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Saturday, January 31, 2015

A Unique Subset of Epithelial Ovarian Cancers with Platinum Sensitivity and PARP Inhibitor Resistance


Platinum and PARP inhibitor (PARPi) sensitivity commonly coexist in epithelial ovarian cancer (EOC) due to the high prevalence of alterations in the homologous recombination (HR) DNA repair pathway that confer sensitivity to both drugs. In this report, we describe a unique subset of EOC with alterations in another DNA repair pathway, the nucleotide excision repair (NER) pathway, which may exhibit a discordance in sensitivities to these drugs. Specifically, 8% of high-grade serous EOC from The Cancer Genome Atlas dataset exhibited NER alterations, including nonsynonymous or splice site mutations and homozygous deletions of NER genes. Tumors with NER alterations were associated with improved overall survival (OS) and progression-free survival (PFS), compared with patients without NER alterations or BRCA1/2 mutations. Furthermore, patients with tumors with NER alterations had similar OS and PFS as BRCA1/2-mutated patients, suggesting that NER pathway inactivation in EOC conferred enhanced platinum sensitivity, similar to BRCA1/2-mutated tumors. Moreover, two NER mutations (ERCC6-Q524* and ERCC4-A583T), identified in the two most platinum-sensitive tumors, were functionally associated with platinum sensitivity in vitro. Importantly, neither NER alteration affected HR or conferred sensitivity to PARPi or other double-strand break-inducing agents. Overall, our findings reveal a new mechanism of platinum sensitivity in EOC that, unlike defective HR, may lead to a discordance in sensitivity to platinum and PARPi, with potential implications for previously reported and ongoing PARPi trials in this disease.

Cancer Res; 75(4); 1-7. ©2014 AACR.
©2014 American Association for Cancer Research

Gynecologic Cancer Imaging with MRI, FDG PET-CT and PET-MRI



MRI and FDG PET-CT play central and complementary roles in gynecologic cancer care. Because treatment often requires combinations of surgery, radio- and chemotherapy, imaging is central to triage and to determine prognosis. This article reviews the use of the two imaging modalities in the initial evaluation of the common cancers --- uterine cervical, uterine endometrial and epithelial ovarian cancers. Imaging features that impact on management and the relative strengths and weaknesses of the two modalities are highlighted. Use of imaging after initial therapy to assess for recurrence and to plan salvage therapy is described. Newer functional and molecular techniques in MRI and PET are evaluated. Finally, we describe our initial experience with PET-MRI, an emerging technology that may prove to be a mainstay in personalized gynecologic cancer care and adaptive therapy.

Copyright © 2015 by the Society of Nuclear Medicine and Molecular Imaging, Inc.

Friday, January 30, 2015

Coffee, tea, and caffeine consumption and risk of epithelial ovarian cancer and borderline ovarian tumors: Results from a Danish case-control study


Background. Epidemiological studies that have investigated the association between coffee, tea and caffeine consumption and ovarian cancer risk have produced conflicting results. Furthermore, only few studies have examined the role of coffee and tea consumption separately for borderline ovarian tumors...........

 Conclusions. Our results indicate that coffee consumption and total caffeine consumption from coffee and tea combined is associated with a modest decreased risk of ovarian cancer. However, more biological studies are needed to identify bioactive chemical compounds in coffee that potentially could affect ovarian cancer development.

Thursday, January 29, 2015

GINA, Genetic Discrimination, and Genomic Medicine — NEJM

open access

  ....As all medicine in a sense becomes genomic medicine, perhaps the genetic nondiscrimination secured by GINA will translate into nondiscrimination in all of medicine.

Venous Thromboembolism Prophylaxis and Treatment in Patients With Cancer: ASCO Clinical Practice Guideline Update 2014


To provide current recommendations about the prophylaxis and treatment of venous thromboembolism (VTE) in patients with cancer.
PubMed and the Cochrane Library were searched for randomized controlled trials, systematic reviews, meta-analyses, and clinical practice guidelines from November 2012 through July 2014. An update committee reviewed the identified abstracts.
Of the 53 publications identified and reviewed, none prompted a change in the
2013 recommendations.
Most hospitalized patients with active cancer require thromboprophylaxis throughout hospitalization. Routine thromboprophylaxis is not recommended for patients with cancer in the outpatient setting. It may be considered for selected high-risk patients. Patients with multiple myeloma receiving antiangiogenesis agents with chemotherapy and/or dexamethasone should receive prophylaxis with either low–molecular weight heparin (LMWH) or low-dose aspirin. Patients undergoing major surgery should receive prophylaxis starting before surgery and continuing for at
least 7 to 10 days. Extending prophylaxis up to 4 weeks should be considered in those undergoing major abdominal or pelvic surgery with high-risk features.
LMWH is recommended for the initial 5 to 10 days of treatment for deep vein thrombosis and pulmonary embolism as well as for long-term secondary prophylaxis (at least 6 months). Use of novel oral anticoagulants is not currently recommended for patients with malignancy and VTE because of limited data in patients with cancer. Anticoagulation should not be used to extend survival of patients with cancer in the
absence of other indications. Patients with cancer should be periodically assessed for VTE risk. Oncology professionals should educate patients about the signs and symptoms of VTE.

Symptomatic Toxicities Experienced During Anticancer Treatment: Agreement Between Patient & Physician Reporting in 3 Randomized Trials


Purpose Information about symptomatic toxicities of anticancer treatments is not based on direct report by patients, but rather on reports by clinicians in trials. Given the potential for under-reporting, our aim was to compare reporting by patients and physicians of six toxicities (anorexia, nausea, vomiting, constipation, diarrhea, and hair loss) within three randomized trials. 

Patients and Methods In one trial, elderly patients with breast cancer received adjuvant chemotherapy; in two trials, patients with advanced non–small-cell lung cancer received first-line treatment. Toxicity was prospectively collected by investigators (graded by National Cancer Institute Common Toxicity Criteria [version 2.0] or Common Terminology Criteria for Adverse Events [version 3]). At the end of each cycle, patients completed the European Organisation for Research and Treatment of Cancer quality-of-life questionnaires, including toxicity-related symptom items. Possible answers were “not at all,” “a little,” “quite a bit,” and “very much.” Analysis was limited to the first three cycles. For each toxicity, agreement between patients and physicians and under-reporting by physicians (ie, toxicity reported by patients but not reported by physicians) were calculated. 

Results Overall, 1,090 patients (2,482 cycles) were included. Agreement between patients and physicians was low for all toxicities. Toxicity rates reported by physicians were always lower than those reported by patients. For patients who reported toxicity (any severity), under-reporting by physicians ranged from 40.7% to 74.4%. Examining only patients who reported “very much” toxicity, under-reporting by physicians ranged from 13.0% to 50.0%. 

Conclusion Subjective toxicities are at high risk of under-reporting by physicians, even when prospectively collected within randomized trials. This strongly supports the incorporation of patient-reported outcomes into toxicity reporting in clinical trials.

