) Chemotherapy Program — Sunnybrook Odette Cancer Centre (April 15/21)
Le programme PPAH est une première au Canada pour les personnes dont le cancer du côlon ou du rectum (cancer colorectal) s'est propagé au foie et ne peut être retiré par une intervention chirurgicale. Le programme implique une approche coordonnée et multidisciplinaire des soins, avec une étroite collaboration entre l'oncologie chirurgicale, l'oncologie médicale (chimiothérapie), la radiologie interventionnelle, la médecine nucléaire et les soins infirmiers en oncologie. La pompe à perfusion de l'artère hépatique (PPAH) est un petit dispositif en forme de disque qui est chirurgicalement implanté juste sous la peau du patient et est relié par un cathéter à l'artère hépatique (principale) du foie. Environ 95 % de la chimiothérapie administrée par cette pompe reste dans le foie, épargnant ainsi le reste du corps des effets secondaires. Les patients reçoivent une chimiothérapie dirigée par PPAH en plus de la chimiothérapie intraveineuse (IV) régulière (chimiothérapie systémique), afin de réduire le nombre et la taille des tumeurs. Les docteurs Paul Karanicolas et Yooj Ko sont les responsables du programme et sont heureux de voir les patients éligibles pour la thérapie.
Maintenant au centre de cancérologie Odette, le PPAH est utilisé chez les patients atteints d'un cancer colorectal qui s'est propagé au foie et qui ne peut être enlevé chirurgicalement et ne s'est pas propagé à d'autres parties du corps. Les patients qui ont peu (1-5) et de très petites tumeurs dans les poumons peuvent être pris en considération si la maladie pulmonaire est jugée traitable avant le PPAH. Si vous pensez pouvoir bénéficier de cette thérapie et/ou si vous souhaitez en savoir plus sur l'essai clinique, votre oncologue médical ou votre chirurgien peut vous adresser par télécopie au 416-480-6179. Pour plus d'informations sur l'essai clinique PPAH, veuillez cliquer sur le lien fourni ci-dessous
http://sunnybrook.ca/content/?page=colorectal-colon-bowel-haip-chemotherapy
11. Living Donor Liver Transplantation for Unresectable Colorectal Cancer Liver Metastases (April 1/21)
Environ la moitié des patients atteints de cancer colorectal (CCR) développent des métastases, généralement au niveau du foie et des poumons. L'ablation chirurgicale des métastases hépatiques (MH) est la seule option de traitement, bien que seulement 20 à 40 % des patients soient candidats à un traitement chirurgical. La thérapie chirurgicale apporte un avantage significatif en termes de survie, avec une survie à 5 ans après résection du foie de 40 à 50 % pour les MH, contre 10 à 20 % pour la chimiothérapie seule. La transplantation du foie (TF) permettrait d'éliminer toute maladie évidente dans les cas où les métastases colorectales sont isolées au foie mais considérées comme non résécables.
Source de l'image : https://www.slideshare.net/AhmedAdel65/preoperative
Alors que la MH du CCR est considérée comme une contre-indication à la TF dans la plupart des centres de cancérologie, un seul centre à Oslo, en Norvège, a démontré une survie à 5 ans de 56 %. Un essai clinique parrainé par le University Health Network de Toronto proposera une transplantation de foie de donneur vivant (TFDV) à certains patients présentant des métastases non résécables limitées au foie et ne progressant pas sous chimiothérapie standard. Les patients seront examinés pour déterminer si la greffe de foie est appropriée et doivent également avoir un donneur vivant en bonne santé qui se présente pour l'évaluation. Les patients qui subissent une TFDV seront suivis pendant 5 ans pour leur survie, leur survie sans maladie et leur qualité de vie et comparés à un groupe témoin qui abandonne l'étude avant la transplantation pour des raisons autres que la progression du cancer. Malgré le résultat négatif de l'essai, la recherche sur l'HIPEC et d'autres stratégies de prévention des métastases péritonéales devrait se poursuivre, concluent-ils dans Gastroentérologie Et Hépatologie Lancet."La récurrence péritonéale de 21 % observée dans l'ensemble de la population étudiée indique l'ampleur du problème clinique dans le cancer du colon localement avancé, et les stratégies thérapeutiques doivent être explorées plus avant", ont-ils déclaré. "Les résultats d'autres essais portant sur l'adjuvant HIPEC sont attendus avec impatience"
https://clinicaltrials.gov/ct2/show/NCT02864485
12. Preoperative ctDNA Levels Are Detectable in the Majority of Patients with Resectable CRC (July.05/21)
A team of investigators in Japan used a personalised assay for circulating tumour DNA (ctDNA) levels in plasma to monitor minimal residual disease following surgery in patients with resectable colorectal cancer (CRC). Their subgroup analysis found statistically significant associations between ctDNA levels and the pathological disease stage.
