Thursday, April 30, 2009
Patient Involvement in Decisions to Limit Treatment: The Crucial Role of Agreement Between Physician and Patient
"Conclusion Only half of the patients were involved in DLT. Surprisingly, the main predictor of patient involvement was not their medical condition, but agreement with physicians' palliative treatment goals. These results show that if physicians switch to comfort care in terminally ill patients and patients are not yet prepared to follow this line, treatment limitations are often decided without involving the patient."
Wednesday, April 29, 2009
Wait times for chemotherapy in Ontario growing, say advocacy groups
Working On IT! a book in progress: Dana Martinez (husband Ron)
I don't mind making this journey as long as I know that I am helping someone else. Every Cancer survivor I have ever met, has felt this way. There is something that happens to you once you have Cancer, you become part of a larger family-- a family bound by a common thread- "survival".
Tuesday, April 28, 2009
Let Me In!
power point presentation: Let Me In!
access link below:
www.scribd.com/doc/13044110/Ovarian-Cancer-Let-Me-In
Ovarian Cancer: Let Me In!
"Doc, Should I See You or My Oncologist?" A Primary Care Perspective
“Doc, Should I See You or My Oncologist?” A
Primary Care Perspective on Opportunities and
Challenges in Providing Comprehensive Care for
Cancer Survivors
Monday, April 27, 2009
Saturday, April 25, 2009
Friday, April 24, 2009
A Rapid and Reliable Test for BRCA1 and BRCA2 Founder Mutation Analysis in Paraffin Tissue Using Pyrosequencing
The founder mutations in BRCA (BRCA1*185delAG, BRCA1*5382insC, and BRCA2*6174delT) account for 95% of the detectable BRCA mutations in breast and ovarian cancer families of Ashkenazi Jewish ancestry.
Thursday, April 23, 2009
Intercepting pelvic cancer in the distal fallopian tube: theories and realities
This review summarizes the recent data supporting the distal fallopian tube as an important site for serous carcinogenesis, stressing both the presence of a novel precursor (the p53 signature) and the application of this model to all women irrespective of BRCA status. The challenges and unmet needs unmasked by this paradigm shift in ovarian cancer research are discussed.
Revisiting perioperative chemotherapy: the critical importance of targeting residual cancer prior to wound healing
Revisiting perioperative chemotherapy: the critical importance of targeting residual cancer prior to wound healing
Wednesday, April 22, 2009
Tuesday, April 21, 2009
April 21, 2009 - NCI Ovarian Cancer Markers Validated for Early Detection
NCI Cancer Bulletin for April 21, 2009 - National Cancer Institute: "The current guidelines of the U.S. Preventive Services Task Force do not recommend ovarian cancer screening with CA-125. Earlier this month another study using PLCO data concluded that screening women for ovarian cancer often led to unnecessary surgeries and failed to detect the disease in its early stages."
Monday, April 20, 2009
Primary Care Physicians' Views of Routine Follow-Up Care of Cancer Survivors
CO Early Release, published online ahead of print Apr 20 2009
Journal of Clinical Oncology, 10.1200/JCO.2008.20.4883
Primary Care Physicians' Views of Routine Follow-Up Care of Cancer Survivors
M. Elisabeth Del Giudice,* Eva Grunfeld, Bart J. Harvey, Eugenia Piliotis, and Sunil Verma
Department of Family and Community Medicine and Dalla Lana School of Public Health, University of Toronto; Sunnybrook Health Sciences Centre; Ontario Institute of Cancer Research and Cancer Care Ontario, Health Services Research Program; and Divisions of Hematology and Medical Oncology, Department of Medicine, Odette Cancer Centre, Toronto, Ontario, Canada.
* To whom correspondence should be addressed. E-mail: lisa.delgiudice@sunnybrook.ca
Purpose: Routine follow-up of adult cancer survivors is an important clinical and health service issue. Because of a lack of evidence supporting advantages of long-term follow-up care in oncology clinics, there is increasing interest for the locus of this care to be provided by primary care physicians (PCPs). However, current Canadian PCP views on this issue have been largely unknown.
