Tuesday, May 18, 2010
Risk of Cancer Following Hospitalization for Type 2 Diabetes The Oncologist
ABSTRACT
Objectives. Cancer and type 2 diabetes (T2D) are two common diseases that may share risk factors. We aimed at determining subsequent cancer risks in patients hospitalized for T2D in Sweden.
Methods. T2D patients were obtained from the nationwide Hospital Discharge Register; cancers were recorded from the Swedish Cancer Registry. Standardized incidence ratios (SIRs) were calculated for cancer
following last hospitalization for T2D. The comparison group was the general Swedish population.
Results. The number of hospitalized T2D patients from 1964 to 2007 was 125,126, of whom 26,641 had an affected family member. Altogether 24 cancers showed an elevated risk when follow-up was started after the
last hospitalization. The highest SIRs were for pancreatic (6.08) and liver (4.25) cancers. The incidences of these cancers were even elevated when follow-up was started 5 years after the last hospitalization for T2D, with primary liver cancer showing the highest SIR of 4.66. Also increased were the incidences of upper aerodigestive tract, esophageal, colon, rectal, pancreatic, lung, cervical, endometrial, ovarian, and kidney cancers. Prostate cancer showed a lower risk. Familial T2D patients showed no exceptional elevated cancer risks but their prostate cancer and melanoma risks were lower.
Conclusions. This study, covering approximately one half of Swedish T2D patients, showed an elevated risk for several cancers after hospitalization for T2D, probably indicating the profound metabolic disturbances of the underlying disease. The highest risks were found for
liver and pancreatic cancers. No excess cancer risks were observed in familial diabetics. The lower risk for prostate cancer remains intriguing
(ovarian cancer incidence rates 15.61/per 100,000 population; risk 1.84 (>1.0 = increased risk)
CCR Clinical Trials at NIH: Health Care Professionals: Join Our Mailing List
Health care professionals who join the National Cancer Institute Clinical Trials at NIH mailing list receive: * Quarterly e-mail notifications about clinical trials * Information about the National Cancer Institute's programs and clinical opportunities
NCI: Talking About Trials: Overcoming Bottlenecks in Clinical Communication (enrolment)
".......“Patient refusal rates may be less of a problem than low rates of trial offers,” wrote the authors."
NCI Cancer Bulletin for May 18, 2010 - SPECIAL ISSUE
Additional Clinical Trials Resources
Cancer Clinical Trials at NIH
NCI supports cancer clinical trials across the country (U.S) through its extramural research program. Meanwhile, on NIH’s main campus, the Institute’s intramural researchers in the Center for Cancer Research (CCR) conduct hundreds of trials each year at the NIH Clinical Center in Bethesda, MD, and these trials often differ from those available elsewhere.While some cancer centers also offer early-stage clinical trials, the difference is that CCR focuses almost exclusively on early-stage trials, said Dr. Bill Dahut, CCR’s clinical director.
NCI’s intramural program is able to pay the transportation costs for patients who are enrolled in Clinical Center trials. This allows CCR to see many more patients with rare cancers, or rare subtypes of common cancers, than other research sites because CCR can fly in patients from around the country to be treated in investigational studies.
One commonly cited barrier to entering clinical trials is the worry among both patients and their physicians of losing control. “An important point about treatment at NCI is that everything we do here for patients is done in close collaboration with their local physicians back home,” Dr. Dahut explained. “Our physicians provide expert clinical care to patients while they are being treated on protocol at NCI, but our physicians can see patients only while they are at the Clinical Center. Thus, continued care by local physicians is incredibly important to allow patients to access standard treatments or other trials not available here. Local physicians must remain closely involved with patients on NCI studies because side effects, from the cancer or the therapy, may occur when the patient is home and far from Bethesda.”
Patients and physicians interested in exploring cancer clinical trials at NIH can visit CCR’s clinical trials Web site. The site includes detailed descriptions of clinical trials currently recruiting patients; information for the general public about clinical trials and participating in trials at NCI; and information for health professionals about referring patients, the Center’s clinical programs and investigators, and ways to keep up to date with CCR research and opportunities.
“We’d really like to encourage physicians to join our mailing list,” said Susan McMullen, patient outreach and recruitment coordinator for CCR’s Office of the Clinical Director. “One of the barriers to recruiting patients at NIH is that our doctors don’t have a patient base outside of clinical trials to draw from, so we rely on community doctors to refer patients to us.”
Family Cancer Registries
To determine what genetic factors may be at work and how environmental influences alter those genetic risks, researchers rely on those affected by familial cancer to participate in family cancer registries.