Biomarker for PARP inhibitor responsiveness in ovarian cancer patients - video

video (2014)

 Prof Swisher talks to ecancertv at the 26th EORTC-NCI-AACR Symposium about data from a phase II trial, ARIEL2, which aims to identify patients with ovarian cancer likely to respond to rucaparib.

Population Distribution of Lifetime Risk of Ovarian Cancer in the United States


In U.S. women, lifetime risk of ovarian cancer is 1.37%, but some women are at a substantially lower or higher risk than this average.

We have characterized the distribution of lifetime risk in the general population.
Published data on the relative risks and their variances for five well-accepted risk and protective factors for ovarian cancer, oral contraceptive (OC) use, parity, tubal ligation, endometriosis and first degree family history of ovarian cancer in conjunction with a genetic risk score using genome-wide significant common, low penetrance variants were used. The joint distribution of these factors (i.e., risk/protective factor profiles) were derived using control data from four US population-based studies, providing a broad representation of women in the US.

Results: A total of 214 combinations of risk/protective factors were observed and the lifetime risk estimates ranged from 0.35% (95% CI 0.29-0.42) to 8.78% (95% CI 7.10-10.9). Among women with lifetime risk ranging from 4-9%, 73% had no family history of ovarian cancer; most of these women had a self-reported history of endometriosis.

Profiles including the known modifiable protective factors of OC use and tubal ligation were associated with a lower lifetime risk of ovarian cancer. OC use and tubal ligation were essentially absent among the women at 4-9% lifetime risk.

This work demonstrates that there are women in the general population who have a much higher than average lifetime risk of ovarian cancer. Preventive strategies are available. Should effective screening become available, higher than average risk women can be identified.

Epigenetic analysis of sporadic and Lynch-associated ovarian cancers reveals histology-specific patterns of DNA methylation

open access


Diagnosis and treatment of epithelial ovarian cancer is challenging due to the poor understanding of the pathogenesis of the disease. Our aim was to investigate epigenetic mechanisms in ovarian tumorigenesis and, especially, whether tumors with different histological subtypes or hereditary background (Lynch syndrome) exhibit differential susceptibility to epigenetic inactivation of growth regulatory genes. Gene candidates for epigenetic regulation were identified from the literature and by expression profiling of ovarian and endometrial cancer cell lines treated with demethylating agents. Thirteen genes were chosen for methylation-specific multiplex ligation-dependent probe amplification assays on 104 (85 sporadic and 19 Lynch syndrome-associated) ovarian carcinomas. Increased methylation (i.e., hypermethylation) of variable degree was characteristic of ovarian carcinomas relative to the corresponding normal tissues, and hypermethylation was consistently more prominent in non-serous than serous tumors for individual genes and gene sets investigated. Lynch syndrome-associated clear cell carcinomas showed the highest frequencies of hypermethylation. Among endometrioid ovarian carcinomas, lower levels of promoter methylation of RSK4, SPARC, and HOXA9 were significantly associated with higher tumor grade; thus, the methylation patterns showed a shift to the direction of high-grade serous tumors.
In conclusion, we provide evidence of a frequent epigenetic inactivation of RSK4, SPARC, PROM1, HOXA10, HOXA9, WT1-AS, SFRP2, SFRP5, OPCML, and MIR34B in the development of non-serous ovarian carcinomas of Lynch and sporadic origin, as compared to serous tumors. Our findings shed light on the role of epigenetic mechanisms in ovarian tumorigenesis and identify potential targets for translational applications.

Improving Care and Support for Unpaid Caregivers in Ontario - Citizen Brief

This Citizen Brief was produced by the McMaster Health Forum to serve as the basis for discussions by a citizen panel about improving care and support for unpaid caregivers in Ontario.

The need to identify how to improve care and support for unpaid caregivers has attracted a lot of attention from governments, media and the public, in part because of the increasing number of people who are acting as unpaid caregivers. In 2012, it was estimated that 8.1 million Canadians provided care to a family member or friend with a long-term health condition (most commonly cancer) or aging-related needs. In Ontario, about 20% of the population serve as a caregivers to family members and provide the majority of care needed.

Much of the burden of continuing care falls on unpaid caregivers. In 2012, it was estimated that 8.1 million Canadians provided care to a family member or friend with a long-term health condition or aging-related needs.

A citizen panel is an innovative way to seek public input on high-priority issues. Each panel brings together 10-14 citizens from all walks of life. Panel members share their ideas and experiences on an issue, and learn from research evidence and from the views of others. The discussions of a citizen panel can reveal new understandings about an issue and spark insights about how it should be addressed.

This brief includes information on this topic, including what is known about:
  • the underlying problem;
  • three possible options to address the problem; and
  • potential barriers and facilitators to implementing these options.
This brief does not contain recommendations, which would have required the authors to make judgments based on their personal values and preferences.

Technology and error-prevention strategies: Why are we still overlooking the IV room?

 open access

Variants of uncertain significance in BRCA : a harbinger of ethical and policy issues to come?

open access

2015 Ovarian Cancer National Conference –scholarships/agenda


 Here's our other can't-miss news about the National Conference:

  • We are now accepting scholarships to attend the National Conference. Our scholarship program allows patients and caregivers to learn about ovarian cancer and connect with others who share their experiences. A limited number of scholarships are available for travel, hotel and/or registration fees. Click here to apply for a 2015 scholarship. Please note: the last day to apply is Friday, April 3, 2015.

Have Insurers Found Way Around Obamacare 'Pre-Existing Conditions' Rule? (U.S.)


WEDNESDAY Jan. 28, 2015, 2015 -- Some insurance companies may be using high-dollar pharmacy co-pays to flout the Affordable Care Act's (ACA) mandate against discrimination on the basis of pre-existing health problems, Harvard researchers claim.
These insurers may have structured their drug coverage to discourage people with HIV from enrolling in their plans through the health insurance marketplaces created by the ACA, sometimes called "Obamacare," the researchers contend in the Jan. 29 issue of the New England Journal of Medicine......

'... It's important for consumers to know that if they find themselves in plans like this, they should be reporting it to their state insurance commissioner, the HHS Office of Civil Rights, and their health insurance marketplace," she said.
More information
For more on the Affordable Care Act, visit the U.S. Department of Health and Human Services.

Wednesday, January 28, 2015

Coexistent ARID1A-PIK3CA mutations promote ovarian clear-cell tumorigenesis through pro-tumorigenic inflammatory cytokine signalling


Ovarian clear-cell carcinoma (OCCC) is an aggressive form of ovarian cancer with high ARID1A mutation rates. Here we present a mutant mouse model of OCCC. We find that ARID1A inactivation is not sufficient for tumour formation, but requires concurrent activation of the phosphoinositide 3-kinase catalytic subunit, PIK3CA. Remarkably, the mice develop highly penetrant tumours with OCCC-like histopathology, culminating in haemorrhagic ascites and a median survival period of 7.5 weeks. Therapeutic treatment with the pan-PI3K inhibitor, BKM120, prolongs mouse survival by inhibiting the tumour cell growth. Cross-species gene expression comparisons support a role for IL-6 inflammatory cytokine signalling in OCCC pathogenesis. We further show that ARID1A and PIK3CA mutations cooperate to promote tumour growth through sustained IL-6 overproduction. Our findings establish an epistatic relationship between SWI/SNF chromatin remodelling and PI3K pathway mutations in OCCC and demonstrate that these pathways converge on pro-tumorigenic cytokine signalling. We propose that ARID1A protects against inflammation-driven tumorigenesis.