Methods: A mail survey of a random sample of PCPs across Canada, stratified by region and proximity to urban centers, was conducted. Views on routine follow-up of adult cancer survivors and modalities to facilitate PCPs in providing this care were determined.
Results: A total of 330 PCPs responded (adjusted response rate, 51.7%). After completion of active treatment, PCPs were willing to assume exclusive responsibility for routine follow-up care after 2.4 ± 2.3 years had elapsed for prostate cancer, 2.6 ± 2.6 years for colorectal cancer, 2.8 ± 2.5 years for breast cancer, and 3.2 ± 2.7 years for lymphoma. PCPs already providing this care were willing to provide exclusive care sooner. The most useful modalities PCPs felt would assist them in assuming exclusive responsibility for follow-up cancer care were (1) a patient-specific letter from the specialist, (2) printed guidelines, (3) expedited routes of rereferral, and (4) expedited access to investigations for suspected recurrence.
Conclusion: With appropriate information and support in place, PCPs reported being willing to assume exclusive responsibility for the follow-up care of adult cancer survivors. Insights gained from this survey may ultimately help guide strategies in providing optimal care to these patients.
Press release: Cochrane Library free access to all Canadians
Ottawa, April 15, 2009— The Canadian Cochrane Network and Centre announces today
that everyone in Canada with access to the Internet will be able to view the full content of
The Cochrane Library, an on-line resource that provides evaluations on health
treatments.
The Canadian Cochrane Network and Centre, in partnership with the Canadian Health
Libraries Association, has successfully secured a national license to The Cochrane
Library. In essence, the license provides a subscription for every Canadian with access to
the Internet to benefit from the immense volume of health information found in The
Cochrane Library. Everybody will be one click away from the best available evidence on
the effectiveness of treatment procedures including which ones may be harmful.
Sunday, April 19, 2009
Hobnail-like cells in serous borderline tumor do not represent concomitant incipient clear cell neoplasms.
Hum Pathol. 2009 Apr 13
Hobnail-like cells in serous borderline tumor do not represent concomitant incipient clear cell neoplasms.
Ohishi Y, Oda Y, Kurihara S, Kaku T, Yasunaga M, Nishimura I, Okuma E, Kobayashi H, Wake N, Tsuneyoshi M.
Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan; Department of Diagnostic Laboratory, Kyushu University Hospital at Beppu, Beppu 874-0838, Japan.
Hobnail-like cells, which suggest a diagnosis of clear cell carcinoma, are also focally observed in serous borderline tumor of the ovary, causing diagnostic confusion. However, the precise nature of hobnail-like cells in serous borderline tumor has not been well characterized. The purpose of this study was to clarify whether or not hobnail-like cells in serous borderline tumor represent concomitant incipient clear cell neoplasms. First, we carefully reviewed hematoxylin and eosin slides taken from 115 ovarian tumors diagnosed as clear cell carcinoma (73 cases), mixed adenocarcinoma containing clear cell carcinoma (5 cases), and serous borderline tumor (37 cases) to clarify the frequency of coexistence of typical clear cell carcinoma and serous borderline tumor. Through the hematoxylin and eosin review, we paid special attention to the cytologic features of hobnail-like cells in serous borderline tumor and serous borderline tumor-like papillary areas in clear cell carcinoma. Second, we selected 19 serous borderline tumors and 16 clear cell carcinomas, in which hobnail-like cells were easily recognizable, and investigated the immunohistochemical expression of estrogen receptor and Wilms tumor gene protein. No coexistence of clear cell carcinoma and serous borderline tumor was evident in any of the above 115 ovarian tumors. Hobnail-like cells were focally positive for estrogen receptor and Wilms tumor gene protein in nearly all serous borderline tumors. Hobnail-like cells in all clear cell carcinomas were completely negative for estrogen receptor and Wilms tumor gene protein, although estrogen receptor expression was very focally observed (less than 5% area) in non-hobnail cells of only one clear cell carcinoma. In conclusion, hobnail-like cells in serous borderline tumor do not represent concomitant incipient clear cell neoplasms because (1) clear cell carcinoma and serous borderline tumor do not coexist and (2) hobnail-like cells in clear cell carcinoma and serous borderline tumor are immunophenotypically distinct. Recognition of our conclusion may protect a patient with "conspicuous hobnail-like cells in serous borderline tumor" from an erroneous overdiagnosis of "concomitant clear cell carcinoma admixed with serous borderline tumor."