“Our major goal in studying these families is to identify what are called high-risk susceptibility genes,” explained Dr. Peggy Tucker, director of the Human Genetics Program and chief of the Genetic Epidemiology Branch in NCI’s Division of Cancer Epidemiology and Genetics (DCEG). “We then try to understand the function of those genes, how they confer risk, and what other factors within the family modify risk.
“Ultimately, we want to be able to alter the risk of cancer in these families either by identifying susceptibility factors we can modify—for example, avoiding sun exposure in melanoma families—or designing interventions that can affect risk—such as prophylactic oophorectomy for women in families with high risk of both breast and ovarian cancer,” she said.
Family cancer registry studies can also help inform researchers about cancer susceptibility risks in the general population. For example, researchers identified dysplastic nevi as a major risk factor for melanoma by studying families at high risk of melanoma.
Researchers at NCI first began conducting family registry studies in the mid-1960s. These long-term studies follow families through successive generations, and allow researchers to examine the role of inherited high-susceptibility genes and cancer. Today, DCEG researchers are studying families with a number of inherited cancers or cancer-susceptibility syndromes, and researchers in NCI’s Division of Cancer Control and Population Sciences (DCCPS) sponsor the Breast and Colon Cancer Family Registries.
Whereas DCEG’s family registries are conducted at the NIH Clinical Center, the family registries based in DCCPS are found throughout the United States, Australia, and Canada. “Currently, we have about 78,000 men and women from nearly 26,000 families participating in these registries,” said Dr. Sheri Schully, program officer for the DCCPS family registries program. “The main objective of these registries is to identify and characterize cancer susceptibility genes, but the investigators also look at gene–gene and gene–environment interactions as well.”
Although family registry studies do not provide treatment to participating families, investigators often provide test results that can help family members learn which of them may be at higher risk because of certain susceptibility genes, such as mutations in the BRCA1 and BRCA2 genes or those associated with Lynch syndrome, said Dr. Schully.
Additionally, the studies are an opportunity for people who are often desperate for answers to ask questions.
“We like to think it’s a positive experience for them because they have a whole day at NIH to meet with physicians and nurses who know a lot about the disease,” Dr. Tucker explained. “We try to keep them updated with new findings about the diagnosis and management of the cancer that affects their family, and they know they can always come to us for referrals for care of the disorders that we’re studying.”
Learn More About Clinical Trial Enrollment....
Breast Cancer Research | Full text | Familial relative risks for breast cancer by pathological subtype: a population-based cohort study
Conclusions
"We may conclude from our results that the FRR (familial relative risk) for breast cancer is significantly increased for each pathological subtype except TN tumours, although the numbers in the latter category were too small to draw definitive conclusions.
When analyzed by tumour subtype, a surprisingly high proportion of FRR (familial relative risk) for ER-negative disease is already explained.
We estimate that 32% of breast cancer FRR for ER-negative disease is explained by BRCA1 and BRCA2 mutations alone.
Patients carrying such mutations may be advised to undergo prophylactic therapies such as oophorectomy or mastectomy.
About 10% of the FRR for ER-positive disease is explained by 12 newly discovered SNPs, and the contributions of these SNPs to FRR are likely to be somewhat higher once the true causal variants are identified.
The construction of informative risk prediction models for ER-positive disease is particularly important as the risk of ER-positive disease can be reduced by chemoprevention such as tamoxifen.
It is possible that including novel (new) genetic variants associated with breast cancer susceptibility in models may improve risk prediction for subtype specific disease."
BSB4uD (Be Smart Before You Donate - see blog posting and income comparisons non-profit employees vs professional salaries) - note updated information on Canadian family physician salaries - average
Blogger Author's Opinion: based on these averages, most family physicians are underpaid
Family Physician salaries as per CMAJ April 9th 2010: $225,521. Cdn avg CMAJ
Update: May 18th, 2010
A separate, unpublished CIHI indice which weights all payments — whether fee-for-service, salary or other form of capitation — for all services, against a national median indicates that Newfoundland and Labrador doctors essentially earn 6.78% less than a national median of $224 875 earned by doctors in 2007–08. On that scale, doctors in Alberta (7.22% above the median) were the highest paid in the country, followed by those in British Columbia (5.84% above), New Brunswick (4.6% above), Saskatchewan (4.24% above), Nova Scotia (1.68% above), Ontario (1.68% below) and Manitoba (4.88% below). Only doctors in Prince Edward Island (18.28% below) and Quebec (28.66% below) earned less than those in Newfoundland and Labrador.
http://www.cmaj.ca/cgi/content/full/182/8/E339?etoc
EpCAM As a Target in Cancer Therapy -- Journal of Clinical Oncology
Function: (ref source WIKI) EpCAM is a pan-epithelial antigen that is expressed on almost all carcinomas. Its constitutional function is being elucidated.