Tuesday, January 27, 2015

Myriad Genetics Ending Patent Dispute on Breast Cancer Risk Testing


Right patient, right drug, wrong dose? Cancer World

open access

Assessment of published models and prognostic variables in ovarian cancer at Mayo Clinic



Epithelial ovarian cancer (EOC) is an aggressive disease in which first line therapy consists of a surgical staging/debulking procedure and platinum based chemotherapy. There is significant interest in clinically applicable, easy to use prognostic tools to estimate risk of recurrence and overall survival. In this study we used a large prospectively collected cohort of women with EOC to validate currently published models and assess prognostic variables.


Women with invasive ovarian, peritoneal, or fallopian tube cancer diagnosed between 2000-2011 and prospectively enrolled into the Mayo Clinic Ovarian Cancer registry were identified. Demographics and known prognostic markers as well as epidemiologic exposure variables were abstracted from the medical record and collected via questionnaire. Six previously published models of overall and recurrence-free survival were assessed for external validity. In addition, predictors of outcome were assessed in our dataset.


Previously published models validated with a range of c-statistics (0.587-0.827), though application of models containing variables not part of routine practice were somewhat limited by missing data; utilization of all applicable models and comparison of results is suggested. Examination of prognostic variables identified only the presence of ascites and ASA score to be independent predictors of prognosis in our dataset, albeit with marginal gain in prognostic information, after accounting for stage and debulking.


Existing prognostic models for newly diagnosed EOC showed acceptable calibration in our cohort for clinical application. However, modeling of prospective variables in our dataset reiterates that stage and debulking remain the most important predictors of prognosis in this setting.

Borderline epithelial tumors of the ovary: Experience of 55 patients.


 The objective of the present study was to evaluate the clinicopathological features and the survival time estimates in patients treated for borderline ovarian tumors (BOTs). A retrospective review of all patients treated for BOTs at the University of Bari (Bari, Italy) between 1991 and 2011 was performed. Data were obtained from hospital records and gynecological oncology charts. A total of 55 patients were identified. The median age was 40 years (range, 13-79 years). The majority of the patients (85.5%) exhibited International Federation of Obstetrics and Gynecology (FIGO) stage I disease and the remainder exhibited FIGO stage II/III (7.3% in each stage). Serous histology was found in 60.0% of the cases and an elevation of the cancer antigen-125 serum level occurred in 23.6% of the cases. All patients underwent surgery and 3.7% received chemotherapy. In total, 10.9% exhibited recurrence and the median survival rate was 39 months. The median survival time and the five-year survival rate were 42 months (range, 16-84 months) and 97%, respectively. Therefore, BOTs have an excellent prognosis. Conservative surgery should be considered for patients of reproductive age who desire preservation of fertility. A long-term follow-up is highly recommended for these tumors.

Lower Limb Lymphedema and Neurological Complications After Lymphadenectomy for Gynecological Cancer


Is There a Role for Oral or Intravenous Ascorbate (Vitamin C) in Treating Patients With Cancer?

abstract plus free full text

Conclusion. There is no high-quality evidence to suggest that
ascorbate supplementation in cancer patients either enhances
the antitumor effects of chemotherapy or reduces its toxicity.
Given the high financial and time costs to patients of this
treatment, high-quality placebo-controlled trials are needed.

 This Article
  1. The Oncologist theoncologist.2014-0381

An international ecological study of adult height in relation to cancer incidence for 24 anatomical sites


Recalls, Market Withdrawals: J.J. Fuds, Inc. Issues Recall of Pet Food Because of Possible Health Risk

Recalls, Market Withdrawals

Monday, January 26, 2015

Causes of Diagnosis Errors & Prevention - CRICO risk Management

Blogger's Note: includes surgery and (selected) cancers; infographs


Causes of Diagnosis Errors & Prevention

CRICO Strategies, a division of the Risk Management Foundation of the Harvard Medical Foundation, just released the 2014 Annual Benchmarking Reporting: Malpractice Risks in the Diagnosis Process. This report analyzes more than 8,400 factors from 2,685 ambulatory diagnosis-related malpractice cases. The analysis helps to identify where and when diagnosis-related errors most commonly occur and what changes are needed to prevent them. This 20-page report is available on the CRICO Strategies website.

Malnutrition at Hospital Admission—Contributors and Effect on Length of Stay (Canada)


In hospitals, length of stay (LOS) is a priority but it may be prolonged by malnutrition. This study seeks to determine the contributors to malnutrition at admission and evaluate its effect on LOS.  

Materials and Methods:
This is a prospective cohort study conducted in 18 Canadian hospitals from July 2010 to February 2013 in patients ≥ 18 years admitted for ≥ 2 days. Excluded were those admitted directly to the intensive care unit; obstetric, psychiatry, or palliative wards; or medical day units. At admission, the main nutrition evaluation was subjective global assessment (SGA). Body mass index (BMI) and handgrip strength (HGS) were also performed to assess other aspects of nutrition. Additional information was collected from patients and charts review during hospitalization.  

One thousand fifteen patients were enrolled: based on SGA, 45% (95% confidence interval [CI], 42%–48%) were malnourished, and based on BMI, 32% (95% CI, 29%–35%) were obese. Independent contributors to malnutrition at admission were Charlson comorbidity index > 2, having 3 diagnostic categories, relying on adult children for grocery shopping, and living alone. The median (range) LOS was 6 (1–117) days. After controlling for demographic, socioeconomic, and disease-related factors and treatment, malnutrition at admission was independently associated with prolonged LOS (hazard ratio, 0.73; 95% CI, 0.62–0.86). Other nutrition-related factors associated with prolonged LOS were lower HGS at admission, receiving nutrition support, and food intake < 50%. Obesity was not a predictor.  

Conclusion: Malnutrition at admission is prevalent and associated with prolonged LOS. Complex disease and age-related social factors are contributors.

Will Cancer Society's Redo Be Its Undoing? (U.S.)

Medpage Today

"... "When I joined the Board funding for external research grants was 22% and when I left it was down to 10%,"...

Sunday, January 25, 2015


open access(pdf)

 .....We suggest that, in patients with history of ovarian cancer who present with axillary or breast mass, every effort should be made to have an accurate histological diagnosis since this has a great impact on treatment. It is critical to recognize histologic pattern and distinguish it from de novo ductal carcinoma in situ. Immunohistochemistry is essential when the diagnosis is still vague.

