Friday, April 15, 2011
PR-USA - Immunovaccine Reports Positive Interim Data from Phase I Clinical Trial of DPX-0907 in Patients With Ovarian Cancer
"....The ongoing Phase I clinical trial of DPX-0907 is an open-label, dose-escalating evaluation of the vaccine's safety and tolerability in patients with advanced breast, ovarian or prostate cancer. Immunovaccine developed DPX-0907 with seven peptide antigens designed to target multiple cancer pathways.
Enrollment in the study has been completed. This preliminary evaluation examined vaccine responses in the first fifteen patients enrolled in the study; three with breast cancer, five with ovarian cancer and seven with prostate cancer. Immunovaccine will perform a more detailed analysis of samples collected from all patients by Q3 2011. Patients received three injections (0.25 mL or 1 mL) of the active immune therapy DPX-0907........"
press release: Experimental drug (NVP-BEZ235) inhibits cell signaling pathway and slows ovarian cancer growth
Note: in research
The study, performed on cells lines and mouse models, appears in the April 15, 2011 issue of the journal Clinical Cancer Research.
article - included comments:
'The experimental drug is being tested as a single agent at the Jonsson Cancer Center in human clinical trials against other solid tumors. Researchers involved with those studies have said early results are encouraging.
"This is clearly a promising agent with activity in humans," said Dr. John Glaspy, a professor of hematology/oncology and a Jonsson Cancer Center scientist involved with the studies. "We are still assessing its tolerability in patients."
Dorigo said he hopes to initiate a clinical trial for women with ovarian cancer that tests the combination of NVP-BEZ235 with platinum chemotherapy, as he believes that the combination might be more effective than each drug alone."
Annual Report Card on Cancer in Canada(TM) reveals canadians fighting cancer on two fronts: the disease and the system
Annual Report Card on Cancer in Canada(TM) reveals canadians fighting cancer on two fronts: the disease and the system Cancer Advocacy Coalition of Canada Provides New Insights into Current Cancer Landscape
Toronto, April 13, 2011 - The Cancer Advocacy Coalition of Canada (CACC) reveals in its 2010-2011 Report Card on Cancer in Canada that the current roadmap for cancer care in this country presents patients with numerous unnecessary barriers to accessing the care and support they need, from prevention programs, to timely diagnostics and access to treatment. At a time when they are at their weakest and most vulnerable, too often Canadian cancer patients are forced to fight not only their disease, but the healthcare system as whole, making an already complex and challenging journey even harder.....
For more information, or to view and download the 2010-2011 Report Card on Cancer in Canada, visit the CACC's website at www.canceradvocacy.ca.
Cochrane Review: abstract - Ultra-radical (extensive) surgery versus standard surgery for the primary cytoreduction of advanced epithelial ovarian can
Note: this blogger participated as a consumer reviewer
BACKGROUND: Ovarian cancer is the sixth most common cancer among women and the leading cause of death in women with gynaecological malignancies. Opinions differ regarding the role of ultra-radical (extensive) cytoreductive surgery in ovarian cancer treatment.
OBJECTIVES: To evaluate the effectiveness and morbidity associated with ultra-radical/extensive surgery in the management of advanced stage ovarian cancer.
MAIN RESULTS: One non-randomised study met our inclusion criteria. It analysed retrospective data for 194 women with stage IIIC advanced epithelial ovarian cancer who underwent either ultra-radical (extensive) or standard surgery and reported disease specific overall survival and perioperative mortality. Multivariate analysis, adjusted for prognostic factors, identified better disease specific survival among women receiving ultra-radical surgery, although this was not statistically significant (Hazard ratio (HR) = 0.64, 95% confidence interval (CI): 0.40 to 1.04). In a subset of 144 women with carcinomatosis, those who underwent ultra-radical surgery had significantly better disease specific survival than women who underwent standard surgery (adjusted HR = 0.64, 95% CI 0.41 to 0.98). Progression-free survival and quality of life (QoL) were not reported and adverse events were incompletely documented. The study was at high risk of bias.
AUTHORS' CONCLUSIONS: We found only low quality evidence comparing ultra-radical and standard surgery in women with advanced ovarian cancer and carcinomatosis. The evidence suggested that ultra-radical surgery may result in better survival. It was unclear whether there were any differences in progression-free survival, QoL and morbidity between the two groups. The cost-effectiveness of this intervention has not been investigated. We are, therefore, unable to reach definite conclusions about the relative benefits and adverse effects of the two types of surgery.In order to determine the role of ultra-radical surgery in the management of advanced stage ovarian cancer, a sufficiently powered randomised controlled trial comparing ultra-radical and standard surgery or well-designed non-randomised studies would be required.
Note: physician blog regarding NY Times article and empathy. (Many oncologists have probably been following Dr. Peter Bach’s moving and beautifully written series, recently concluded in the New York Times)
......Hearing the patient’s voice directly without health provider filtering is a small step toward minimizing traditional barriers to empathy. And I would have to believe that appreciating the psychosocial aspects of the patient’s cancer experience is the area that needs the most work for providers. I know that for my own practice and interactions with patients, I am probably decent at understanding physical toxicities – not that I can’t do a better job any given day. But I am sure I do far less well at understanding the true impact their cancer has on the things that I don’t see, like what happens when they go home and try to deal with the pressures of child care, trying to function at work while battling treatment-related fatigue, and agonizing over the financial impact of their cancer on their daily lives........