As of 28 February 2021, the GALAXY study enrolled 1,236 patients with 808 patients being included in this analysis. Preoperative baseline ctDNA was detected in 799 patients. ctDNA was available in 797 patients 4 weeks after operation, in 531 patients 12 weeks after operation, and in 263 patients 24 weeks after operation. Stage I-III CRC had 654 patients and 154 patients had stage IV cancer. Among 65, 280, and 301 patients with pathological stages I, II, and III, preoperative ctDNA was detected in 50 (77%), 267 (95%), and 288 (96%) patients, respectively.
Longitudinal ctDNA positivity at postoperative week 4, 12 and 24 was significantly associated with inferior disease-free survival (DFS). Sensitivity of relapse detection was 93.1%. Six-months DFS rate in ctDNA negative patients in overall and pathologic stage I-III were ≥99%, showing unprecedented, good prognosis. Researchers concluded that further investigation whether ctDNA status could become new surrogate endpoint beyond DFS is warranted.
About ctDNA:
Circulating tumor DNA (ctDNA) are circulating tumor cells that are shed by tumors into the blood. Finding ctDNA in the blood means that there is very likely some small amounts of cancer remaining after surgery. However, this cancer, if detected, cannot be found on other tests usually used to find cancer, such as CT Scans, as it may be too small to measure. Testing for ctDNA levels may help identify patients with colon cancer after surgery.
ctDNA may help guide precision medicine in patients with cancer in the following settings:
- Detection of minimal residual disease (‘MRD’) following colorectal surgery.
- Monitoring the treatment response in the metastatic setting.
- Identifying genomic drivers of therapeutic sensitivity and resistance.
- Guiding treatment strategies to overcome resistance to treatment.
LES RADIOTHÉRAPIES/RADIOLOGIE INTERVENTIONNELLE
13. Study Offered at the Odette Cancer Centre to Treat Recurrent Rectal Cancer (Mar.12/20)
L'échographie focalisée guidée par résonance magnétique (EFG-RM) est une modalité moins invasive et ambulatoire qui est étudiée pour le traitement thermique du cancer. Dans le EFG-RM, un transducteur spécialement conçu est utilisé pour focaliser un faisceau d'énergie ultrasonore de faible intensité dans un petit volume à un endroit spécifique du corps. La RM est utilisée pour identifier et délimiter la tumeur, focaliser le faisceau d'ultrasons sur la cible et fournir une cartographie thermique en temps réel pour assurer un chauffage précis de la cible désignée avec un effet minimal sur les tissus sains adjacents. Le faisceau ultrasonore focalisé produit une hyperthermie thérapeutique (40-42°C) dans le champ de la cible, provoquant la dénaturation des protéines et des lésions cellulaires. Actuellement, aucune donnée clinique prospective n'a été rapportée sur l'utilisation de l'UF-RMg dans le cadre d'un cancer rectal récurrent. Le cancer récurrent du rectum est un problème clinique délicat. Les protocoles de retraitement actuels ont une efficacité limitée. L'ajout de l'hyperthermie à la radiothérapie et à la chimiothérapie peut améliorer la réponse thérapeutique. Grâce aux récents progrès technologiques, les chercheurs émettent l'hypothèse que la EFG-RM est techniquement réalisable et peut être utilisée en toute sécurité en combinaison avec une réirradiation et une chimiothérapie simultanées pour le traitement du cancer du rectum récurrent sans augmentation des effets secondaires. L'étude est proposée au centre de cancérologie d'Odette. Voici le lien vers le protocole de l'étude :
DÉPISTAGE
14. Trends in the Incidence of Young-Onset CRC with a Focus on Years Approaching Screening Age (Apr.10/21)
With recent evidence for the increasing risk of young-onset colorectal cancer (yCRC), the objective of this population-based longitudinal study was to evaluate the incidence of yCRC in one-year age increments, particularly focusing on the screening age of 50 years. The study was conducted using linked administrative health databases in British Columbia, Canada including a provincial cancer registry, inpatient/outpatient visits, and vital statistics from January 1, 1986 to December 31, 2016. We calculated incidence rates per 100,000 at every age from 20 to 60 years and estimated annual percent change in incidence (APCi) of yCRC using joinpoint regression analysis.
3,614 individuals were identified with yCRC (49.9% women). The incidence of CRC steadily rose from 20 to 60 years, with a marked increase from 49 to 50 years. Furthermore, there was a trend of increased incidence of yCRC among women. Analyses stratified by age yielded APCi’s of 2.49% and 0.12% for women aged 30-39 years and 40-49 years, respectively and 2.97% and 1.86% for men. These findings indicate a steady increase over one-year age increments in the risk of yCRC during the years approaching and beyond screening age. These findings highlight the need to raise awareness as well as continue discussions regarding considerations of lowering the screening age.