Cytologic features of ovarian granulosa cell tumors in pleural and ascitic fluids


Adult granulosa cell tumor (AGCT) is an uncommon neoplasm of the ovary with potential for aggressive behavior and late recurrence. The most important prognostic factor for AGCT is tumor stage. Thus, cytological assessment of pleural or ascitic fluids is crucial for initial staging and subsequent patient management. We report herein two cases of ovarian AGCT presenting with exfoliated tumor cells in pleural and ascitic fluid. The first case involved a 61-year-old woman who presented with stage Ic (a) AGCT. Seven years after initial diagnosis, pleural effusion and pleural dissemination were identified. The second case involved a 50-year-old woman who presented with stage IV AGCT with massive ascites and right pleural effusion. Fluid cytology from both cases showed cohesive or loose clusters of small uniform neoplastic cells with round-to-oval nuclei, coffee-bean-shaped nuclear grooves, small nucleoli, and scant cytoplasm. Call-Exner bodies were also observed in these cytologic specimens. In the differential diagnosis of small monomorphic tumor cells in pleural effusion or ascites, coffee-bean-shaped nuclear grooves and cell clusters forming Call-Exner bodies are diagnostic clues of AGCT. 

Saturday, January 24, 2015

Relationship Between Surgical Oncologic Outcomes and Publically Reported Hospital Quality and Satisfaction Measures

abstract / editorial


 Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons

Background: Hospital-level measures of patient satisfaction and quality are now reported publically by the Centers for Medicare and Medicaid Services. There are limited metrics specific to cancer patients. We examined whether publically reported hospital satisfaction and quality data were associated with surgical oncologic outcomes

Methods: The Nationwide Inpatient Sample was utilized to identify patients with solid tumors who underwent surgical resection in 2009 and 2010. The hospitals were linked to Hospital Compare, which collects data on patient satisfaction, perioperative quality, and 30-day mortality for medical conditions (pneumonia, myocardial infarction [MI], and congestive heart failure [CHF]). The risk-adjusted hospital-level rates of morbidity and mortality were calculated for each hospital and the means compared between the highest and lowest performing hospital quartiles and reported as absolute reduction in risk (ARR), the difference in risk of the outcome between the two groups. All statistical tests were two-sided. 

Results: A total of 63197 patients treated at 448 hospitals were identified. For patients at high vs low performing hospitals based on Hospital Consumer Assessment of Healthcare Providers and Systems scores, the ARR in perioperative morbidity was 3.1% (blogger note: see abstract for stats -abbreviated for easy reading). Similarly, the ARR for mortality based on the same measure was -0.4% . High performance on perioperative quality measures resulted in an ARR of 0% to 2.2% for perioperative morbidity . Similarly, there was no statistically significant association between hospital-level mortality rates for MI , heart failure  or pneumonia  and complications for oncologic surgery patients. 

Conclusion: Currently available measures of patient satisfaction and quality are poor predictors of outcomes for cancer patients undergoing surgery. Specific metrics for long-term oncologic outcomes and quality are needed.

Correspondence: Are we ready for conservative treatment in ovarian cancer?

Correspondence: open access

In conclusion, we think we are ready for fertility-sparing surgery in early epithelial ovarian cancer as an effective alternative to conventional radical surgery in younger women but just for selected cases where recurrence rate is very low such as FIGO stage IA/IB-G1/G2, and we need to be very careful with stages IC and G3 individualizing every case.

Original article: open access

Genetic polymorphisms and gene-dosage effect in ovarian cancer risk and response to paclitaxel/cisplatin chemotherapy (Poland)

open access


[brain tumors] Glioblastomas, astrocytomas and oligodendrogliomas linked to Lynch syndrome


 Glioblastomas, astrocytomas and oligodendrogliomas linked to Lynch syndrome

Background and purpose

Brain tumors represent a rare and relatively uncharacterized tumor type in Lynch syndrome.


The national Danish Hereditary Nonpolyposis Colorectal Cancer Register was utilized to estimate the cumulative life-time risk for brain tumors in Lynch syndrome, and the mismatch repair (MMR) status in all tumors available was evaluated.


Primary brain tumors developed in 41/288 families at a median age of 41.5 (range 2–73) years. Biallelic MMR gene mutations were linked to brain tumor development in childhood. The risk of brain tumors was significantly higher (2.5%) in MSH2 gene mutation carriers compared to patients with mutations in MLH1 or MSH6. Glioblastomas predominated (56%), followed by astrocytomas (22%) and oligodendrogliomas (9%). MMR status was assessed in 10 tumors, eight of which showed MMR defects. None of these tumors showed immunohistochemical staining suggestive of the IDH1 R132H mutation.


In Lynch syndrome brain tumors occurred in 14% of the families with significantly higher risks for individuals with MSH2 gene mutations and development of childhood brain tumors in individuals with constitutional MMR defects.

Reporting and Grading Financial Toxicity (the Art of Oncology series)

open access

Proposed Financial Toxicity Grading Criteria
Grade Description
1 Lifestyle modification (deferral of large purchases or reduced spending on vacation and leisure activities) because of medical expenditure

Use of charity grants/fundraising/copayment program mechanisms to meet costs of care
2 Temporary loss of employment resulting from medical treatment

Need to sell stocks/investments for medical expenditure

Use of savings accounts, disability income, or retirement funds for medical expenditure
3 Need to mortgage/refinance home to pay medical bills

Permanent loss of job as a result of medical treatment

Current debts > household income

Inability to pay for necessities such as food or utilities
4 Need to sell home to pay for medical bills

Declaration of bankruptcy because of medical treatment

Need to stop treatment because of financial burden

Consideration of suicide because of financial burden of care

What We Really Talk About When We Talk About Food (the Art of Oncology series)

maple syrup

Genetic cancer ovary - (review) Clinical Ovarian & Other Gynecologic Cancer

open access

 Article Outline

Exceptions to the Rule: Case Studies in the Prediction of Pathogenicity for Genetic Variants in Hereditary Cancer Genes


 Based on current consensus guidelines and standard practice, many genetic variants detected in clinical testing are classified as disease-causing based on their predicted impact on the normal expression or function of the gene in the absence of additional data. However, our laboratory has identified a subset of such variants in hereditary cancer genes for which compelling contradictory evidence emerged after the initial evaluation following the first observation of the variant. Three representative examples of variants in BRCA1, BRCA2 and MSH2 that are predicted to disrupt splicing, prematurely truncate the protein, or remove the start codon were evaluated for pathogenicity by analyzing clinical data with multiple classification algorithms. Available clinical data for all 3 variants contradicts the expected pathogenic classification. These variants illustrate potential pitfalls associated with standard approaches to variant classification as well as the challenges associated with monitoring data, updating classifications, and reporting potentially contradictory interpretations to the clinicians responsible for translating test outcomes to appropriate clinical action. It is important to address these challenges now as the model for clinical testing moves towards the use of large multi-gene panels and whole exome/genome analysis, which will dramatically increase the number of genetic variants identified.