Saturday, April 18, 2009
article: Guidelines needed for optimal vitamin D supplementation in cancer patients
"There may be specific benefits and harms associated with vitamin D supplementation in cancer patients that are not present in the general population, despite the fact that these benefits and harms have not been conclusively demonstrated,” Dr. Goodwin writes. “As a result, oncologists making recommendations to individual patients should take a cautious approach.”
Bias in the exchange of arguments: the case of scientists' evaluation of lay viewpoints- Public Understanding of Science
Note: a bit off topic but the last point taken:
"Abstract
Most perspectives on public participation share the notion that dialogues should be open, allowing participants to articulate and evaluate different views and knowledge claims. We hypothesize that participants' evaluation of claims may be biased because participants have a preference for a particular type or source of a claim. This would hamper an open dialogue.....
Contrary to our expectation, scientists evaluated claims of the public more positively than claims of experts."
The risk of colorectal cancer with symptoms at different ages and between sexes: a case-control study
Differences with age and sex are important; current guidance for referral ignores age
The diagnosis of colorectal cancer in patients with symptoms: finding a needle in a haystack
Table 1. Presenting symptoms and signs for 194 patients with colorectal cancer
Symptom Percentage of patients:
Fecal occult blood test positive 77
Rectal bleeding 58
Anemia* 57
Abdominal pain 52
Weight loss 39
Anorexia 27
Constipation 27
Altered stools 25
Fatigue 25
Diarrhea 22
Nausea and vomiting 22
Tenesmus 8
Mucus in stools 6
Rectal pain 5
Obstruction 4
Adapted from . Majumdar et al. [1].
*Anemia = a hemoglobin of <13.4g/dl in men or <12.3g/dl in women.
Friday, April 17, 2009
Inhibition of functional HER family members increases the sensitivity to docetaxel in human ovarian cancer cell lines.
In conclusion, a combination of docetaxel with inhibitors of HER family members, such as cetuximab plus pertuzumab, may be considered for a clinical trial in ovarian carcinomas with functional receptors.
Parity and the risk of breast and ovarian cancer in BRCA1 and BRCA2 carriers
This is the third independent study to find that, as in the general population, parity appears to be associated with protection from breast cancer in women with mutations in BRCA1 and BRCA2. Parity appears to be protective for ovarian cancer in BRCA1 mutation carriers, but its role in BRCA2 mutation carriers remains unclear. Whether later age at first birth is also protective for ovarian cancer in mutation carriers requires further confirmation.
Cochrane Collaboration: Interval debulking surgery for advanced epithelial
* Rates of toxic reactions to chemotherapy were similar in both arms (RR = 1.3, 95%CI: 0.4 to 3.6), but little information is available for other adverse events.
* Only one trial reported quality of life (QOL), which was generally similar in both treatment arms.
* No conclusive evidence was found to determine whether IDS between cycles of chemotherapy would improve or decrease the survival rates of women with advanced ovarian cancer, compared with conventional treatment of primary surgery followed by adjuvant chemotherapy. IDS appeared to yield benefit only in the patients whose primary surgery was not performed by gynecologic oncologists or was less extensive.