Thursday, April 14, 2011
"In the study, which was published online April 6 in PLoS ONE, Dr. Cosgrove and colleagues examined the potential association between tricyclic antidepressants (TCAs) or SSRIs and cancer in 35 preclinical and 26 epidemiologic studies."
"If you take women who have the same stage of breast cancer, and half have depression and the other half do not, the women with depression have twice the rate of death...That's enormous. That is so much bigger than the small increased risk shown in this study."
Governor Scott names local physician to state Board of Medicine
|Dr. James Orr, a local Florida physician, is appointed to the Florida Board of Medicine|
Dr. Orr is a nationally recognized expert in the management of reproductive tract cancer. In addition to an active medical practice, he currently serves or has served as the President of the Florida Obstetric and Gynecologic Society, the President of the Florida Society of Gynecologic Oncologists, The President of The Society of Gynecologic Oncologists (national), The Executive Committee of The American College of Obstetrics and Gynecology (national), as a board member of the American Cancer Society and vice chairman of the Lee Memorial Health System Foundation.....
Note: includes media commentary regarding financial conflicts of interest, doctors' barriers in advocating for patients....
Wednesday, April 13, 2011
UK phase 1 - ADZ5363 - New cancer drug to be tested by patients - Business News - Healthcare Digital
"Medication that prevents the enzyme, Protein Kinase B (PKB), has the potential to treat breast cancer, prostate cancer, ovarian cancer, pancreatic cancer and gastric cancers.
The Royal Marsden NHS Foundation Trust and the Christie Hospital NHS Trust in the UK are going to be involved in testing the drug, along with a hospital in the Netherlands.
Scientists and doctors are looking for patients with advanced solid tumours to test the drug, in order to determine the safety, tolerability and initial anti-cancer activity of ADZ5363....."
OVARIAN CANCER: South Coast Gynecologic Oncology is actively enrolling women with recurrent ovarian cancer for participation in a clinical research study called Trinova-1. The study is open to women 18 years or older who have been diagnosed with recurrent ovarian cancer, have undergone surgery to remove at least one ovary, and have been previously treated with chemotherapy. For details, call Judith Addison, RN, of South Coast Gynecologic Oncology at 858-455-5524 or visit www.TRINOVA-1.com.
When Combined with Chemotherapy, Bevacizumab Is Associated with Increased Risk of Death - National Cancer Institute (discusses various tumor types....
Note: this NCI article does not include ovarian cancer but does include platinum/taxane combination therapies (Carboplatin, Taxol); the JAMA paper most likely included ovarian cancer, however, the full text of the article is pay-per-view ($$$)
"The results were published February 2, 2011, in JAMA.":
Treatment-Related Mortality With Bevacizumab in Cancer Patients
"The overall incidence of FAEs (fatal adverse events) with bevacizumab was 2.5%."
Complementary and alternative medicine dialogue lacking between patients, providers , April 13, 2011 News Release - National Institutes of Health (NIH)
The AARP/NCCAM survey was conducted by telephone interview in October 2010, with a random sample of 1,013 people aged 50 and older.
For a complete copy of the survey report, please visit http://nccam.nih.gov/news/camstats/2010/.
Welcome to The Health Evidence Network of CanadaEvidenceNetwork.ca is a non-partisan web-based project funded by the Canadian Institutes of Health Research and the Manitoba Health Research Council to make the latest evidence on controversial health policy issues available to the media. This site links journalists with health policy experts to provide access to credible, evidence-based information.
Canadian Women's Health Network - survey re: care in nursing homes/long-term care - cancer patients - take survey!
We are a group of researchers with the national working group, Women and Health Protection, based at York University. We have a longstanding interest in the uses of prescription medications and in this project want to learn about the experiences of people who have family members* in long-term care facilities who may be taking prescription drugs. Family members often have the most direct knowledge about these issues and have much to contribute to a discussion about medication use. We hope to find out more about these experiences from responses to this survey, and plan to use this (anonymously-provided) information to develop a series of recommendations that may make things better for seniors in care.
If you are involved with the care of someone in a nursing home or long term care facility, we invite you to fill out the survey found at the following link:
The survey will take about 15-20 minutes to complete. All information you provide will be anonymous; no one is required to provide a name. More information about our research is provided in the introduction to the survey The closing date for completing this survey is Monday, 21 March 2011.
We thank you in advance for helping us out. And please pass this invitation to others you know who may have a family member* in long term care so we can hear from as diverse a group as possible. We have also attached a pdf of the survey if individuals would prefer to fill it in manually and return to us by mail.
Anne Rochon Ford, Co-Director
National Network on Environments and Women’s Health
Canada’s leading independent voice for trusted women’s health information is seeking a new Executive Director. The organization, with its head office in Winnipeg, has strong networks and affiliations throughout the country. The CWHN focuses on providing high quality information about women’s health for researchers, health care providers, policy makers and Canadian women.
We strive to be an independent, critical voice for women’s health in Canada. Throughout our 14-year history, we have helped to lead and define the women’s health agenda in this country. We have taken courageous positions, built strong communities, and spoken out on behalf of women and girls.
The CWHN is seeking an experienced, enthusiastic and determined champion for women’s health. We are looking for an exceptional woman to help us take our next steps into the future, a thoughtful leader with passion and a commitment to social change.
For the complete job posting, click the link below. Deadline is May 18, 2011.
Establishing specialty jurisdictions in medicine: the case of American obstetrics and gynaecology 2011 - Sociology of Health & Illness
Yet, recent research has neglected the intra-occupational processes influencing medical specialisation.