Usefulness of Diagnostic Indices Comprising Clinical, Sonographic, and Biomarker Data for Discriminating Benign From Malignant Ovarian Masses


The objective of this study was to review the accuracy of indices combining several diagnostic variables, in comparison to other models, sonography alone, and biomarker assays, for predicting benign or malignant ovarian lesions. Different single modalities were reviewed. The most useful complex models were International Ovarian Tumor Analysis (IOTA) sonographic logistic regression model 2 (area under the curve, 0.949), risk of malignancy index-cancer antigen 125-human epididymis protein 4 (0.950), risk of malignancy algorithm (0.953), pelvic mass score (0.960), non-IOTA logistic regression model (0.970), and histoscanning score logistic regression model (0.970). None of the indices was superior to an expert subjective sonographic assessment (0.968). For women with adnexal tumors, indices with high accuracy are available that are applicable in clinical practice and comparable to an expert subjective sonographic assessment for discriminating benign from malignant masses.

Pazopanib and Liposomal Doxorubicin in the Treatment of Patients with Relapsed/Refractory Epithelial Ovarian Cancer: A Phase Ib Study of the Sarah Cannon Research Institute


Purpose: To investigate the combination of liposomal doxorubicin/pazopanib in advanced relapsed/refractory ovarian cancer.

Patients and Methods: Twenty-two patients received liposomal doxorubicin/pazopanib. Initial doses (liposomal doxorubicin, 40 mg/m2 monthly; pazopanib, 400 mg daily) were too toxic; three subsequent groups received lower doses/altered schedules.

Results: The maximum tolerated doses (MTD) were liposomal doxorubicin, 30 mg/m2, and pazopanib, 400 mg daily. Severe toxicity included neutropenia (18%), rash/desquamation (14%), hypertension (9%), and hand-foot syndrome (9%). Five of the eight patients treated with MTD had grade 3 toxicity during the first two cycles. Dose reductions were frequently required.

Conclusions: Further development of the liposomal doxorubicin/pazopanib combination is not recommended.

Friday, January 23, 2015

Rare Cancers Europe (RCE) methodological recommendations for clinical studies in rare cancers: a European consensus position paper

open access

International Profiles of Health Care Systems, 2014: Australia, Canada, Denmark, England, France, Germany, Italy, Japan, The Netherlands, New Zealand, Norway, Singapore, Sweden, Switzerland, and the US

The Commonwealth Fund


This publication presents overviews of the health care systems of Australia, Canada, Denmark, England, France, Germany, Italy, Japan, the Netherlands, New Zealand, Norway, Singapore, Sweden, Switzerland, and the United States. Each overview covers health insurance, public and private financing, health system organization and governance, health care quality and coordination, disparities, efficiency and integration, use of information technology and evidence-based practice, cost containment, and recent reforms and innovations. In addition, summary tables provide data on a number of key health system characteristics and performance indicators, including overall health care spending, hospital spending and utilization, health care access, patient safety, care coordination, chronic care management, disease prevention, capacity for quality improvement, and public views. Read the report.

video: Future of cancer treatment at the World Economic Forum

video CBS news

 |CBS News medical contributor Dr. David Agus speaks with Dr. Jose Baselga, physician-in-chief and chief medical officer of Memorial Sloan Kettering Cancer Center, about the future of cancer treatment and genome mapping.

ASCO launches big data effort to study cancer


The American Society of Clinical Oncology is teaming up with SAP on an big data initiative that will use EHRs to examine previously inaccessible information that may lead to early identification on potential cancer patients.....

Unexpected Gynecologic Malignancy Diagnosed After Hysterectomy Performed for Benign Indications


OBJECTIVE: To define the incidence of unexpected gynecologic malignancies among women who underwent hysterectomy for benign indications.

METHODS: We conducted a data analysis of hysterectomy cases from a quality and safety database maintained by the Michigan Surgical Quality Collaborative, a statewide group of hospitals that voluntarily reports perioperative outcomes. Cases were abstracted from January 1, 2013, through December 8, 2013. Benign preoperative surgical indications included pelvic mass, family history of cancer, hyperplasia without atypia, prolapse, endometriosis, pelvic pain, abnormal uterine bleeding, or leiomyomas. Women with a surgical indication of cancer, cervical dysplasia, or hyperplasia with atypia were excluded.

Costs and Benefits of Opportunistic Salpingectomy as an Ovarian Cancer Prevention Strategy

abstract/full text

OBJECTIVE: To conduct a cost-effectiveness analysis of opportunistic salpingectomy (elective salpingectomy at hysterectomy or instead of tubal ligation).

METHODS: A Markov Monte Carlo simulation model estimated the costs and benefits of opportunistic salpingectomy in a hypothetical cohort of women undergoing hysterectomy for benign gynecologic conditions or surgical sterilization. The primary outcome measure was the incremental cost-effectiveness ratio. Effectiveness was measured in terms of life expectancy gain. Sensitivity analyses accounted for uncertainty around various parameters. Monte Carlo simulation estimated the number of ovarian cancer cases associated with each strategy in the Canadian population.

RESULTS: Salpingectomy with hysterectomy was less costly ($11,044.32±$1.56) than hysterectomy alone ($11,206.52±$29.81) or with bilateral salpingo-oophorectomy ($12,626.84±$13.11) but more effective at 21.12±0.02 years compared with 21.10±0.03 and 20.94±0.03 years, representing average gains of 1 week and 2 months, respectively. For surgical sterilization, salpingectomy was more costly ($9,719.52±$3.74) than tubal ligation ($9,339.48±$26.74) but more effective at 22.45±0.02 years compared with 22.43±0.02 years (average gain of 1 week) with an incremental cost-effectiveness ratio of $27,278 per year of life gained. Our results were stable over a wide range of costs and risk estimates. Monte Carlo simulation predicted that salpingectomy would reduce ovarian cancer risk by 38.1% (95% confidence interval [CI] 36.5–41.3%) and 29.2% (95% CI 28.0–31.4%) compared with hysterectomy alone or tubal ligation, respectively.

CONCLUSION: Salpingectomy with hysterectomy for benign conditions will reduce ovarian cancer risk at acceptable cost and is a cost-effective alternative to tubal ligation for sterilization. Opportunistic salpingectomy should be considered for all women undergoing these surgical procedures.

 Over the past decade, there is increasing evidence that the majority of ovarian cancers arise in the fallopian tube and not primarily in the ovary.1–4 Consequently, in 2010 the British Columbia Ovarian Cancer Research Group

Dying with Dignity | It's your life. It's your choice. - Take action (Ontario)

Dying with Dignity 


Toolkit for Submissions on CPSO's Draft Policy on End-of-Life Care

Looking to provide feedback on the College of Physicians and Surgeons of Ontario's draft policy of end-of-life care? We've put together a toolkit to help you craft a forceful appeal.
As we've said, the CPSO has made it easy to provide feedback on its proposed end-of-life care policies. You can submit your thoughts in the following ways:
  • By posting to the CPSO's end-of-life care discussion forum;
  • By firing off an e-mail to ;
  • By filling out a quick and easy online survey (there are text boxes in which you can elaborate on your responses);
  • By sending a letter through the mail. (To: College of Physicians and Surgeons of Ontario, 80 College St., Toronto, Ont., M5G 2E2)
Just remember: the deadline to submit is February 20, so don't delay!