15. Cancer-detecting blood test accurate enough to be used as early screening tool: cfDNA study (Jun.25/21)
Results from a study of a blood test that can detect more than 50 types of cancer suggest that it is accurate enough to be used as a screening tool among people at higher risk of the disease, including those who are not symptomatic.
The test accurately detected cancer, often before any symptoms were present, and delivered a very low false-positive rate. It also successfully predicted where in the body the cancer is located with a high degree of accuracy (88.7% of cases) – a development researchers say can help doctors narrow down diagnostic testing and confirm a diagnosis sooner. The test, developed by U.S.-based company Grail, detects chemical changes in fragments of genetic code – known as cell-free DNA (cfDNA) – that leak from tumours and other cells into the bloodstream. The company promises results will be made available within 10 business days from the time the sample reaches the lab.
Speed aside, the latest study of the test suggests an impressively high level of accuracy, correctly identifying the presence of cancer in 51.5% of cases across all stages of the disease. During the study, scientists analyzed 2,823 people with the disease and 1,254 people without. The test wrongly detected cancer in only 0.5% of cases. In solid tumours that do not have any screening options, like those associated with oesophageal, liver and pancreatic cancers, the ability to generate a positive test result was twice as high (65.6%) as cancers with solid tumours that do have screening options, such as breast, bowel, cervical or prostate cancers. The test’s ability to detect cancer in the blood such as lymphoma and myeloma, however, was 55.1%.
This isn’t the first cancer-detecting blood test to perform well in studies. However, in a study published in July 2020, the authors studying the test cautioned that large-scale studies across long time periods are needed to confirm the potential of the test for early cancer detection.
16. CRC Patients Diagnosed Before 50 Have Better Survival Odds (Jun.23/21)
New research has found that younger patients who are diagnosed with colorectal cancer (CRC) have high rates of survival if they’re diagnosed with the disease early. The study analyzed data from 769,871 people diagnosed with colorectal cancer. The results showed that the people diagnosed with CRC when they were younger than 50 had a “survival advantage” over the people who were diagnosed between the ages of 51 and 55. Additionally, people who were diagnosed at ages 35 through 39, and with stages I and II, had the best outcomes.
The authors concluded that the study’s findings clearly showed the potentially life-saving benefit of early screening for CRC. The study’s findings are timely, coming just a month after the United States Preventive Services Task Force (USPSTF) lowered the recommended age to start colorectal cancer screenings from 50 to 45. “What this study suggests is that, if you present at a younger age, if it’s detected at an early stage, your survival is actually better,” says Anton Bilchik, MD, PhD, adding that this finding “reinforces the need to screen at a younger age.”
https://www.verywellhealth.com/study-diagnosing-colorectal-cancer-early-matters-5189721
17. Olympus Supports New Recommendation to Begin CRC Screenings at Age 45 (Jul.01/21)
Olympus announced its support of the new recommendation issued by the United States Preventive Services Task Force (USPSTF) to begin colorectal cancer (CRC) screenings for all individuals beginning at age 45. Lowering the recommended screening age will allow more people to be screened, especially those among whom CRC rates are increasing most quickly. The Multi-Society Taskforce, which includes the American College of Gastroenterology (ACG), the American Gastroenterological Association (AGA), and the American Society for Gastrointestinal Endoscopy (ASGE), is in full support of this new recommendation.
When screening is done via colonoscopy, colorectal cancer prevention is possible through the detection and removal of precancerous and cancerous polyps. “Now more than ever it is important to not only support but advocate for people to be screened for CRC starting at the age of 45,” said Ross D. Segan, MD, MBA, FACS, Chief Medical Officer for Olympus Corporation. Since the start of the COVID-19 pandemic in 2020, screening rates for colorectal cancer have declined by 84.5%.
Source de l'image : https://www.cedars-sinai.org/blog/at-home-colorectal-cancer-screening.html
AUTRE
18. Young Adult CRC Clinic Available at Sunnybrook (Apr.12/21)
Une étude récente menée par les médecins de l'université de Toronto a observé une augmentation des taux de cancer colorectal chez les patients de moins de 50 ans. Cette étude reflète les résultats obtenus aux États-Unis, en Australie et en Europe. L'augmentation des taux de cancer colorectal chez les jeunes survient après des décennies de baisse des taux chez les personnes de plus de 50 ans, qui s'expliquent très probablement par le recours accru au dépistage du cancer colorectal (par le biais de programmes de dépistage en population) qui permet d'identifier et d'éliminer les polypes précancéreux. Les patients diagnostiqués avant 50 ans ont un ensemble unique de besoins, de défis et d'inquiétudes. Ils sont différents de ceux qui ont été diagnostiqués après 50 ans. Le Dr Shady Ashamalla (oncologue chirurgien spécialisé dans le cancer colorectal) et son équipe du Centre des sciences de la santé Sunnybrook comprennent les besoins de cette population de patients.