This article aims to correct this oversight.
It develops an historical account of intra-occupational factors influencing the decision to establish gynaecologic oncology as American ob/gyn’s surgical subspecialty in 1972. Working within the framework initially developed by Everett C. Hughes and his students, the article examines this development as the outcome of a three-party relationship among gynaecologic oncologists, American ob/gyns, and gynaecologic pelvic surgeons.
Aggressive movement by the gynaecologic pelvic surgeons challenging the established élite’s identity definition for the ob/gyn specialty helped spur official recognition of gynaecologic oncology, a less threatening subspecialty. The article draws theoretical implications from the case regarding the role of a threatening other in influencing the specialisation process.
Tuesday, April 12, 2011
full free access: PLoS ONE: Antidepressants and Breast and Ovarian Cancer Risk: A Review of the Literature and Researchers' Financial Associations with Industry
BackgroundAntidepressant (AD) use has been purported to increase the risk of breast and ovarian cancer, although both epidemiological and pre-clinical studies have reported mixed results –. Previous studies in a variety of biomedical fields have found that financial ties to drug companies are associated with favorable study conclusions .......
It is recommended that future research examine this body of literature and investigate the association between industry funding and qualitative conclusions regarding cancer risk.
OXiGENE, Inc. - OXiGENE Announces First Patient Enrolled in Phase 2 Study of ZYBRESTAT in Patients With Ovarian Cancer (comparing Avastin alone)
"SOUTH SAN FRANCISCO, Calif., April 11, 2011 (GLOBE NEWSWIRE) -- OXiGENE, Inc. (Nasdaq:OXGN), a clinical-stage, biopharmaceutical company developing novel therapeutics to treat cancer and eye diseases, announced today that clinical investigators have enrolled the first patient in a randomized Phase 2 trial of ZYBRESTAT in combination with bevacizumab in patients with relapsed ovarian cancer. The study, which is being conducted by investigators from the Gynecologic Oncology Group (GOG), is expected to enroll approximately 105 patients with a primary endpoint of progression-free survival. OXiGENE expects results of the study to become available in early 2013.
"We believe that the combination of an anti-angiogenic agent with a vascular disrupting agent in the treatment of ovarian cancer has the potential to represent an entirely new treatment paradigm for patients with relapsed disease," said Bradley Monk, M.D., FACS, Professor of Gynecologic Oncology at Creighton University Hospital and lead investigator of the study."Patients with recurrent ovarian cancer have few therapeutic options, and ZYBRESTAT could become a valuable addition to current treatment modalities."
The study is being conducted under a Cooperative Research and Development Agreement (CRADA) with the National Cancer Institute (NCI) for ZYBRESTAT and a CRADA with Genentech for the development of bevacizumab. The aim of the trial, sponsored by the NCI's Division of Cancer Treatment and Diagnosis, is to determine if the combination of ZYBRESTAT and bevacizumab will enhance anti-tumor effects and further delay tumor progression when compared to bevacizumab alone....."
Apr 12/2011 recruiting (contact information) Lynch Syndrome Survivorship Study - Cancerwise | Cancer blog from MD Anderson Cancer Center
"At MD Anderson, we are interested in finding out how colorectal cancer survivors live with having Lynch syndrome. We are currently recruiting for a new mailed survey study for people with Lynch syndrome who have had colorectal cancer.
Individuals who are over the age of 18 and English-speaking are eligible. The survey takes approximately 45 minutes and participants will receive a $10 gift card for their time.
If you are interested in participating or want more information, please contact Allison Burton, Ph.D., at 713-792-6280 or at firstname.lastname@example.org "
webcasts (3) prIME Oncology - after official ESMO: Evolving Strategies in the Management of Advanced Ovarian Cancer (Italy/US/Spain)
Conclusions: In this large prospective study, there was no association between duration of rotating night shift work and risk of ovarian cancer.
Impact: Although associated with other cancers, night shift work does not appear to be associated with increased risk of ovarian cancer. However, further exploration of the association between melatonin and risk of ovarian cancer is warranted.
CONCLUSION: In women with an adnexal mass, a diagnostic strategy prior to the decision for surgery by a general gynaecologist or a gynaecological oncologist provides the best balance between costs and effects.
"Newer definitions of EBM now acknowledge
that research evidence alone is not adequate
to guide action."
2011 Implementation Science - The effectiveness of strategies to change organisational culture to improve healthcare performance: a systematic review
BackgroundOrganisational culture is an anthropological metaphor used to inform research and consultancy and to explain organisational environments. Increasing emphasis has been placed during recent years on the need to change organisational culture in order to improve healthcare performance. However, the precise function of organisational culture in healthcare policy often remains under specified and the desirability and feasibility of strategies to be adopted have been called into question. The objective of this review was to determine the effectiveness of strategies to change organisational culture in order to improve healthcare performance.
ResultsThe search strategy yielded 4239 records. After the full text assessment, two CBA ( controlled before and after studies) studies were included in the review. They both assessed the impact of interventions aimed at changing organisational culture, but one evaluated the impact on work-related and personal outcomes while the other measured clinical outcomes. Both were at high risk of bias. Both reported positive results.
ConclusionsCurrent available evidence does not identify any effective, generalisable strategies to change organisational culture. Healthcare organisations considering implementing interventions aimed at changing culture should seriously consider conducting an evaluation (using a robust design, e.g. ITS) to strengthen the evidence about this topic.