Toolkit for written submissions to the College of Physicians and Surgeons of Ontario

1) Read the CPSO’s draft policy, “Planning for and Providing Quality of End-of-Life Care.” It’s not long — only 15-pages, and the font is large. Knowing what’s in the document will help you respond to, and expand upon, the organization’s new policies.
2) Include a forceful opening statement. In clear, concise language, tell committee members why the CPSO needs to play a strong role in developing a legal and regulatory framework for assisted dying in Ontario. This can take the form of a short introductory paragraph or a list of bullet points.
3) Stress the importance of timing. With the Supreme Court set to weigh in on the future of the Criminal Code ban on assisted dying, and with end-of-life bills on the table in Parliament, Canadian doctors face the very real possibility that the practice could become legal this year.
4) Bring up Quebec. Physicians were instrumental in the crafting of Bill 52, an end-of-life care bill that passed through Quebec’s National Assembly last year. Set to come into force at the end of 2015, the law ensconces palliative care as a right and grants Quebecers the option to choose medically assisted dying so long as they fulfill certain criteria.
4) Use personal experience. If possible, include a personal anecdote to illustrate why it’s important for the CPSO to take a stand. Have you encountered physicians who were ill-equipped or simply unwilling to discuss a wide range of end-of-life care options, including assisted dying, with you or members of your family? Are you worried that the orders you’ve made in your Advance Care Plan won’t be respected? It is our experience personal stories carry a lot of weight in consultations like these.
5) Include your professional qualifications/background, if appropriate. Do you have a background in the healthcare profession? If so, note it. In addition, state how your work has shaped your perspective on end-of-life care. If you don’t work in health field, feel free to state your professional background affects your point of view, too. The CPSO is asking for the input from people from all walks of life — not just medical practitioners

Salpingectomy as a Means to Reduce Ovarian Cancer Risk

PDF] Salpingectomy as a Means to Reduce Ovarian Cancer Risk

Cancer Prevention 2015

Bilateral salpingo-oophorectomy (BSO) has become the standard of care for risk
reduction in women at hereditary risk of ovarian cancer. While this procedure significantly
decreases both the incidence of and mortality from ovarian cancer, it impacts quality of life, and the premature cessation of ovarian function may have long term health hazards. Recent advances in our understanding of the molecular pathways of ovarian cancer point to the fallopian tube epithelium as the origin of most high grade serous cancers (HGSC). This evolving appreciation of the role of the fallopian tube in HGSC has led to the consideration of salpingectomy alone as an option for risk management, especially in premenopausal women. In addition, it is postulated that bilateral salpingectomy with ovarian retention (BSOR), may have a public health benefit for women undergoing benign gynecologic surgery. In this review we provide the rationale for salpingectomy as an ovarian cancer risk reduction strategy.

A Systematic Review of the Bimanual Examination as a Test for Ovarian Cancer



An annual bimanual pelvic examination remains widely recommended for healthy women, but its inclusion may discourage attendance. Our goal was to determine the accuracy of the pelvic examination as a screening test for ovarian cancer and to distinguish benign from malignant lesions.

Evidence acquisition

PubMed was searched to identify studies evaluating the accuracy of the bimanual pelvic examination for ovarian cancer diagnosis. Data regarding study design, study quality, and test accuracy were abstracted. Heterogeneity was evaluated and meta-analysis performed where appropriate, including bivariate receiver operating characteristic curves.

Evidence synthesis

Eight studies in screening populations (n=36,599) and seven studies in symptomatic patients (n=782) were identified. Search was completed in November 2013; included studies were published between 1988 and 2009. Screening studies were homogeneous; the summary estimates of sensitivity and specificity of the pelvic examination as a screening test for ovarian cancer were 0.44 and 0.98 (positive likelihood ratio, 24.7; negative likelihood ratio, 0.57). For distinguishing benign versus malignant lesions, there was considerable heterogeneity, with a range of sensitivity from 0.43 to 0.93 and specificity from 0.53 to 0.91.


The bimanual pelvic examination lacks accuracy as a screening test for ovarian cancer and as a way to distinguish benign from malignant lesions. In a typical screening population, the positive predictive value of an abnormal pelvic examination is only 1% (95% CI=0.67%, 3.0%). Its inclusion in a health maintenance examination cannot be justified on the basis of using it to screen for ovarian cancer.

Bilateral ovarian metastases from ureteric urothelial cancer: Initial case report and distinguishing role of immunohistochemistry

 Blogger's Note: of interest to Lynch Syndrome patients

Full Text: PDF


Urothelial cancers of the upper tract are aggressive malignancies with a propensity for distant metastases. Transitional cell carcinoma can also develop de novo in the ovaries and differentiation between these lesions requires immunohistochemistry. We report a case of right lower ureteric urothelial carcinoma with metastases to both ovaries. To our knowledge, this is the first reported case of bilateral ovarian metastases from an upper tract primary, diagnosed with immunohistochemistry.
"... CK20 expression is specific for urinary tract origin.5 In our
case, the ovarian lesions were positive for CK7 and CK20,
and negative for WT1, indicating the primary was in the
urinary tract. Differentiation is important as ovarian primaries
are more chemosensitive and have a better prognosis.5"

Paradoxes of follow-up – health professionals’ views on follow-up after surgical treatment in gynecological cancer care

 Blogger's Note: "shift in focus is needed from relapse to quality of life after cancer"
In absence of the full text, a case could be made for prevention and/or early detection of second primary cancers. Myriad Genetics recently published stats on Lynch Syndrome patients of which 50% will face a second primary within 15 years of original diagnosis. 


Objective. Evidence now reveals that attending a follow-up program may not improve survival for low-stage gynecological cancer patients. The aim of this study was to explore health professionals’ experiences with the follow-up programs and their views on follow-up in the future.
Methods. A qualitative approach was undertaken with semi-structured focus group interviews. Three focus group interviews were conducted at neutral ground. One group with onco-gynecologists, one group with specialist nurses, and one mixed group. The main themes of the interviewguide were: Existing follow-up program, life after cancer and future follow-up. The interviews were transcribed verbatim. Patterns and themes were uncovered from the data inspired by interpretive description.
Results. The doctors described most advantages, such as: Quality control of their own work, detection of sequelae after surgery, and credit and appraisal from the patients. A disadvantage was the inadequate use of the nurses’ main competencies. Some dilemmas were described by the nurses as well as doctors: First, both groups were aware of the existing evidence that attendance of follow-up programs may not improve survival and yet, health professionals still performed the follow-ups and most often did not address this paradox for the patients. Second, the existing follow-up program seemed to bring the patients comfort and security on one hand, but on the other hand it seemed to induce insecurity and anxiety. The health professionals agreed that future follow-up should be individualized with focus on the single patients’ needs and psychological wellbeing. The health professionals identified a great challenge in communicating the evidence and the forthcoming changes in the follow-up programs to the patients.
Conclusions. This study revealed that the existing follow-up regime contains several dilemmas. According to the health professionals, future follow-up must be more individualized, and a shift in focus is needed from relapse to quality of life after cancer.