Le Dr Ashamalla fait partie d'une équipe multidisciplinaire d'experts de La Clinique Du Cancer Colorectal Des Jeunes Adultes qui travaillera avec les jeunes patients atteints de cancer colorectal, quel que soit le stade de la maladie, afin de créer un plan de traitement individualisé pour soutenir chaque patient dans son parcours contre le cancer. Leurs besoins et leurs préoccupations seront pris en compte dans la mesure où ils s'y rapportent :
- Préoccupations et questions relatives à la fécondité
- Les jeunes enfants à la maison
- Questions relatives aux données et à l'intimité
- Les défis au travail
- Inquiétudes concernant le cancer héréditaire
- Relations avec la famille et les amis
- Stress psychologique dû à l'un ou à l'ensemble des éléments ci-dessus
L'équipe d'experts est composée de :
- Oncologues (médicaux, chirurgicaux, radiologiques)
- Travailleurs sociaux
- Psychologues
- Généticiens
- Infirmière navigatrice
Si un patient souhaite être orienté vers Sunnybrook, il peut demander à son médecin traitant ou à son spécialiste de l'orienter vers Sunnybrook via le formulaire d'orientation électronique, accessible via le lien figurant ci-dessous. Une fois l'orientation reçue La Clinique Du Cancer Colorectal Des Jeunes Adultes sera informée si le patient a moins de 50 ans. Un rendez-vous sera alors fixé, au cours duquel le patient rencontrera différents membres de l'équipe afin de répondre à leurs préoccupations spécifiques.
http://sunnybrook.ca/content/?page=young-adult-colorectal-cancer-clinic
19. Association of Cumulative Social Risk and Social Support with Receipt of Chemotherapy Among Patients with Advanced CRC (Jun.09/21)
Researchers conducted a cross-sectional, population-based survey study to determine whether cumulative social risk (ie, multiple co-occurring sociodemographic risk factors) is associated with lower receipt of chemotherapy among patients with advanced colorectal cancer (CRC) and whether social support would moderate this association.
Results showed participants with 3 or more risk factors were less likely to receive chemotherapy than participants with 0 risk factors. Participants with 2 or more support sources had higher odds of undergoing chemotherapy than those without social support. Within each social support level, participants were less likely to receive chemotherapy as cumulative social risk increased.
Thus, the study found that cumulative social risk was associated with reduced receipt of chemotherapy. These associations were mitigated by social support. Assessing cumulative social risk may identify patients with CRC who are at higher risk for omitting chemotherapy who can be targeted for support programs to address social disadvantage and increase social support.
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2780796
20. Are Antibiotics Linked to Early-Onset CRC? (Jul.03/21)
The use of antibiotics may lead to an increased risk of colon cancer at all ages, an analysis of a large Scottish primary care database suggested. During a presentation at the virtual World Congress on Gastrointestinal Cancer, Sarah Perrott, of the University of Aberdeen in Scotland, pointed out that the incidence of early-onset colorectal cancer (CRC) has been increasing globally, while at the same time there has been an increase in antibiotic consumption.
Researchers identified 7,903 CRC cases (5,281 colon cancers and 2,622 rectal cancers) diagnosed from 1999 to 2011 and matched them with 30,418 controls. Of the patients with CRC, 445 were under the age of 50, and 45% were prescribed antibiotics during the exposure period. Perrott and colleagues also found that antibiotic use was associated with an increased risk of proximal colon cancer in patients under 50, but not among those in the older age group. “No association was observed with rectal cancer,” Perrott pointed out, “which we find interesting, in that rectal cancer is a common cancer site in early-onset CRC compared to later onset.” Most classes of antibiotics were not significantly associated with colon, rectal, or distal colon cancers, the authors reported. However, quinolones and sulfonamides/trimethoprim were associated with proximal colon cancer in the early-onset group.
“More epidemiological and translational studies are required to evaluate the true role of antibiotics in the development of colorectal cancer and also to evaluate the long-term effects of antibiotics on gut health,” Perrott said.
https://www.medpagetoday.com/meetingcoverage/additionalmeetings/93412
https://www.medscape.com/viewarticle/954225
Source de l'image : https://www.healthline.com/health/how-do-antibiotics-work
21. Many Early Onset Colon Cancers are Caused by Genetic Mutations Through Families (Apr.15/21)
One in every six colorectal cancer (CRC) patients (16 percent) diagnosed under age 50 has at least one inherited genetic mutation that increases his or her cancer risk and many of these mutations could go undetected with the current screening approach, according to initial data from a statewide CRC screening study conducted at The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC – James).
In this new analysis, the OSUCCC – James team offers the first detailed report of the prevalence and spectrum of specific mutations in 25 genes associated with inherited (passed down through families) cancer syndromes in an unselected series of CRC patients.
