Tuesday, July 20, 2010
What the Doctor Is Really Thinking - WSJ.com
"The year-long OpenNotes study, funded with a $1.5 million grant from the Robert Wood Johnson Foundation, involves 25,000 patients and their primary-care physicians at Beth Israel Deaconess, Geisinger Health System in Danville, Pa., and Harborview Medical Center in Seattle. "We want to break down an important wall that currently separates patients from those who care for them," says lead investigator Tom Delbanco, a Harvard Medical School professor who treats patients at Beth Israel."
"Patients have a legal right to see their entire medical record including doctor's notes."
Lynch Syndrome symposium (free) Saturday August 28th, 2010 Indianapolis IN
see brochure (pdf file) for registration details:
www.stvincent.org/.../Cancer/LynchCMESymposium_Brochure.pdf
St.Vincent Cancer Care
Attention: Heather Tibbs
8402 Harcourt Road, Suite 324
Indianapolis, IN 46260
317-338-3188
317-583-2325 (fax)
hrtibbs@stvincent.org
sponsors:
AmeriPath; Myriad
Vanderbilt First to Use Specialized PET/CT Scan to Uncover Cancerous Tumors
"....The 68Ga-DOTATATE PET/CT scan offers higher resolution and sensitivity locating tumors. Although performed in Europe, this specialized type of radiologic scan has been viewed in the U.S. as offering only limited benefit to a small number of cancer patients. However a recent increase of neuroendocrine cancers seen at Vanderbilt led Walker and his associates to more widely apply usage of this new technology...."
Transparency Through Open Notes: The Risks And Rewards Of Inviting Patients To Review Their Medical Records-media article
"In “Open Notes: Doctors and Patients Signing On,” published in the July 20 issue of the Annals of Internal Medicine, researchers speculate about the risks and rewards of making clinicians’ notes transparent to patients."
Understanding Prognosis and Cancer Statistics - National Cancer Institute
"Because survival rates are based on large groups of people, they cannot be used to predict what will happen to a particular patient. No two patients are exactly alike, and treatment and responses to treatment vary greatly."
Understanding risk : Cancer Research UK
Understanding risk
Every week it seems that there’s a news story about something that increases or cuts the risk of cancer.Often, these reports are full of numbers - 11 per cent lower risk, 65 per cent increased risk, double the risk - but what do they actually mean?
To make things clearer, there’s a detailed explanation of risk on our Healthy Living pages.
Read our other top tips:
abstract: Presenting the Results of Cochrane Systematic Reviews to a Consumer Audience: A Qualitative Study
Results. Participants preferred results presented as words, supplemented by numbers in a table. There was a lack of understanding regarding the difference between a review and an individual study, that the effect is rarely an exact number, that evidence can be of low or high quality, and that level of quality is a separate issue from intervention effect.
Conclusion. Through testing and iteration the authors identified and addressed several problems, using explanations, rephrasing, and symbols to present scientific concepts. Other problems remain, including how best to present confidence intervals and continuous outcomes. Future research should also test information elements in combination rather than in isolation. The new Plain Language Summary format is being evaluated in a randomized controlled trial.
Weight, Physical Activity, Diet, and Prognosis in Breast and Gynecologic Cancers --JCO (abstract)
ABSTRACT
Diet, physical activity, and weight may affect prognosis among women who are diagnosed with breast or gynecologic cancer. Observational studies show associations between being overweight or obese and weight gain with several measures of reduced prognosis in women with breast cancer and some suggestion of poor prognosis in underweight women. Observational studies have shown an association between higher levels of physical activity and improved breast cancer–specific and all-cause mortality, although a dose-response relationship has not been established. One large randomized controlled trial reported increased disease-free survival after a mean of 5 years in patients with breast cancer randomly assigned to a low-fat diet versus control. However, another trial of similar size found no effect from a high vegetable/fruit, low-fat diet on breast cancer prognosis. The few reported studies suggest that obesity negatively affects endometrial cancer survival, while the limited data are mixed for associations of weight with ovarian cancer prognosis. Insufficient data exist for assessing associations of weight, physical activity, or diet with prognosis in other gynecologic cancers. Associations of particular micronutrient intake and alcohol use with prognosis are not defined for any of these cancers. The effects of dietary weight loss and increase in physical activity on survival or recurrence in breast and gynecologic cancers are not yet established, and randomized controlled trials are needed for definitive data.
A review of PARP inhibitors: from bench to bedside — Ann Oncol
Conclusion: PARP inhibitors show promise as a powerful therapeutic tool, especially in the management of BRCA-associated breast and ovarian cancers but also in tumours where BRCA genes may be dysfunctional. Clinical studies are ongoing and many translational questions remain unanswered that will help clarify how to determine the best way to use PARP inhibitors.
abstract: Cochrane Collaboration review: DNA-repair pathway inhibitors for the treatment of ovarian cancer (PARP inhibitors)
"Our objective was to compare effectiveness and side effects of PARP inhibitors compared to conventional chemotherapy in women with ovarian cancer. The identification of a safe dose of AZD2281 (a PARP inhibitor) has been found by small non randomised trials, with encouraging results. For ovarian cancer, there are currently two ongoing RCTs, but outcome data are not yet available. Results of these trials are awaited to determine if DNA repair inhibitors have a role in addition to conventional chemotherapy in the treatment of ovarian cancer."
Main results
The search strategy identified 473 unique references of which 461 were excluded on the basis of title and abstract. The remaining 12 articles were retrieved in full, but none satisfied the inclusion criteria. However, two ongoing randomised phase II clinical trials were identified from the clinical trials databases that met our inclusion criteria, but no preliminary data were available.
Authors' conclusions
There are to date no published RCT data on the effectiveness and side effects of DNA-repair pathways inhibitors used alone or in association with conventional chemotherapy in the treatment of ovarian cancer. On-going trials have been identified and results are awaited and will be included in future updates of this review.
Identifying Adverse Drug Reactions Associated with Drug-Drug Interactions: patient/drug safety
Conclusions: This study validates that spontaneous reporting, despite its limitations, can be an important resource for detecting ADRs associated with the concomitant use of interacting drugs. Moreover, our data confirm that DDIs could be a real problem in clinical practice, showing that more than one in five patients exposed to a potential DDI (drug-drug-interaction) experienced a related ADR (adverse drug reaction).
Overcoming TRAIL resistance in ovarian carcinoma
CONCLUSION: Continued efforts with combination therapy designed to target multiple steps in apoptotic pathways may not only improve the efficacy of TRAIL-mediated therapies, but may also improve quality of life for ovarian cancer patients by reducing toxicity associated with cancer therapy.
abstract: Measuring the effect of including multiple cancers in survival analyses using data from the Canadian Cancer Registry
Background: In survival analyses using cancer registry data, second and subsequent primary cancers diagnosed in individuals are typically excluded.
Conclusion: Inclusion of second and subsequent primary cancers in the analysis tended to lower estimates of relative survival, the extent of which varied by cancer and age and depended in part on the proportion of first primary cancers.
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