Table of Contents
1. Executive Summary ................................................................................................. 1
2. Health Care and the Challenge for Governments .................................................... 3
3. The Magnitude of Canadian Health Care Costs ....................................................... 4
4. Health Care Costs are Sustainable for our Society .................................................. 5
5. Canadian Government Health Spending .................................................................. 7
6. Options for Governments ......................................................................................... 8
7. What is Responsible for Increased Health Care Spending? .................................... 9
7.1 What can be done to Control Health Spending? ............................................. 11
7.2 Addressing Social Determinants ..................................................................... 13
8. Costs and Cost Reductions - Summary ................................................................. 14
9. Market-based solutions .......................................................................................... 15
9.1 User Fees ....................................................................................................... 15
9.2 Private Insurance - the Health Care Market .................................................... 16
9.3 Health as a Commodity ................................................................................... 18
10. Public versus Private Finance ............................................................................ 19
10.1 Equity .............................................................................................................. 19
10.2 Autonomy ........................................................................................................ 19
10.3 Efficiency......................................................................................................... 20
10.4 Cost Control .................................................................................................... 21
10.5 Effectiveness ................................................................................................... 21
10.6 Wait lists.......................................................................................................... 22
10.7 Overall Economic Impact ................................................................................ 23
10.8 Physicians’ Work ............................................................................................. 24
10.9 Public versus Private Finance: The Bottom Line ............................................. 25
11. Public Options for Increasing Revenues for Health Care ................................... 25
11.1 Increasing income tax rates ............................................................................ 27
11.2 Elimination of the private health insurance subsidy ........................................ 27
11.3 Taxes directed to health care .......................................................................... 27
11.4 "Sin" taxes ....................................................................................................... 28
11.5 Social Insurance ............................................................................................. 29
12. Conclusion .......................................................................................................... 30
13. References ......................................................................................................... 32
National Coalition for Cancer Survivorship: Expense-Paid Training Opportunity on Oral Chemotherapy Adherence
Expense-Paid Training Opportunity on Oral Chemotherapy AdherenceThe National Coalition for Cancer Survivorship (NCCS), the National Association of Social Workers (NASW), the Oncology Nursing Society (ONS) and the Association of Oncology Social Work (AOSW) are pleased to host a Train-the-Trainer conference on cancer oral medication adherence at the NASW National Office in Washington, DC on Wednesday June 15, 2011. This one-day conference will provide attendees with the knowledge and skills necessary to train their colleagues in promoting adherence to cancer oral medication among patients and their family members. 30 people will be selected to participate in this one-day training, which will be led by social work, nursing and pharmacy professionals. Preference will be given to team applications. Expenses related to the conference (travel, lodging and meals) will be covered by NASW. In the 12 months following the conference, each attendee will be required to train at least 20 of his/her professional peers. Applications Due: Monday, April 25th . Click here to download the application materials.
Monday, April 11, 2011
American Academy of Neurology issues new guideline on best treatments for diabetic nerve pain (neuropathy)
Sunday, April 10, 2011
JAMA full free access: Health Outcomes After Stopping Conjugated Equine Estrogens Among Postmenopausal Women With Prior Hysterectomy-randomized control trial
Health Outcomes After Stopping Conjugated
Equine Estrogens Among Postmenopausal
Women With Prior Hysterectomy
By THE NEW YORK TIMES
Published: April 9, 2011
The Women’s Health Initiative and the Body Politic (April 10, 2011)
2003 Women taking E+P are not protected from mild memory loss; they are found to be at increased risk for developing dementia.
2004 The second W.H.I. hormone study is stopped one year early because women taking estrogen only show a small increased risk of stroke.
2006 An updated analysis of the estrogen-only trial shows hormone therapy does not increase the risk of breast cancer in postmenopausal women.
2007 Combined data from both hormone trials suggest that timing of therapy may affect risk; hormones may reduce heart disease in women who start therapy closer to menopause.
2009 Women using E+P for more than about five years double their annual risk of breast cancer. That risk is higher than previously thought.
2011 Follow-up of women in the estrogen-only study shows those who took just estrogen had 23 percent fewer breast cancers; younger estrogen users had 46 percent fewer heart attacks.
Sources: Women’s Health Initiative; New York Times reports
Friday, April 08, 2011
abstract: Differences in regional brain metabolism associated with specific formulations of hormone therapy in postmenopausal women at risk for AD (Alzheimer's disease)
"In conclusion, particular areas of relatively preserved metabolism were seen in women with more years of endogenous estrogen exposure, as well as in women taking estradiol-based formulations or estrogen therapies unopposed by progesterone, together suggesting regionally specific neuroprotective estrogenic effects."
abstract: Sympathetic and parasympathetic activity in cancer-related fatigue: More evidence for a physiological substrate in cancer survivors
also media report
"Persistent fatigue that plagues many breast cancer survivors even 10 years after treatment may be caused by the autonomic nervous, U.S. researchers say.'
Thursday, April 07, 2011
"...In the UK, bowel cancer is the one of the top three most common cancers diagnosed in both men and women, yet nearly three quarters of the women included in the survey did not recognize the disease as being one of the three most prevalent cancers in women."
"Menopausal status has a striking effect on the dose-response for the association," said Cramer. "Premenopausal women with frequent use may have more than a threefold increase in their risk for invasive serous cancer of the ovary. Repeating these analyses in existing data sets may help clarify the association between talc and ovarian cancer."