For this study, researchers recruited 450 patients who had undergone surgery for newly diagnosed, invasive colorectal cancer on or after Jan. 1, 2013. Blood and tumor samples were collected from each patient and tumor pathology characteristics were verified prior to testing. All tumors were screened for microsatellite instability and/or abnormal immunohistochemistry, characteristics that are found in cancers from individuals with Lynch syndrome. All colorectal cancer patients diagnosed under age 50 underwent genetic testing for 25 cancer susceptibility genes [including the genes that cause Lynch syndrome (MLH1, MSH2, EPCAM, PMS2 et MSH6)] using a multi-gene panel.
Overall, 75 cancer susceptibility gene mutations were identified in 72 patients. Eight percent (36 patients) had Lynch syndrome only, 0.4 percent (2 patients) had Lynch syndrome plus another hereditary cancer syndrome, 7.6 percent (34 patients) had a different hereditary cancer syndrome (including a third patient with two syndromes).
Researchers of the study believe this data offers additional support for complete genetic testing for all early-onset colorectal patients. This could save lives by identifying at-risk families so that they can benefit from intensive cancer surveillance and prevention options.
NUTRITION/MODE DE VIE SAIN
22. CRC Survivors Ask: What Can I Do Now? (Apr.29/21)
Benefits of Exercise
Clinical trials have evaluated the benefit of exercise in cancer patients, and most have found an association with improved quality of life, reduced risk of cancer recurrence and prolonged survival. In a meta-analysis of 49,000 survivors of colorectal cancer (CRC) physical activity had a dose-related effect on survival. A reduction in mortality risk was observed with increasing exercise and physical activity. Similarly, a 16-year longitudinal study found that more physical activity before and after a diagnosis of CRC was associated with lower mortality, whereas more sedentary time was associated with a higher risk.
Nutrition and Weight Management
The National Surgical and Adjuvant Bowel Project evaluated the association between Body Mass Index (BMI) and outcomes in two clinical trials of adjuvant chemotherapy involving 4,288 individuals with colon cancer. When compared with normal-weight people (BMI, 18.5-24.9 kg/m2), very obese patients (BMI =35 kg/m2) had a 38% greater risk for colon cancer recurrence or development of a second primary cancer, a 36% increased risk for CRC-related mortality, and a 28% increased risk for death from any cause.
In addition to obesity, certain diets appear to contribute to poor survivorship following treatment for colon cancer. In a study involving 1,000 patients with stage II/III colon cancer patients in the highest quintile of a Western diet (red meat, fat, refined foods, desserts) versus lowest had double or triple the risk for CRC recurrence and CRC-related death. Patients whose diets reflected a high glycemic index also had worse disease-free survival, recurrence-free survival and overall survival.
https://news.cancerconnect.com/colon-cancer/healthy-lifestyle-improves-colorectal-cancer-outcomes
Source de l'image : https://www.oncostem.com/blog/must-follow-lifestyle-changes-post-cancer-treatment/
23. ’Mounting’ Data Link Red Meat Consumption to CRC Risk, Mortality (Jun.28/21)
Researchers have identified a possible molecular link between high consumption of both processed and unprocessed red meat and increased colorectal cancer (CRC) risk and mortality. “We have known for quite a while now that environmental factors, including diet, can impact colorectal cancer incidence. What was missing were data demonstrating whether we could see an impact of these environmental carcinogens in cancer specimens of patients,” Marios Giannakis, MD, PhD, oncologist at Dana-Farber Cancer Institute and assistant professor of medicine at Harvard Medical School, said during an interview with Healio.
By examining sequencing data of 900 patients with CRC, Giannakis and colleagues identified a previously un-described pattern of mutations — a “mutational signature” — that exists in CRC. They attributed this signature to alkylating damage and next investigated for possible culprits. One of the known risk factors for CRC is red meat, and it is known to contain chemicals that potentially can cause alkylation. They essentially found that patients who were consuming the most red meat overall, including both processed and unprocessed red meat, had cancers with increased alkylating damage. Giannakis noted that one of the next steps is to further investigate the mechanism by which increased red meat consumption can causes these mutations and explore what other factors modify this risk.
Source de l'image : https://www.uicc.org/news/study-finds-possible-link-between-meat-consumption-and-risk-breast-cancer
24. CRC Risk May Be Increased by Low Exposure to UVB Light (Jul.05/21)
Researchers from the University of California San Diego, USA, discovered a strong association between low exposure to UVB light from the sun and higher rates of colorectal cancer (CRC) across all age groups and countries surveyed.