Note: search blog for other references to EpCAM and in particular to Lynch Syndrome"...Like for every targeted therapy, the level of EpCAM target expression will have an impact on the outcome of a trial. This was evident for the human anti-EpCAM antibody adecatumumab in patients with metastatic breast cancer. Although a high level and frequency of EpCAM expression can be assumed for patients with colorectal cancer, none of the previous trials prospectively or retrospectively analyzed patients for levels of EpCAM expression on tumor tissue. Particularly for a low-affinity antibody, such as edrecolomab, it may be of importance that tumor cells express EpCAM at a high and not just at an intermediate level..... Future studies will certainly benefit from stratifying patients for their level of EpCAM target expression."
Warfarin diet: What foods should I avoid? - MayoClinic.com
Warfarin is a blood-thinning medication that helps treat and prevent blood clots. There is no specific warfarin (Coumadin) diet. However, certain foods and beverages can make it so warfarin doesn't effectively prevent blood clots. It's important to pay attention to what you eat while taking warfarin.
One nutrient that can lessen warfarin's effectiveness is vitamin K. It's important to be consistent in how much vitamin K you get daily. The average daily allowance of vitamin K for adult men is 120 micrograms (mcg). For adult women, it's 90 mcg. While eating small amounts of foods that are rich in vitamin K shouldn't cause a problem, avoid eating or drinking large amounts of:
- Kale
- Spinach
- Brussels sprouts
- Parsley
- Collard greens
- Mustard greens
- Chard
- Green tea
Stem cell transplant - MayoClinic.com (Overview)
Definition
By Mayo Clinic staff A stem cell transplant is the infusion of healthy stem cells into your body. A stem cell transplant may be necessary if your bone marrow stops working and doesn't produce enough healthy stem cells. A stem cell transplant can help your body make enough healthy white blood cells, red blood cells or platelets, and reduce your risk of life-threatening infections, anemia and bleeding.Although the procedure to replenish your body's supply of healthy blood-forming cells is generally called a stem cell transplant, it's also known as a bone marrow transplant or an umbilical cord blood transplant, depending on the source of the stem cells. Stem cell transplants can use cells from your own body (autologous stem cell transplant) or they can utilize stem cells from donors (allogenic stem cell transplant).
Retrospective comparison of patient outcomes after in-person and telephone results disclosure counseling for BRCA1/2 genetic testing.
"This study suggests that telephone results disclosure is clinically appropriate when counselors utilize their clinical judgment to determine which patients are appropriate candidates."
The predictive value of serum VEGF in multiresistant ovarian cancer patients treated with bevacizumab (Avastin)
CONCLUSIONS:
Single agent bevacizumab has activity in ovarian cancer patients. Pre-treatment serum VEGF seems to have predictive value.
A Comparison of Quality-of-Life Domains and Clinical Factors in Ovarian Cancer Patients: A Gynecologic Oncology Group Study
CONCLUSION:
Ovarian cancer patients have decreased QOL in physical, functional, and emotional domains; however, they may compensate with increased social support. At the time of diagnosis and treatment, patients' QOL is affected by inherent characteristics. Assessment of treatment outcomes should take into account the effect of these independent variables.
Comparison of a novel multiple marker assay vs the Risk of Malignancy Index for the prediction of epithelial ovarian cancer in patients with a pelvic
"CONCLUSION: The dual marker algorithm utilizing HE4 and CA125 to calculate a ROMA value achieves a significantly higher sensitivity for identifying women with EOC than does RMI."
abstract: Hormone prevention strategies for breast, endometrial and ovarian cancers
"The prevention of epithelial ovarian cancer (EOC) is of particular interest given its high mortality rate and the lack of a cost-effective screening program. OC (oral contraceptives) usage significantly diminishes the incidence of EOC, in both the general population, as well as in patients with BRCA 1 or 2 mutations. Risk reduction is greatest with prolonged usage and persists for more than 30 years after OC use, but diminishes over time. Prospective, randomized trials, designed to control for all known variables, are mandatory to fully assess the potential for hormonal chemoprevention in breast, endometrial and ovarian cancers."
Multicentric parallel phase II trial of the polo-like kinase 1 inhibitor BI 2536.....