OCATS: Cancer survivor helps launch awareness campaign
media article:
Cancer survivor helps launch awareness campaign
e-letter of response:
Now, after close to a decade as one of the minority who has survived ovarian cancer, it is apparent that the message concerning this highly lethal woman's cancer, still is not receiving the respect nor attention it deserves. How, as a society, is it that we fail and continue to fail not only ovarian cancer women/families, but, all those who envision best care for this woman's cancer? The impact of hearing: "well, they are going to die anyway" is distressingly commonplace even today. Those are infuriatingly painful words to hear time and time again. Yet, here we have a small group of women fighting not only for themselves but for the future of Saskatchewan's children - your children. Each time we lose an ovarian cancer woman to this deadly cancer, a part of us dies with her - again and again. In good and bad economic times, little has changed, so it should be obvious that funding is not the issue. Policy makers need to be reminded that these women are not number-crunching statistics, but walking, breathing, caring Mothers, Sisters, Grandmothers and Citizens who have much Hope in the face of extreme adversity. Stick your neck out on this issue and make the obvious right decisions! You could make worse decisions. Sandi Pniauskas
OCATS: Cancer survivor helps launch awareness campaign
media article:
Cancer survivor helps launch awareness campaign
e-letter of response:
Now, after close to a decade as one of the minority who has survived ovarian cancer, it is apparent that the message concerning this highly lethal woman's cancer, still is not receiving the respect nor attention it deserves. How, as a society, is it that we fail and continue to fail not only ovarian cancer women/families, but, all those who envision best care for this woman's cancer? The impact of hearing: "well, they are going to die anyway" is distressingly commonplace even today. Those are infuriatingly painful words to hear time and time again. Yet, here we have a small group of women fighting not only for themselves but for the future of Saskatchewan's children - your children. Each time we lose an ovarian cancer woman to this deadly cancer, a part of us dies with her - again and again. In good and bad economic times, little has changed, so it should be obvious that funding is not the issue. Policy makers need to be reminded that these women are not number-crunching statistics, but walking, breathing, caring Mothers, Sisters, Grandmothers and Citizens who have much Hope in the face of extreme adversity. Stick your neck out on this issue and make the obvious right decisions! You could make worse decisions. Sandi Pniauskas
Thursday, April 16, 2009
Caring for the Morbidly Obese GYN Oncology Patient - Oncology Nursing News
"“In addition, there are obesity bias issues,” Ms Stuckwisch revealed, explaining that many studies exist indicating that nurses view obese patients as overindulgent, lazy, noncompliant, and unsuccessful. Other research shows 31% of nurses would prefer not to care for an obese patient and 24% say obese patients repulse them."
“Obesity can happen to anyone,” Ms. Stuckwisch reminded the attendees. “Overweight is a product of many factors. Overweight is not just related to overeating. There are multiple issues and no real answer to what causes people to cross over to extreme morbid obesity.”
Wednesday, April 15, 2009
Novogen 'Ovature' trial hit by crisis - Phenoxodiol
Novogen 'Ovature' trial hit by crisis
April 15, 2009 - 2:54PM
Biotech Novogen Ltd's US subsidiary has decided to undertake an interim analysis of its phase III "Ovature" trial, saying slowing patient recruitment rates and the global financial crisis has made it imprudent to fund the trial to completion.
The Ovature (Ovarian Tumour Response) study is trialling the anti-cancer drug phenoxodiol in women with advanced ovarian cancer to determine its safety and effectiveness when used in combination with chemotherapy drug carboplatin.
Novogen said its US subsidiary, Marshall Edwards Inc, had announced that new patient recruitment to the Ovature trial would cease and available data from the 141 completed and current patients would be analysed for safety and efficacy outcomes.
"The company has decided to assess these data from the Ovature trial at this time as the current downturn in the global financial markets makes raising further equity or debt in the near term to fund the trial through to completion most unlikely," Marshall Edwards said....cont'd
Tuesday, April 14, 2009
Monday, April 13, 2009
PharmaLive: Manhattan Research Releases Digital DTC Relevance Rankings, Revealing Which Condition Groups Are Most Likely to Adopt eHealth
New York, April 8, 2009 - More than 60% of U.S. adults turn to the Internet as a decision support tool in healthcare and disease management, and certain condition groups are more likely to use online health resources than others, according to pharmaceutical and healthcare market research company Manhattan Research.
Conscience vs. Conscience - Blog - NYTimes
The clause, called the Provider Refusal Rule, allows heath care providers to refuse to participate in procedures they find objectionable for moral or religious reasons.
It is called the “conscience clause” because it affirms the claims of conscience — one’s inner sense of what is right — against the competing claims of professional obligations.
Saturday, April 11, 2009
Chemotherapy toxicity in gynecologic cancer patients with a body surface area (BSA) >2m(s)
"...women with a BSA>2 m(2) on paclitaxel dosed by ABW do not experience excess toxicity in comparison to women on paclitaxel capped at a maximum BSA or women in published trials of adjuvant P/C. Empiric dose reduction is unnecessary and may result in suboptimal treatment...."