The authors suggest that lower UVB exposure may reduce levels of vitamin D. Vitamin D deficiency has previously been associated with an increased risk of CRC. Raphael Cuomo, Co-author of the study, said: “Differences in UVB light accounted for a large amount of the variation we saw in colorectal cancer rates, especially for people over age 45. Although this is still preliminary evidence, it may be that older individuals, in particular, may reduce their risk of colorectal cancer by correcting deficiencies in vitamin D.” The researchers recommend that future studies should look directly at the potential benefits on CRC of correcting vitamin D deficiencies. However, researchers warn that the observational nature of the study does not allow for conclusions about cause and effect and more work is needed to understand the relationship between UVB and vitamin D with CRC in more detail.
MISES À JOUR COVID-19
25. What to Know About the Coronavirus Lambda Variant (July.06/21)
The lambda variant was first identified in Peru in December 2020. In June, the World Health Organization (WHO) labeled lambda a “variant of interest” based on the presence of several concerning genetic changes. “Lambda carries a number of mutations with suspected phenotypic implications, such as a potential increased transmissibility or possible increased resistance to neutralizing antibodies,” the WHO wrote in its Weekly Epidemiological Update published on June 15. Lambda is now in 31 countries, according to data from GISAID, including the United States, United Kingdom, and Canada.
Variants of interest differ from “variants of concern” — like alpha, beta, delta, and gamma — which have strong evidence showing they’re more dangerous to people. Although lambda isn’t a variant of concern right now, this could change over time. Currently, we don’t know for sure whether lambda can evade the immune protection offered by COVID-19 vaccines, but scientists are trying to figure that out.
As with any coronavirus variant, though, you should be cautious of it. But right now, the delta variant is much more of a concern in the United States. With delta and other variants of concern, people who are fully vaccinated have a much lower risk of severe illness and death, even if they contract an infection. Vaccination offers high protection against the coronavirus, but it’s not the only line of defense. Wearing face masks in crowded places and practicing physical distancing when possible are also effective ways to protect yourself and others.
26. Pfizer to Ask Regulators to Authorize Covid-19 Vaccine Booster (Jul.08/21)
Pfizer Inc. will seek clearance from U.S. regulators in coming weeks to distribute a booster shot of its Covid-19 vaccine to heighten protection against infections, as new virus strains rise.
Pfizer and partner BioNTech SE said Thursday that they will seek authorization for the third shot, based on encouraging initial study data. The companies said the data showed that a booster shot given at least six months after the second dose produced antibodies protective against the original strain of the virus and a more recent strain, Beta. The companies also noted that the antibody levels were 5-10x higher than after two doses.
Pfizer also said it plans to start clinical trials in August of an updated version of its vaccine that would better protect against the Delta variant. However, the companies do not think they will need to replace the current version of their highly successful shot.
27. Even with New Variants, Experts Say We May Not Need COVID-19 Booster Shots (Jul.08/21)
As coronavirus variants emerge and spread, speculation is increasing about whether we’ll eventually need booster shots to maintain our protection against COVID-19. All viruses mutate. The coronavirus that causes COVID-19, SARS-CoV-2, has already gone through many mutations and will continue to evolve over time. But that doesn’t necessarily mean our vaccines will lose their power to protect us, or that we’ll need a booster shot.
Growing evidence suggests the shots will provide long lasting immunity, even against new variants. In addition to antibodies that act fast and attack the coronavirus spike protein, our bodies have the cell-mediated immune response, which includes T cells and memory B cells. “Vaccines induce much more than antibodies. T-cell immunity is a critical component of immunity that the press often ignores when reporting on vaccination studies,” Dr. Amesh Adalja, an infectious disease specialist and a senior scholar at the Johns Hopkins University Center for Health Security, told Healthline. T cells are crucial for long lasting immunity and protection against severe disease. All the major vaccine clinical trials looked at T-cell production and concluded that the shots produce a strong and durable T-cell response, according to Dr. Monica Gandhi, an infectious disease specialist with the University of California, San Francisco.
Scientists have yet to discover just how long protection from our T cells and memory B cells will last, but research on other viruses show they can, in certain cases, last for years. Scientists will continue observing people over time to understand how long protection against severe disease lasts.
Source de l'image : https://theconversation.com/covid-19-delta-variant-in-canada-faq-on-origins-hotspots-and-vaccine-protection-162653
28. COVID-19 Treatments: What’s In, What’s Out (Mar.17/21)
Below is a live list of currently authorized and/or validated therapies — noting the stage of disease for which they work best — as well as some others that didn’t pan out or are still under evaluation. To read more about each treatment method listed, follow the link below.
Treatments in Use:
- Remdesivir (Veklury)
- Dexamethasone
- Tocilizumab (Actemra)
- Baricitinib
- Anticoagulation
- Convalescent plasma
- Monoclonal Antibodies: bamlanivimab/etesevimab, casirivimab/imdevimab, and sotrovimab
- Budesonide (Pulmicort)
Failed or Debated Therapies:
- Hydroxychloroquine
- Ivermectin
- Vitamin C
- Vitamin D
- Zinc
- Protease Inhibitors
- Colchicine
- Fluvoxamine
29. Foire aux questions pour COVID-19
Qu'est-ce que le COVID-19 (ou nouvelle maladie à coronavirus-19)?