Thursday, January 22, 2015

Editorial: Cancer: mixed messages, common purpose (Lancet)


full text

On Jan 2, a research paper published in Science by Cristian Tomasetti and Bert Vogelstein proclaimed that most individual cancers, 65%, could be attributed to “bad luck”—random events such as errors in DNA replication—rather than to environmental or inherited risk factors. This eyecatching message has drawn comment, partly because of the inbuilt uncertainty in the study's methods and headline estimate (with its 95% confidence interval of 39–81) and partly because of the conclusion's incompatibility with public health evidence and thinking......

AllTrials – America’s Institute of Medicine says sharing data from clinical trials should “become the norm”


Breast Cancer Patients Referred for Genetic Testing Likely to Have Mutations Other Than BRCA1/2


Results revealed that 1608 (9.5%) of females and 32 (16.2%) of males were positive for at least one deleterious or suspected deleterious mutation. Interestingly, among these mutations:
  • 48.9% were detected in the Hereditary Breast and Ovarian Cancer (HBOC) genes BRCA1 and BRCA2.
  • 42.1% were detected in other genes associated with breast cancer.
  • 6.6% were detected in Lynch syndrome genes (MLH1, MSH2, MSH6, PMS2, EPCAM).
  • 2.3% were detected in other genes not associated with breast cancer (APC, MUTYH, RAD51D, CDKN2A, SMAD4).
- See more at: http://www.targetedonc.com/conference/sabcs-2014/Breast-Cancer-Patients-Referred-for-Genetic-Testing-Likely-to-Have-Mutations-Other-Than-BRCA12#sthash.qnb07U8O.dpuf
Results revealed that 1608 (9.5%) of females and 32 (16.2%) of males were positive for at least one deleterious or suspected deleterious mutation. Interestingly, among these mutations:
  • 48.9% were detected in the Hereditary Breast and Ovarian Cancer (HBOC) genes BRCA1 and BRCA2.
  • 42.1% were detected in other genes associated with breast cancer.
  • 6.6% were detected in Lynch syndrome genes (MLH1, MSH2, MSH6, PMS2, EPCAM).
  • 2.3% were detected in other genes not associated with breast cancer (APC, MUTYH, RAD51D, CDKN2A, SMAD4).
- See more at: http://www.targetedonc.com/conference/sabcs-2014/Breast-Cancer-Patients-Referred-for-Genetic-Testing-Likely-to-Have-Mutations-Other-Than-BRCA12#sthash.qnb07U8O.dpuf

Aprea granted European orphan drug designation for APR-246 in ovarian cancer (p53)


Cancer mortality trends in Mexico, 1980-2011


 Objective. To evaluate trends in cancer mortality in Mexico between 1980-2011.

Material and methods. Through direct method and using World Population 2010 as standard population, mortality rates for all cancers and the 15 most frequent locations, adjusted for age and sex were calculated. Trends in mortality rates and annual percentage change for each type of cancer were estimated by joinpoint regression model.

Results. As a result of the reduction in mortality from lung cancer (-3.2% -1.8% in men and in women), stomach (-2.1% -2.4% in men and in women) and cervix (-4.7%); since 2004 a significant (~1% per year) decline was observed in cancer mortality in general, in all ages, and in the group of 35-64 years of both sexes. Other cancers such as breast and ovarian cancer in women; as well as for prostate cancer in men, showed a steady increase.

Conclusions. Some of the reductions in cancer mortality may be partially attributed to the effectiveness of prevention programs. However, adequate records of population-based cancer are needed to assess the real impact of these programs; as well as designing and evaluating innovative interventions to develop more cost-effective prevention policies.

Wednesday, January 21, 2015

Environmental (nongenetic) factors in gynecological cancers: update and future perspectives


 Globally, gynecological cancers comprise three of the seven most common female cancers and are responsible for more than 1,000,000 new cases and 500,000 deaths annually. This review summarizes current knowledge regarding the role of environmental factors in gynecological cancer etiology and survival, focusing on those that are potentially amenable to intervention. Strong associations with use of exogenous hormones are countered by opposing risks of breast cancer, thus current hormonal preparations are not an option for prevention. Weight control would reduce risk of endometrial cancer but this and other lifestyle modifications are unlikely to have a major effect on gynecological cancer mortality rates. There is little information regarding the potential for lifestyle changes to improve outcomes for women with gynecological cancer.

Study of rare ovarian cancer featured in ASCO 'Cancer Advances' annual report (Small cell carcinoma ovary)

medical news

Ovarian stimulation and in-vitro fertilization outcomes of cancer patients



Most IVF outcomes appear comparable for cancer patients and age-matched controls. Higher twin pregnancy rates in cancer patients may reflect lack of underlying infertility or need for cancer-specific transfer guidelines.

A Systematic Review of the Bimanual Examination as a Test for Ovarian Cancer


Population-Based Lynch Syndrome Screening by Microsatellite Instability in Patients ≤50 (Louisiana, U.S.)


Population-Based Lynch Syndrome Screening by Microsatellite Instability in Patients ≤50: Prevalence, Testing Determinants, and Result Availability Prior to Colon Surgery.


As there are no US population-based studies examining Lynch syndrome (LS) screening frequency by microsatellite instability (MSI) and immunohistochemistry (IHC), we seek to quantitate statewide rates in patients aged ≤50 years using data from a Centers for Disease Control and Prevention-funded Comparative Effectiveness Research (CER) project and identify factors associated with testing. Screening rates in this young, high-risk population may provide a best-case scenario as older patients, potentially deemed lower risk, may undergo testing less frequently. We also seek to determine how frequently MSI/IHC results are available preoperatively, as this may assist with decisions regarding colonic resection extent.


Data from all Louisiana colorectal cancer (CRC) patients aged ≤50 years diagnosed in 2011 were obtained from the Louisiana Tumor Registry CER project. Registry researchers and physicians analyzed data, including pathology and MSI/IHC.


Of the 2,427 statewide all-age CRC patients, there were 274 patients aged ≤50 years, representing health care at 61 distinct facilities. MSI and/or IHC were performed in 23.0% of patients. Testing-associated factors included CRC family history (P<0.0045), urban location (P<0.0370), and care at comprehensive cancer centers (P<0.0020) but not synchronous/metachronous CRC or MSI-like histology. Public hospital screening was disproportionately low (P<0.0217). Of those tested, MSI and/or IHC was abnormal in 21.7%. Of those with abnormal IHC, staining patterns were consistent with LS in 87.5%. MSI/IHC results were available preoperatively in 16.9% of cases.


Despite frequently abnormal MSI/IHC results, LS screening in young, high-risk patients is low. Provider education and disparities in access to specialized services, particularly in underserved populations, are possible contributors. MSI/IHC results are infrequently available preoperatively

New Clinical Advisory Panel launched to answer your questions | Target Ovarian Cancer


Management of ovarian and endometrial cancers in women belonging to HNPCC carrier families: review of the literature and results of cancer risk assessment in Polish HNPCC families

open access

Randomized trial of oral cyclophosphamide and veliparib in high-grade serous ovarian, primary peritoneal, or fallopian tube cancers, or BRCA-mutant ovarian cancer


 Purpose: Veliparib, a poly(ADP-ribose) polymerase (PARP) inhibitor, demonstrated clinical activity in combination with oral cyclophosphamide in patients with BRCA-mutant solid tumors in a phase 1 trial. To define the relative contribution of PARP inhibition to the observed clinical activity, we conducted a randomized phase 2 trial to determine the response rate of veliparib in combination with cyclophosphamide compared to cyclophosphamide alone in patients with pretreated BRCA-mutant ovarian cancer or in patients with pretreated primary peritoneal, fallopian tube, or high-grade serous ovarian cancers (HGSOC).

