Friday, August 06, 2010
Medical News: Anesthesia Given by Nurses Found Safe - in Anesthesiology, Anesthesiology from MedPage Today
The analysis -- funded by the American Association of Nurse Anesthetists -- looked at what happened after Medicare allowed opting out in 2001.
Note: see Einstein's quote at the top of this blog
Quality of life (QoL) in medicine and in oncology is an accepted parameter for the evaluation of the benefit of treatments. Scientific methods exist to assess QoL measures in clinical trials. However, many components of the person that are properly humane and determine the patient’s attitude towards the disease are not measured by current criteria. Based on clinical experience, the author considers that a shift in knowledge and in doctors’ attitudes is required to also include non-measurable parameters in the doctor-patient relationship.
Note: there are numerous articles of interest, but, subscription required $$$
Note: the abstract does not include what criteria was used to define "older"
The majority of older newly diagnosed cancer patients underwent the recommended cancer treatment but partial or complete cancer treatment refusal in older newly diagnosed cancer patients was not uncommon.
abstract: Ranked importance of outcomes of first-line versus repeated chemotherapy among ovarian cancer patients
Approximately half (54%) of newly diagnosed ovarian cancer patients (65% with residual disease >2 cm and 49% with no or ≤2 cm residual disease) ranked ‘tumour shrinkage (or decrease in blood levels of CA125)’ as ‘most important’ during first-line chemotherapy. Approximately two thirds (65–70%) of all women whose disease had relapsed also ranked ‘tumour shrinkage’ as ‘most important’ during repeated chemotherapy. Few women (<8%) rated symptom relief or absence of side-effects as most important. While both patients' and doctors' belief about cure decreased over successive treatments, patients grew more optimistic relative to doctors over time. Women's reports of advice by doctors about cure were consistent with doctors' stated intents for repeat chemotherapy. However, discordance between doctors' actual treatment intent and patients' beliefs about cure increased from 24% at first-line to 83% by fourth-line chemotherapy.
Women prioritise tumour response as the most important outcome of chemotherapy for ovarian cancer. This priority predominates in women with residual and relapsed disease despite declining likelihood of cure. Women may still hope for a cure while acknowledging their doctor's advice that their disease is incurable.
Correlation of extreme drug resistant assay results and progression-free survival following intraperitoneal chemotherapy for advanced ovarian cancer (Oncotech assay)
The aim of this study was to determine if in vitro extreme drug resistance (EDR) to platinum and/or taxane chemotherapy was predictive of patient response to intraperitoneal (I.P.) chemotherapy in patients with stage III or recurrent epithelial ovarian cancer (EOC).
Fifty-six patients were retrospectively identified who underwent optimal cytoreductive surgery for primary or recurrent eOC and then received at least three cycles of either intravenous (I.V.) or I.P. chemotherapy with platinum and paclitaxel-based chemotherapy. EDR to platinum and/or paclitaxel was determined using a commercially available assay (Oncotech, Inc., Tustin, CA).
The primary outcome measure was progression-free survival (PFS).
Twenty-nine (52%) patients received I.P. chemotherapy and 27 (48%) received I.V. chemotherapy. The patients were well matched in terms of age, stage, grade and histology. Ten (35%) patients in the I.OP. arm and ten (37%) patients in the I.V. arm showed EDR to either platinum and/or paclitaxel. Median PFS for all I.P. chemotherapy patients was 23 months, compared with 13 months for those receiving I.V. chemotherapy (p = 0.04).
Patients with EDR to platinum and/or taxane who underwent I.V. chemotherapy had a median PFS of 13.5 months, whereas those who underwent I.P. treatment had a median PFS of 15 months (p = 0.69). Median overall survival had not been reached at the time of analysis. No significant difference in PFS was noted between patients who underwent I.P. and those who underwent I.V. chemotherapy when EDR was predicted to either platinum or paclitaxel or both. These data suggest that the decision to offer I.P. chemotherapy, with the attendant increase in morbidity, in the setting of EDR to platinum and/or taxane chemotherapy, may not be beneficial.
Prospective studies, preferably analyzing platinum or taxane EDR individually, are required to validate these observations.
Weekly paclitaxel is a highly active and well tolerated regimen that is increasingly being adopted for the treatment of relapsed ovarian cancer. This regimen is usually administered at 80-90 mg/m(2)/week, and the use of a 1 h infusion helps minimize myelosuppression. When compared with the 3-weekly schedule, weekly paclitaxel is better tolerated, with a reduced frequency of grade 3-4 toxic effects. Single-agent weekly paclitaxel for relapsed ovarian cancer yields response rates in the range of 20-62%; however, response duration can be short. Responses to weekly paclitaxel have been observed in patients whose tumors are resistant to 3-weekly paclitaxel. The level of activity of weekly paclitaxel for relapsed disease has led to its detailed evaluation in the first-line setting, and interest has been enhanced by the results of a Japanese Gynecological Oncology Group study that demonstrated a survival advantage for weekly paclitaxel compared with 3-weekly paclitaxel in combination with carboplatin as initial treatment. The enhanced efficacy of weekly paclitaxel may be due to greater drug exposure, a direct antiangiogenic effect, or both. Current research topics include the combination of weekly paclitaxel with molecular-targeted agents and the use of molecular profiling to better select patients for treatment.
Second-line treatment of first relapse recurrent ovarian cancer.Australian and New Zealand Journal of Obstetrics and Gynaecology abstract
cytoreductive surgery • intraperitoneal chemotherapy • ovarian cancer
First-line therapy of advanced ovarian cancer involves primary cytoreductive surgery and adjuvant systemic chemotherapy. Progression of incompletely resected disease or recurrence after cytoreduction is inevitable. The approach to second-line treatment is ill-defined and chemotherapy remains the conventional approach, with surgery being reserved in some patients to debulk or palliate symptoms. Increasing evidence suggests that secondary cytoreduction improves progression-free and overall survival. This approach may be appropriate in selected patients. Intraperitoneal chemotherapy delivered in the adjuvant setting postoperatively has been shown to be more effective than systemic chemotherapy in advanced ovarian cancer after primary surgery. However, its use has not been well accepted and has not been adopted in secondary surgery. Hyperthermic intraperitoneal chemotherapy delivered intraoperatively during surgery has been of clinical interest and may prove to be efficacious and advantageous. The support of the gynaecological cancer medical and surgical community to embrace the efforts and assist in the recruitment of appropriate patients into randomised trials of first relapse recurrent ovarian cancer will provide answers to questions and establish evidence that would impact the care of ovarian cancer patients.
full free access: Women's Constructions of the 'Right Time' to Consider Decisions about Risk-Reducing Mastectomy and Risk-Reducing Oophorectomy (B.C.)
In-depth interviews were conducted with 22 BRCA1/2 carrier women and analyzed using qualitative, constant comparative methods.
pdf file (free access):A women-centred approach addresses issues beyond traditional
medical interventions, placing health in its broad social context, and also addresses barriers to access and respects women’s diversity . Although risk-reducing surgery decisions are women’s decisions, women should not be saddled with the burden of tackling barriers to accessing health care services.
Health care professionals, health care organizations, and government must work hard to resolve these challenges.