R : Les coronavirus sont une grande famille de virus qui peuvent provoquer des maladies chez les humains et les animaux. Les coronavirus peuvent provoquer des maladies dont la gravité va du simple rhume à des maladies plus graves telles que le syndrome respiratoire aigu sévère (SRAS) et, plus récemment, le COVID-19. Le COVID-19 ou nouveau coronavirus est né d'une épidémie à Wuhan, en Chine, en décembre 2019. Les symptômes les plus courants associés au COVID-19 peuvent comprendre de la fièvre, de la fatigue et une toux sèche. Mais d'autres symptômes ont été associés à la maladie, notamment des douleurs, une congestion nasale, un écoulement nasal, un mal de gorge, de la diarrhée, des éruptions cutanées et des vomissements. Il est également possible d'être infecté par le COVID-19 et de ne présenter aucun symptôme ou de se sentir malade. La propagation de COVID-19 se fait principalement par la transmission de gouttelettes provenant du nez ou de la bouche lorsqu'une personne tousse, expire ou éternue. Ces gouttelettes se posent sur les surfaces autour d'une personne proche. COVID-19 peut être transmis à cette personne proche qui peut finir par toucher la surface contaminée par COVID-19 et ensuite se toucher le nez, la bouche ou les yeux. Une personne peut également contracter COVID-19 en inhalant ces gouttelettes d'une personne atteinte de COVID-19. Bien que les recherches soient toujours en cours, il est important de noter que les populations plus âgées (plus de 65 ans), celles dont le système immunitaire est affaibli et celles qui souffrent d'affections préexistantes, notamment de maladies cardiaques, d'hypertension, de maladies pulmonaires, de diabète ou de cancer, peuvent être plus exposées à une maladie grave due à COVID-19.
https://www.who.int/news-room/q-a-detail/q-acoronaviruses)
Que puis-je faire pour éviter de contracter le coronavirus ?
R : Il y a plusieurs façons de réduire le risque de contracter le COVID-19. Voici quelques mesures suggérées par l'Organisation mondiale de la santé
- Gardez au moins 2 mètres (ou 6 pieds) entre vous et les autres personnes. Cela réduira le risque d'inhaler les gouttelettes des personnes infectées par COVID-19.
- Nettoyez-vous régulièrement les mains pendant au moins 20 secondes avec de l'eau chaude et du savon, ou avec un produit de nettoyage à base d'alcool. Cela permettra de tuer tous les virus présents sur vos mains.
- Évitez de vous toucher les yeux, le nez et la bouche. Si le virus se trouve sur vos mains, il peut pénétrer dans le corps par ces zones.
- Suivez une bonne hygiène respiratoire en vous couvrant la bouche et le nez avec un mouchoir en papier ou le coude lorsque vous toussez et éternuez. Cela empêche les gouttelettes de se déposer sur les surfaces ou d'être libérées dans l'air autour de vous.
- Restez chez vous autant que possible, surtout si vous ne vous sentez pas bien. Si vous pensez être atteint du coronavirus, veuillez consulter la section "Que dois-je faire si je pense être atteint du coronavirus ?
- Veuillez porter un masque ou un couvrevisage en public lorsque la distance physique n'est pas possible.
https://www.who.int/news-room/q-adetail/q-a-coronaviruses
Existe-t-il des traitements contre le coronavirus?
R : Les personnes atteintes d'un cancer sont plus exposées à une maladie grave en raison de la COVID-19, car le cancer est considéré comme un problème de santé préexistant. Certains traitements du cancer, notamment la chimiothérapie, la radiothérapie et la chirurgie, peuvent affaiblir le système immunitaire, ce qui rend l'organisme plus difficile à combattre les infections et les virus, comme le coronavirus. Il est important de suivre avec diligence les recommandations de l'Organisation mondiale de la santé ci-dessus pour réduire le risque de contracter le COVID-19. Si vous avez des inquiétudes quant à votre risque, il est préférable de contacter votre médecin ou votre équipe de soins.
Il n'existe actuellement aucun traitement disponible pour COVID-19, mais des essais sont en cours pour déterminer la meilleure façon de traiter et de gérer les personnes atteintes du virus. Les vaccins candidats sont soumis à des tests rigoureux dans un certain nombre de pays du monde, dont le Canada. Le gouvernement américain finance trois grands essais de phase 3 sur des vaccins potentiels COVID-19 et ces trois essais sont menés par trois sociétés pharmaceutiques différentes qui étudient différents candidats vaccins. L'espoir est de disposer d'un vaccin d'ici la fin de l'année !