Experimental Design: Adult patients were randomized to receive cyclophosphamide alone (50 mg orally once daily) or with veliparib (60 mg orally once daily) in 21-day cycles. Crossover to the combination was allowed at disease progression.

Results: Seventy-five patients were enrolled and 72 were evaluable for response; 38 received cyclophosphamide alone and 37 the combination as their initial treatment regimen. Treatment was well tolerated. One complete response was observed in each arm, with three partial responses (PR) in the combination arm and six PRs in the cyclophosphamide alone arm. Genetic sequence and expression analyses were performed for 211 genes involved in DNA repair; none of the detected genetic alterations were significantly associated with treatment benefit.

Conclusions: This is the first trial that evaluated single agent, low dose cyclophosphamide in HGSOC, peritoneal, fallopian tube, and BRCA-mutant ovarian cancers. It was well tolerated and clinical activity was observed; the addition of veliparib at 60 mg daily did not improve either the response rate or the median progression free survival.

Stopping ovarian cancer screening in BRCA1/2 mutation carriers: Netherlands


Stopping ovarian cancer screening in BRCA1/2 mutation carriers: Effects on risk management decisions & outcome of risk-reducing salpingo-oophorectomy specimens

Impact of investigations in general practice on timeliness of referral for patients subsequently diagnosed with cancer: UK

open access

 "....We analysed data on patients with lung (1494), colorectal (2111), stomach (246), oesophagus (513), pancreas (327), and ovarian (345) cancer. These six cancer sites were selected because they each have a range of presenting symptoms from high to low risk, and because for each there is one or more investigation that may be appropriately ordered as part of the patient’s assessment in primary care and that is generally available to GPs in England.....

"Occult" ovarian Leydig cell tumor: when laboratory tells more than imaging


Hyperandrogenism is a common finding in premenopausal age and is generally caused by polycystic ovarian syndrome or other benign disease. Androgen-secreting tumors represent only 0.2 % of the causes of hyperandrogenism and usually present with severe clinical features, abrupt onset, and very high androgens levels. We describe here three cases of occult ovarian Leydig cell tumors suspected on the basis of severe clinical features of hyperandrogenism rapidly worsening, with elevated serum total testosterone levels, in which bilateral ovariectomy was performed and tumor was confirmed by post-operative histology. In all three cases, imaging was negative for ovarian tumor. Moreover, in one case the confounding concomitant finding of bilateral adrenal masses posed an additional challenge. Our experience highlights that testosterone levels represent the most helpful marker in the diagnosis of androgen-secreting ovarian tumor. In the absence of imaging findings, bilateral ovariectomy should be indicated, if supported by unequivocal clinical and laboratory data.

Mindfulness: a way to live life in the present tense


Is There a Role for Oral or Intravenous Ascorbate (Vitamin C) in Treating Patients With Cancer?

A Systematic Review

  Conclusion. There is no high-quality evidence to suggest that ascorbate supplementation in cancer patients either enhances the antitumor effects of chemotherapy or reduces its toxicity. Given the high financial and time costs to patients of this treatment, high-quality placebo-controlled trials are needed.

A Meta-Analysis on the Impact of Platinum-Based Adjuvant Treatment on the Outcome of Borderline Ovarian Tumors With Invasive Implants

Gynecologic Oncology

The Oncologist first published on January 19, 2015; doi:10.1634/theoncologist.2014-0144
Borderline ovarian tumors (BOTs) have been a challenge for patients, pathologists, and oncologists. For the group of patients with invasive implants, there is no consensus regarding standard therapy. This meta-analysis examines the benefits, or lack thereof, of platinum-based adjuvant treatment for BOT, showing that at present there is no evidence to support this treatment form.

Editorial: Breaking Down the Evidence for Bevacizumab in Ovarian Cancer


Breaking Down the Evidence for Bevacizumab in Ovarian Cancer

The Oncologist first published on January 19, 2015; doi:10.1634/theoncologist.2014-0302
Bevacizumab has been FDA-approved for use in combination with single-agent chemotherapy for platinum-resistant ovarian cancer; however, its optimal role remains unclear. In this editorial, the timing, efficacy, safety, and rationale for use of bevacizumab in ovarian cancer are discussed.

Advancing the science of measurement of diagnostic errors in healthcare

open access

Drug companies to blame for antibiotic resistance, says pharmaceutical boss

UK media

Pharmacy errors: How often do they happen? Nobody knows

CBC News

Tuesday, January 20, 2015

A Note about DWD Canada's Charity Status | Dying with Dignity

Dying with Dignity


Dying with Dignity Canada (DWD Canada) has learned it will lose its registered charity status as the result of recent political-activity audits by the Canada Revenue Agency (CRA).
In a letter dated January 16, the CRA said DWD Canada’s charitable status will be annulled as soon as next month because the organization, in the federal agency’s view, had been “registered in error” in 1982 and again when DWD Canada was re-registered in 2011.
“Based on our findings, it is our opinion that the Organization was, in fact, registered in error and, as a result, its registration under the [Income Tax Act] should be annulled,” the letter reads.
Founded in 1982, DWD Canada is a health and educational charity focused on promoting choice and dignity at end of life. The organization educates about the case for physician assisted dying, provides information about patient rights and advance care planning, and offers one-on-one support to individuals who are dying and want to do so on their own terms. In addition to making the case for the legalization of physician assisted dying, the charity had categorized a number of its activities as advancing education, such as its: • workshops and presentations
• quarterly newsletter,
• website and
• advance care planning resource kits.
However, the CRA determined that DWD Canada does not conduct “any activities advancing education in the charitable sense”. DWD Canada has a small staff (there were four staff positions during the audit period) and relies on volunteers for much of its work. In 2013, supporters donated approximately 8,000 volunteer-hours to the cause.
After fully assessing all options, the charity’s board of directors has voted not to oppose the annulment, which is expected to come into effect on or after February 15.  The change in status will not affect the tax deductibility of any donations made to DWD Canada prior to that date. Until the annulment is finalized, DWD Canada will remain a registered charity to which Canadians can make tax-deductible donations. After that point, the organization will become a non-profit without registered charity status. 
Because the CRA is proposing to annul DWD Canada’s registered status — as opposed to revoking it — all assets belonging to DWD Canada will remain with the organization. As a result, DWD Canada will not only be able to continue its important work in the area of promoting choice and dignity at end of life, but it will also, after its conversion to a non-profit, be free to focus on political advocacy without constraints.
More information about DWD Canada's next steps will be forthcoming in the weeks ahead. If you have any immediate concerns, please call us at 1-800-495-6156 or send an e-mail