"....Despite the costs and resources involved, leading oncology organizations
plan conferences every year. Pre- and postconference events,
including conference-revisited events, are regular rituals after large
specialty conferences. But is the physical attendance of delegates at
conferences still required? Will the oncology community rise up and
stop this perennial waste of time, effort, and money and instead use
this money for a more scientific or nobler cause?5 One suggestion
would be to create a single global research fund to which all oncology
bodies and governments contribute and to which all nations,
both developed and developing, can apply for funding of their
trials. This would greatly improve the standards of global research
and enhance scientific pursuits."
"........But no matter how much time remains, and whether the goal of care is cure, control, or comfort, we can tell our patients with absolute certainty that we will not abandon them to the unknown."
Note: online version
Highlights of April 2011
Don’s Notes 1
Managing Your Fears and Anxieties 2
May Ovarian Cancer Survivor Course 3
Improving Care through Clinical trials 4
Suggestion/request from reader 4
Survivor Anniversaries for April 5
Upcoming Event 6
Tips for Traveling by Automobile 7
Resource: CarePages.com 7
Name change: From GCF to FWC 8
National Race to End Women’s Cancer 8
Survivor Course Schedule 8
June Ovarian Cancer Survivor Course 9
Grand Finale 10
PURPOSE: Patients with Lynch syndrome are much more likely to have generally rare upper urinary tract urothelial carcinoma but not bladder urothelial carcinoma. While the risk has been quantified, to our knowledge there is no description of how this population of patients with Lynch syndrome and upper urinary tract cancer differs from the general population with upper urinary tract cancer.
MATERIALS AND METHODS: We obtained retrospective data on a cohort of patients with Lynch syndrome from the Hereditary Cancer Center in Omaha, Nebraska and compared the data to those on a control general population from western Sweden. These data were supplemented by a new survey about exposure to known risk factors.
RESULTS: Of the patients with Lynch syndrome 91% had mutations in MSH2 rather than in MSH1 and 79% showed upper tract urothelial carcinoma a mean of 15.85 years after prior Lynch syndrome-type cancer. Median age at diagnosis was 62 years vs 70 in the general population (p <0.0001). Only half of our patients had a significant smoking history and the male-to-female ratio was 0.95. Of patients with Lynch syndrome 51% had urothelial carcinoma in the ureter while it occurred in the renal pelvis in 65% of the general population (p = 0.0013). Similar numbers of high grade tumors were found in the Lynch syndrome and general populations (88% and 74%, respectively, p = 0.1108).
CONCLUSIONS: Upper urinary tract tumors develop at a younger age and are more likely to be in the ureter with an almost equal gender ratio in patients with Lynch syndrome.
It has high grade potential similar to that in the general population.
"However, Huang and colleagues found no studies in the medical literature documenting the frequency and nature of menopausal symptoms in gynecologic cancer survivors."
"Note that the percentage of gynecologic cancer survivors who reported menopausal symptoms was extremely high regardless of whether they received hormonal therapy."
Medical News: AACR: Bad News, Good News for BRCA and Ovarian Ca - in Meeting Coverage, AACR from MedPage Today
Wednesday, April 06, 2011
AbstractThe purpose of this study was to investigate retrospectively the mRNA expression of genes involved in different DNA repair pathways implicated in processing platinum-induced damage in 171 chemotherapy-naïve ovarian tumours and correlate the expression of the different genes with clinical parameters. The expression of genes involved in DNA repair pathways (PARP1, ERCC1, XPA, XPF, XPG, BRCA1, FANCA, FANCC, FANCD2, FANCF and PolEta), and in DNA damage transduction (Chk1 and Claspin) was measured by RT-PCR in 13 stage I borderline and 77 stage I and 88 III ovarian carcinomas.
ERCC1, XPA, XPF and XPG genes were significantly less expressed in stage III than in stage I carcinoma; BRCA1, FANCA, FANCC, FANCD2 gene expressions were low in borderline tumours, higher in stage I carcinomas and lower in stage III samples. High levels of ERCC1, XPA, FANCC, XPG and PolEta correlated with an increase in Overall Survival (OS) and Progression Free Survival (PFS), whilst high BRCA1 levels were associated with PFS on univariate analysis.
With multivariate analyses no genes retained an association when adjusted by stage, grade and residual tumour. A tendency towards a better PFS was observed in patients with the highest level of ERCC1 and BRCA1 after platinum-based therapy than those given both platinum and taxol. The expression of DNA repair genes differed in borderline stage I, stage I and stage III ovarian carcinomas. The role of DNA repair genes in predicting the response in ovarian cancer patients seems far from being established.
"....With an aim toward making some small step forward in that direction, Cohn et al tried analyzing the cost-effectiveness of Avastin in the treatment of ovarian cancer. (I know I’ve written about Avastin here before, and I don’t mean to pick on this drug, as if it is the richest child on the fancy pharmaceutical playground. This kind of analysis works well here because the high-priced drug acts almost like a caricature for cost considerations in general.)..."
Research Advocacy Network: 2010 Survey of Advocates Providing Results to Participants in Biospecimen Studies
Overview of Advocate Survey
Summary and Conclusions
If you provided a biospecimen for research
purposes, would you want to know the
results of your individual tests? Would you
want these results only if they had health
implications? Who would you want to
provide you with these results – your
doctor? A genetic counselor? Someone else?..."
full free access: Proportion of second cancers attributable to radiotherapy treatment in adults: a cohort study in the US SEER cancer registries : The Lancet Oncology
Note: there is also chemotherapy-induced secondary cancers (not part of this study) but putting all treatment-related therapies (adverse events) in perspective
A relatively small proportion of second cancers are related to radiotherapy in adults, suggesting that most are due to other factors, such as lifestyle or genetics.