Ovarian Cancer Screening Resulted in Many Unnecessary Surgeries
Screening women for ovarian cancer often led to unnecessary surgeries and failed to detect the disease in its early stages, according to new results from the Prostate, Lung, Colorectal and Ovarian (PLCO) cancer screening trial. The analysis focused on the 34,000 women in the NCI-sponsored trial who were screened annually for signs of ovarian cancer using transvaginal ultrasound and/or the CA-125 blood test.
Friday, April 10, 2009
Prognostic and predictive factors in epithelial ovarian cancer (Bull)
[Prognostic and predictive factors in epithelial ovarian cancer.]
[Article in French]
Comité de gynécologie, Institut Gustave-Roussy, 39, rue Camille-Desmoulins, 94800 Villejuif, France.
Even if prognosis of epithelial ovarian cancer remains very bad, survival and response to treatment are variable according to the patients. Determination of new prognostic markers helps us to adapt therapeutics for each patient and is necessary for the elaboration and the interpretation of clinical research studies. Many prognostic factors related to the tumor, the patient or the treatment, have been evaluated. The goal of this work is to review these parameters. So far, the most powerful variables are volume of residual disease after cytoreductive surgery, FIGO tumor stage, histologic type and grade of differentiation. The progress and accessibility to novel technologies applied to biology will make possible in the future the assessment of new prognostic profiles-based on genetic and/or proteomic tumor characteristics. The future also relies on the identification of predictive factors of response to treatment, but force is to note that on the last hundred publications testing predictive factors (p53, HER2, Topo-2-alpha, BRCA...), none have modified today our clinical practices.
Thursday, April 09, 2009
Alcohol intake and cigarette smoking and risk of a contralateral breast cancer: the Women's Environmental Cancer and Radiation Epidemiology Study
Microarray Analysis of Early Stage Serous Ovarian Cancers Shows Profiles Predictive of Favorable Outcome
"Conclusions: These data suggest that serous ovarian cancers detected at an early stage generally have a favorable underlying biology similar to advanced-stage cases that are long-term survivors. Conversely, most late-stage ovarian cancers seem to have a more virulent biology. This insight suggests that if screening approaches are to succeed it will be necessary to develop approaches that are able to detect these virulent cancers at an early stage."
New ACOG Guidelines Recommend Routine Genetic Risk Assessment
Some families are at particularly high risk of cancer due to hereditary cancer syndromes. These families often have multiple family members with cancer and are more likely to develop cancer at a young age. In the case of breast and ovarian cancers, inherited mutations in two genes—BRCA1 and BRCA2—have been found to greatly increase the lifetime risk of developing breast and ovarian cancer. Mutations in these genes can be passed down through either the mother’s or the father’s side of the family. The lifetime risk of ovarian cancer is estimated to be 39-46% among women with a BRCA1 mutation and 12-20% among women with a BRCA2 mutation. Lifetime risk of breast cancer among BRCA1 or BRCA2 carriers is 65-74%.[1]
An estimated 1 in 300 to 1 in 800 people in the United States have a BRCA1 or BRCA2 mutation. Questions about personal and family history of breast and ovarian cancer can help identify women who are at increased risk of carrying a BRCA mutation.Tuesday, April 07, 2009
On the Rock, in a Hard Place: Challenges in Working with Advocacy and Care Provider Groups :: Vol. 2 No. 1 2006 :: Healthcare Policy / Politiques de Santé :: Longwoods Pub
"Lessons Learned
This experience taught us valuable lessons about KT in practice. Decision-making and knowledge translation occur in a complex, dynamic environment where the partners' interest in, and perspective towards, the research findings, the researchers, and other partners continually evolve. The desire to use evidence in decision-making competes with other organizational and personal motivations, not the least of which are self-preservation and self-promotion."