Multicentric parallel phase II trial of the polo-like kinase 1 inhibitor BI 2536 in patients with advanced head and neck cancer, breast cancer, ovarian cancer, soft tissue sarcoma and melanoma. The first protocol of the European Organization for Research and Treatment of Cancer (EORTC) Network Of Core Institutes (NOCI)
CONCLUSIONS: BI 2536 showed limited antitumour activity according to the design of this trial in five different tumour types. Derivatives of BI 2536 with a more favourable pharmacological profile are currently explored further in prospective studies.
JCO -- Early Release CORRESPONDENCE Accrual Strategies for Cancer Genetics Research: Blurred Boundaries (ethics)
CORRESPONDENCE
Accrual Strategies for Cancer Genetics Research: Blurred Boundaries
Daniel Rayson and Karen A. Gelmon JCO published online May 17, 2010, DOI:10.1200/JCO.2010.29.0759 [PDF]
TO THE EDITOR:
Metcalfe et al1 describe the incidence of BRCA1 and BRCA2 founder mutations in an unselected group of Ashkenazi Jewish women, with an astounding 2,000 women enrolled within 14 days of an article appearing in one of Canada’s most respected newspapers. Given the overwhelming interest amongthe target population, one might ask exactly what information prompted such an overwhelming response. The article in question was published on the front page of the Toronto Globe and Mail (Saturday May 24, 2008) with a large-font headline reading: “Cancer test a genetic crystal ball for Jewish women.” The first line in the piece stated: “For the first time in Canada, Jewish women will be offered the chance to alter their genetic destiny by taking a test…” a patently untrue and sensationalistic statement, given that presymptomatic BRCA1 and BRCA2 mutation testing, including Ashkenazi Jewish founder mutations, have been available for many years through medical genetics services nationwide." "The study by Metcalfe et al has accentuated these concerns and should serve as a basis for additional discussion in the oncology and
medical genetics communities regarding appropriate methodologies or recruitment to clinical investigations in cancer genetics."
Response to D. Rayson et al - re: Correspondence - Accrual strategies for cancer genetics research: blurred boundaries (ethics)
Correspondence: Narod/Metcalfe:
"If Drs Rayson and Gelmon1 are under the impression that we
have influence over how the Globe and Mail2 chooses to present its
news items, they are mistaken—perhaps their comments should be
addressed to the Globe Editorial office. We too are frustrated by the
incessant optimism of the media when they enter into the realms of
genetics or oncology—each gene discovery ineluctably will lead to a
treatment of a devastating genetic disease, each new molecule is a
target for a new cancer drug—but we suppose that unfettered optimism
is good for the newspaper business and is included in the price
we pay for freedom of the press...."
If the opinions of Drs Rayson and Gelmon are representative of the medical communities of Nova Scotia and British Columbia, then it is unlikely that populationbased genetic screening for Jewish women will be introduced in those provinces any time soon."
REFERENCES
1. Rayson D, Gelmon KA: Accrual strategies for cancer genetics research:
blurred boundaries. J Clin Oncol doi: 10.1200/JCO.2010.29.0759
2. Cancer test a genetic crystal ball for Jewish women. Toronto Globe and
Mail, Saturday May 24, 2008
3. Metcalfe KA, Poll A, Royer R, et al: Screening for founder mutations in
BRCA1 and BRCA2 in unselected Jewish women. J Clin Oncol 28:387-391, 2010
DOI: 10.1200/JCO.2010.29.1146; published online ahead of print at
www.jco.org on May 17, 2010
OvPlex ovarian cancer screening now available in the UK
OvPlex website: OvPlex™ targets symptomatic women and has been designed as a simple blood test for earlier diagnosis of ovarian cancer and is statistically significantly better than CA125 alone (the current standard blood test) in the detection of ovarian cancer. OvPlex™ outperforms CA125 for the detection of ovarian cancer in all stages of the disease - particularly, early stage. As mentioned, if a woman is diagnosed with ovarian cancer at an early stage of the disease, five year survival rates are greatly increased.
Cancer Clinical Trial: E-health Intervention for Cancer Survivors
Brief Summary
Official Title: “E-health Intervention for Cancer Survivors”
Intervention(s):
* Behavioral: Project Onward website + social network
* Behavioral: Project Onward website + Coach
* Behavioral: Project Onward website
This study will develop and examine the effectiveness of an intervention that utilizes multiple telecommunications technologies to improve cancer survivors' access to mental health care and increase their ability to manage the high risk transition time from active cancer treatment to survivorship. The intervention, referred to as Project Onward, uses an interactive website, e-mail, telephone, and an online social network. The purpose of this study is to pilot a novel intervention that can reduce costs, examine methods to improve adherence to internet based treatment and overcome numerous barriers to treatment for mental health concerns.
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