Colonic stenting versus emergency surgery for acute left-sided malignant colonic obstruction: a multicentre randomised trial : The Lancet Oncology
We aimed to establish whether colonic stenting has better health outcomes than does emergency surgery.
"Despite biologic plausibility and widespread enthusiasm, the IOM committee found that the evidence that vitamin D reduces cancer incidence and related mortality was inconsistent and inconclusive as to causality.
New trials assessing moderate-to-high-dose vitamin D supplementation for cancer prevention are in progress and should provide additional information within 5 to 6 years.
Although future research may demonstrate clear benefits of vitamin D related to cancer and other nonskeletal health outcomes, and possibly support higher intake requirements, the existing evidence falls short."
Apr 2011(pdf): Cost-Effectiveness of Genetic Screening for Lynch Syndrome (Available at obgmanagement.com)
Myriad Genetics Laboratories, Inc
• Lynch syndrome is a hereditary predisposition to
colorectal and endometrial cancers (and other specific
malignancies), resulting from a gene mutation
• Lynch syndrome is the most common heritable cause
of colorectal cancer and endometrial cancer
• Practice guidelines limit risk assessment of Lynch syndrome
to 1) genetic testing in people in whom malignancies
have already developed and 2) mitigation of
the impact of disease by colonoscopic and endometrial
surveillance, and surgical prophylaxis
• No primary screening strategies currently exist for Lynch
• Over 50% of women with Lynch syndrome who develop
two primary cancers develop a gynecologic cancer
before colon cancer
• Guidelines issued by ACOG recommend that ObGyns
incorporate identification and management of women
who have hereditary breast and ovarian cancer syndrome
into practice; similar guidelines do not exist for
• A new and powerful study has established evidence for
a protocol of primary screening of Lynch syndrome at a
particular threshold of individual risk
• Specifically, primary screening for unaffected patients,
with risk assessment conducted beginning between
25 and 35 years of age, followed by genetic testing of
people whose risk exceeds 5%, has the potential to improve
health outcomes in a cost-effective way
Saturday, April 02, 2011
...Clinical Practice Guidelines We Can Trust is the tandem document from the IOM—tandem in the sense that one of these standards states that a systematic review must precede guideline formulation. The IOM points out that the database of the Guidelines International Network includes more than 3700 guidelines from 39 countries. The standards were formulated to overcome common deficiencies—particularly in bias and how bias is handled—in existing guidelines. These deficiencies include the variable quality of evidence, poorly done systematic reviews, methodology that is not transparent, a development group that does not reflect all stakeholders, and unmanaged conflicts of interest. The IOM recommends that before the development group is formed, conflicts of interest need to be fully disclosed—and their definition includes financial, intellectual, and institutional interests. The prospective panel members should also explain how any conflicts they might have could influence the guideline process. The IOM is clear in some specific areas: members of the group need to divest relevant financial investments they or family members hold, and not take part in advisory boards or marketing activities with relevant companies. Additionally, the chair and co-chairs should have no conflicts of interest, members with conflicts should form a minority, and funders should have no role in guideline development. Overall, tough talk from the IOM—but much needed talk. Apart from expert members in the group, the standards include involvement of patients or their representatives.
Thursday, March 31, 2011
video/text: Palliative Medicine: Care versus Cure? Dr Diane Meier/ Richard Heffner's Open Mind - dialogue (U.S.)
AIR DATE: 2/26/2011
Wednesday, March 30, 2011
Increased Risk of CancerIf a parent carries a Lynch mutation there is a 50-50 chance that their child will inherit Lynch syndrome with
- 60 to 80 percent increased lifetime risk of colorectal cancer.
- 40 to 70 percent increased risk of endometrial cancer (cancer of the uterus lining).
- 13 percent increased risk for stomach cancer
- 12 percent increased risk of ovarian cancer.
- smaller, but significant risk of small intestine, urinary tract, heptobiliary (liver, gall bladder and bile ducts), skin, and brain cancers.
- Some families may also have increased risk for breast cancer.
Lynch Syndrome is also noted for multiple primary cancers (different cancers in one person)
"A unique formulation of antioxidants taken orally before imaging with ionizing radiation minimizes cell damage, noted researchers at the Society of Interventional Radiology's 36th Annual Scientific Meeting in Chicago, Ill. In what the researchers say is the first clinical trial of its kind, as much as a 50 percent reduction in DNA injury was observed after administering the formula prior to CT scans.
"In our initial small study, we found that pre-administering to patients a proprietary antioxidant formulation resulted in a notable dose-dependent reduction in DNA injury," said Kieran J. Murphy, M.D., FSIR, professor and vice chair, director of research and deputy chief of radiology at the University of Toronto and University Health Network, Toronto, Ontario, Canada. "This could play an important role in protecting adults and children who require imaging or a screening study," he added.