Monday, April 06, 2009
Mechanisms of chemoresistance and poor prognosis in ovarian clear cell carcinoma
Published Online: 28 Mar 2008 © Japanese Cancer Association
Review Article
Mechanisms of chemoresistance and poor prognosis in ovarian clear cell carcinoma
Clear cell carcinoma (CCC) accounts for 4% to 12% of epithelial ovarian cancer in Western countries and, for some unknown reasons, it comprises more than 20% of such cancers in Japan. CCC shows unique clinical features such as a high incidence of stage I disease, a large pelvic mass, an increased incidence of vascular thromboembolic complications, and hypercalcemia. It is frequently associated with endometriosis.
Compared to serous adenocarcinoma (SAC), CCC is relatively resistant to conventional platinum, or taxane-based chemotherapy which is associated with its poor prognosis. However, the mechanisms underlying CCC's resistance to chemotherapy have not been understood...... Therefore, lower proliferation of the tumor cells may contribute to their resistance to chemotherapy...."
Sunday, April 05, 2009
eMJA: What is the health service for?
"To the Editor: “What is the health service for?”1 In essence, this is a question of definition and ownership. What is the definition of quality health care and who decides how it is defined? Who are the recipients of health services, the funders, those who stand to lose or benefit from the way in which health care is delivered? The answer is citizens"
Saturday, April 04, 2009
Cystic and Adenofibromatous Clear Cell Carcinomas of the Ovary: Distinctive Tumors That Differ in Their Pathogenesis and Behavior: 122 cases
Friday, April 03, 2009
The Clearity Foundation - Improving Treatment Options For Ovarian Cancer Patients
"The Clearity Foundation seeks to improve treatment outcomes in recurrent and progressive patients by providing diagnostic services that determine the molecular profile of the individual patient. Having this profile may help match your patient with an appropriate clinical trial or other treatment. We also maintain a database of results that over time, may help identify new treatments. The Clearity Foundation is a 501(c)(3) not-for-profit and sponsors molecular profiling diagnostic tests at no cost to patients."
Thursday, April 02, 2009
news item: Medical skeptic wins top award Dr David Sackett - Gairdner Wightman Award
Medical skeptic wins top award
A pioneer of McMaster University's medical school has been recognized with a prestigious international award for his groundbreaking research, which he dedicated to the millions of patients in history who have been wronged by doctors prescribing "dumb treatments."
Wednesday, April 01, 2009
Comparisons of Patient and Physician Expectations for Cancer Survivorship Care
Purpose: To compare expectations for cancer survivorship care between patients and their physicians and between primary care providers (PCPs) and oncologists.
Conclusion: Patients and physicians have discordant expectations with respect to the roles of PCPs and oncologists in cancer survivorship care. Uncertainties around physician roles and responsibilities can lead to deficiencies in care, supporting the need to make survivorship care planning a standard component in cancer management.
2009 publication: American College of Gastroenterology Guidelines for Colorectal Cancer Screening 2008 (including risk categories)
Alternatively, reference the NCCN Guidelines (http://www.nccn.org)
2009 Hon Justice Margaret A. Cameron: Commission of Inquiry on Hormone Receptor Testing Canada
About the Inquiry
The Commission of Inquiry on Hormone Receptor Testing was established by the Government of Newfoundland and Labrador under the Public Inquiries Act, 2006 on July 3, 2007. The Honourable Margaret A. Cameron was appointed Commissioner.
Genetic testing for Lynch Syndrome in the first year of colorectal cancer: a review of the psychological impact
Conclusion:
This review identifies the psychological impact of colorectal
cancer during the first year after treatment and
indicates specific subgroups of patients with colorectal
cancer who could be vulnerable for genetic-testing-related
distress. Most of the retrieved studies on diagnostic genetic
testing for Lynch syndrome exclusively measured distress
prior to genetic test disclosure and focused on patients who
were diagnosed with colorectal cancer several years ago.
Therefore, we are still unable to identify the psychological
impact of genetic testing for Lynch syndrome in recently
diagnosed patients with colorectal cancer.
Vancouver Coastal Health Research Institute - News Releases - $15 Million Donation Launches Research Centre at VGH - Wed Apr 1, 2009
The seven-storey, 69,350 sq. ft. (6,442 sq.m.) facility will house three of VGH's key research programs: the Vancouver Prostate Centre at VGH; the Centre for Hip Health and Mobility; and the Ovarian Cancer Research Initiative.
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