Source: https://www.who.int/news-room/q-a-detail/q-acoronaviruses
Y a-t-il des précautions particulières que les personnes atteintes d'un cancer peuvent prendre ?
R : Les personnes atteintes de cancer (et d'autres maladies chroniques telles que les maladies cardiaques, le diabète, l'hypertension et les maladies pulmonaires) sont plus exposées à une maladie grave en raison de la COVID-19, le cancer étant considéré comme un problème de santé préexistant. Certains traitements contre le cancer, notamment la chimiothérapie, les radiations et la chirurgie, peuvent affaiblir le système immunitaire, ce qui rend l'organisme plus difficile à combattre les infections et les virus, comme le Coronavirus. Il est important de suivre avec diligence les recommandations de l'Organisation mondiale de la santé ci-dessus pour réduire le risque de contracter le COVID-19. Si vous avez des inquiétudes quant à votre risque, il est préférable de contacter votre médecin ou votre équipe de soins.
Y a-t-il des changements en ce qui concerne mes visites médicales liées au cancer ? Chaque patient et chaque plan de traitement étant uniques, il est toujours préférable de contacter votre prestataire de soins de santé pour obtenir des informations actualisées sur votre plan de traitement. Dans certains cas, il est possible de retarder le traitement du cancer jusqu'à ce que le risque de pandémie ait diminué. Dans d'autres cas, il peut être sûr de se rendre dans une clinique distincte de celle où sont traités les patients COVID-19. Les options de traitement oral pourraient être prescrites par votre prestataire de soins de manière virtuelle, sans qu'il soit nécessaire de se rendre à la clinique. Enfin, certains rendez-vous ou discussions de suivi pourraient être organisés virtuellement (via skype ou zoom par exemple) ou par téléphone pour minimiser votre risque. Comme nous le savons, les conditions et les protocoles changent quotidiennement en raison de la nature de l'épidémie de COVID-19 et varient en fonction du lieu, par conséquent, la meilleure première étape consiste à demander conseil à votre prestataire de soins.
https://www.cancer.gov/contact/emergencypreparedness/coronavirus
Si vous souhaitez contacter votre agence locale de santé publique, veuillez voir ci-dessous.
Alberta
Informations COVID-19 pour Alberta
Les médias sociaux : Instagram @albertahealthservices, Facebook @albertahealthservices, Twitter @GoAHealth
Numéro de téléphone : 811
Colombie-Britannique
Informations COVID-19 pour Colombie-Britannique
Les médias sociaux : Facebook @ImmunizeBC, Twitter @CDCofBC
Numéro de téléphone : 811
Manitoba
Informations COVID-19 pour Manitoba
Les médias sociaux : Facebook @manitobagovernment, Twitter @mbgov
Numéro de téléphone : 1-888-315-9257
Nouveau Brunswick
Informations COVID-19 pour Nouveau-Brunswick
Les médias sociaux : Facebook @GovNB, Twitter @Gov_NB, Instagram @gnbca
Numéro de téléphone : 811
Terre-Neuve et Labrador
Informations COVID-19 pour Terre-Neuve-et-Labrador
Les médias sociaux : Facebook @GovNL, Twitter @GovNL, Instagram @govnlsocial
Numéro de téléphone : 811 ou 1-888-709-2929
Territoires du Nord-Ouest
Informations COVID-19 pour Territoires du Nord-Ouest
Les médias sociaux : Facebook @NTHSSA
Numéro de téléphone : 811
Nouvelle-Écosse
Informations COVID-19 pour Nouvelle-Écosse
Les médias sociaux : Facebook @NovaScotiaHealthAuthority , Twitter @healthns, Instagram @novascotiahealthauthority
Numéro de téléphone : 811
Nunavut
Informations COVID-19 pour Nunavut
Les médias sociaux : Facebook @GovofNunavut , Twitter @GovofNunavut, Instagram @gouvernement du Nunavut
Numéro de téléphone : 1-888-975-8601
Ontario
Informations COVID-19 pour Ontario
Les médias sociaux : Facebook @ONThealth, Twitter @ONThealth , Instagram @ongov
Numéro de téléphone : 1-866-797-0000
Île-du-Prince-Édouard
Informations COVID-19 pour Île-du-Prince-Édouard
Les médias sociaux : Facebook @GovPe, Twitter @InfoPEI,
Québec
Informations COVID-19 pour Québec
Les médias sociaux : Facebook @GouvQc, Twitter @sante_qc
Numéro de téléphone : 1-877-644-4545
Saskatchewan
Informations COVID-19 pour Saskatchewan
Les médias sociaux : Facebook @SKGov, Twitter @SKGov
Numéro de téléphone : 811
Yukon
Informations COVID-19 pour Yukon
Les médias sociaux : Facebook @yukonhss, Twitter @hssyukon
Numéro de téléphone : 811
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