"Pre-administering this formula before a medical imaging exam may be one of the most important tools to provide radioprotection and especially important for patients in the getting CT scans," said Murphy. The study's data support the theory about a protective effect during these kinds of exposure, he explained....."cont'd
link to abstract:
We examine use of the free radical scavengers vitamin C (VC), glutathione (GL) and uric acid (UA) as a pre-medication strategy prior to radiation exposures typical of medical imaging studies. Our intent was to develop a simple cocktail of antioxidants to be taken orally prior to X-Ray exposures that can protect a patient’s DNA against free radical mediated radiation injury"
link to meeting:
Note: 61 articles
Note: 175 individual articles
Why do People get Cancer? « Dr. Robert A. Nagourney – Rational Therapeutics – Blog discusses multiple primaries uterine/colon (Lynch Syndrome)
Note: the article lacks specific drug/chemotherapy intervention information which may be helpful to others
open access journal: Journal of Ovarian Research Differential hRad17 expression by histologic subtype of ovarian cancer
In the search for unique ovarian cancer biomarkers, ovarian specific cDNA microarray analysis identified hRad17, a cell cycle checkpoint protein, as over-expressed in ovarian cancer. The aim of this study was to validate this expression.
Immunohistochemistry was performed on 72 serous, 19 endometrioid, 10 clear cell, and 6 mucinous ovarian cancers, 9 benign ovarian tumors, and 6 normal ovarian tissue sections using an anti-hRad17 antibody. Western blot analysis and quantitative PCR were performed using cell lysates and total RNA prepared from 17 ovarian cancer cell lines and 6 normal ovarian epithelial cell cultures (HOSE).
Antibody staining confirmed upregulation of hRad17 in 49.5% of ovarian cancer cases. Immunohistochemistry demonstrated that only 42% of serous and 47% of endometrioid subtypes showed overexpression compared to 80% of clear cell and 100% of mucinous cancers.
hRad17 is over-expressed in ovarian cancer. This over-expression varies by subtype suggesting a role in the pathogenesis of these types. Functional studies are needed to determine the potential role of this protein in ovarian cancer.
REVIEW ARTICLE Online Open article: Biosimilar agents in oncology/haematology: from approval to practice
The regulation of biosimilars is a process that is still developing. In Europe, guidance regarding the approval and use of biosimilars has evolved with the products under consideration. It is now more than 3 years since the first biosimilar agents in oncology support, erythropoiesis-stimulating agents, were approved in the EU. More recently, biosimilar granulocyte colony-stimulating factors have received marketing approval in Europe. This review considers general issues surrounding the introduction of biosimilars and highlights current specific issues pertinent to their use in clinical practice in oncology. Information on marketing approval, extrapolation, labelling, substitution, immunogenicity and traceability of each biosimilar product is important, especially in oncology where patients are treated in repeated therapy courses, often with complicated protocols, and where biosimilars are not used as a unique therapy for replacement of e.g. growth hormone or insulin. While future developments in the regulation of biosimilars will need to address multiple issues, in the interim physicians should remain aware of the inherent differences between biosimilar and innovator products.
Proportion of second cancers attributable to radiotherapy treatment in adults: a cohort study in the US SEER cancer registries : The Lancet Oncology
Blogger's Note: anticancer therapies also infer a risk of secondary cancers - treatment related secondary cancers - to put this in perspective
"State leaders, including the Governors of Oregon, Nevada, Arizona, Colorado, Missouri, Louisiana and Alabama, have joined a nationwide public awareness campaign by proclaiming March 30, 2011, Lynch Syndrome Hereditary Cancers Public Awareness Day....cont'd
full free access: Breast and Ovarian Cancer Risk due to Prevalence of BRCA1 and BRCA2 Variants in Pakistani Population: A Pakistani Database Report
Pakistani population has a very rich anthrogeneological background with waves of migration from neighboring regions. Incidence rates of breast and ovarian cancer in Pakistan are on such a rapid rise that it is necessary to check the contributory factors, genetic and nongenetic. An insight into the prevalence data emphasizes the formulation of a BRCA1 and BRCA2 database for the Pakistani population.....
Most of BRCA1 and BRCA2 research has been focused on the Caucasian populations; however, the allelic frequency of higher penetrance genes in the Asian population may be higher than that in Caucasian population.................. cont'd (abstract/full free access)
see full paper for further information
examples: Figure 3 & 4: (brca 1/brca 2/specific mutations/variants):
abstract: DICER1 Mutations in Familial Multinodular Goiter (thyroid) With and Without Ovarian Sertoli-Leydig Cell Tumors
multinodular goiter - A multinodular goiter is a thyroid gland that is usually enlarged and contains multiple thyroid nodules.
Pleuropulmonary blastoma (PPB) is a rare cancer originating in the lung or pleural cavity....
Cisplatin and several related antineoplastic agents used to treat many types of solid tumors are neurotoxic, and most patients completing a full course of cisplatin chemotherapy develop a clinically detectable sensory neuropathy. Effective neuroprotective therapies have been sought.
At present, the data are insufficient to conclude that any of the purported chemoprotective agents (acetylcysteine, amifostine, calcium and magnesium, diethyldithiocarbamate, glutathione, Org 2766, oxycarbazepine, or Vitamin E) prevent or limit the neurotoxicity of platin drugs among human patients.
EvidenceUpdates: Interventions to enhance return-to-work for cancer patients. Cochrane Database Systematic Rev. 2011
Cancer survivors are 1.4 times more likely to be unemployed than healthy people. It is therefore important to provide cancer patients with programmes to support the return-to-work process.
OBJECTIVES: To evaluate the effectiveness of interventions aimed at enhancing return-to-work in cancer patients.
|link - updated Comments from Clinical Raters|
Tuesday, March 29, 2011
included in the article:
This month The Journal of the American College of Surgeons published the results of a study on how well patients come through when a surgeon-in-training is involved in the operation.
(STUDY DESIGN:We identified 607,683 surgical cases from 234 hospitals from the 2006 to 2009 American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP). Outcomes were compared by resident involvement for all general and vascular cases as well as for specific general surgical procedures.)
Surgeons' and residents' double-gloving practices at 2 teaching hospitals in Ontario (patient safety/injury)
".......Of the 77% who reported at least 1 injury/year, 67% stated that they had not reported it to an employee health service.
Background: Surgeons and residents are at increased risk of exposure to blood-borne pathogens owing to percutaneous injury (PI) and contamination. One method known to reduce risk is double-gloving (DG) during surgery.
Conclusion: Percutaneous injuries occur frequently during surgery, yet routine DG (double gloved), an effective means of reducing risk, was carried out by less than half of the surgeons and residents participating in this study. This highlights the need for a more concerted and broad-based approach to increase the use of a measure that is effective, inexpensive and easily carried out."
"........Perhaps a wider range of
skills would provide new surgeons with a buffer, helping
them to work within a resource-constrained system. The
idea that “you get to know so much about 1 thing that
pretty soon you know little about everything” haunts surgeons
who limit their skill sets...."
2) states included in report: Arkansas, California, Delaware, Florida, Louisiana, Michigan, Missouri, Montana, North Carolina, Ohio, Pennsylvania, Tennessee, Texas
The Natural Resources Defense Council (NRDC) is an international nonprofit environmental organization with
more than 1.3 million members and online activists. www.nrdc.org.
Disease, and the need to Protect
People from Toxic Chemicals
An unusually large number of people sickened by a disease in a certain place and
time is known as a ‘disease cluster’. Clusters of cancer, birth defects, and other
chronic illnesses have sometimes been linked to chemicals or other toxic pollutants
in local communities, although these links can be controversial. There is a need for
better documentation and investigation of disease clusters to identify and address
possible causes. Meanwhile, toxic chemicals should be identified and controlled
through reform of the Toxic Substances Control Act, so these chemicals don’t
pollute communities and sicken people.
full free access: Subtype-specific mutation of PPP2R1A in endometrial and ovarian carcinomas - Journal of Pathology
AbstractPPP2R1A mutations have recently been described in 3/42 (7%) of clear cell carcinomas of the ovary. ...............This putative tumour suppressor complex is involved in growth and survival pathways. Through targeted sequencing of PPP2R1A, we identified somatic missense mutations in 40.8% (20/49) of high-grade serous endometrial tumours, and 5.0% (3/60) of endometrial endometrioid carcinomas. Mutations were also identified in ovarian tumours at lower frequencies: 12.2% (5/41) of endometrioid and 4.1% (2/49) of clear cell carcinomas. No mutations were found in 50 high-grade and 12 low-grade serous carcinomas. Amino acid residues affected by these mutations are highly conserved across species and are involved in direct interactions with regulatory B-subunits of the PP2A holoenzyme. PPP2R1A mutations in endometrial high-grade serous carcinomas are a frequent and potentially targetable feature of this disease. The finding of frequent PPP2R1A mutations in high-grade serous carcinoma of the endometrium but not in high-grade serous carcinoma of the ovary provides clear genetic evidence that these are distinct diseases
Monday, March 28, 2011
Charities Listings (ovarian cancer) Canada - government of Canada website including tax return information
Basic Search ResultsStatistics and data on the Charities and Giving Web pages are compiled by the Charities Directorate of the Canada Revenue Agency (CRA) for the sole purpose of providing the public with direct access to information about charities in Canada.
The CRA is not responsible for the use and manipulation by any persons of this information.
Charity Status: Canadian Registered Charities
Charity Name: ovarian cancer
5 matches found.
"....What about all of us who are carrying around the baggage of the disease? It's real and if you ask me, it's an epidemic."
Treating Depression with Anti-Inflammatory Agents > CMELLC - Life Long Learning > Treating the Whole Patient
Note: interesting discussion regarding aspirin (anti-inflammatory) and depression
Expert Review - slides: Renal Cell Carcinoma Biology and the Rationale for VEGF (sorafenib, sunitinib, erlotinib, avastin, interleukins, etc)
|Note: if you are unable to access this slide presentation it is because you need to register on the site (free); it may be of interest to those with clear cell ovarian cancer; the largest % of renal cancers are of the clear cell subtype (a known ~75%) |
MODULE 1: Renal Cell Carcinoma Biology and Rationale for VEGF
Expert review with Lee Lokey, MD, and Brian I. Rini, MD, focusing on renal cell carcinoma
|Discussant:||Brian I. Rini, MD—Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio, United States|
|Interviewed by:||Lee Lokey, MD—prIME Oncology, Atlanta, Georgia, United States|
click here for the pdf file
Although there is still much we don’t know, today the picture of wait times across priority areas and provinces is more complete and comparable than in the past. All-Canada estimates indicate that 8 out of 10 patients across the country receive priority procedures (hip, knee, hip fracture repair, cataract and bypass
surgery and radiation treatment) within the time frames that clinical evidence shows is appropriate. That said, the likelihood of receiving treatment within these time frames varies considerably, depending on both the priority area and where one lives in Canada. While there have been some improvements in wait times for priority area procedures over the last three years, these improvements are not being seen consistently across
all procedures or across all provinces. The ability to report these important findings has been enabled by provincial collaboration on measuring and collecting data. Important steps remain in improving consistency of cardiac urgency levels, as well as building more comprehensive diagnostic imaging data before the wait time information can be assessed in a more meaningful way."
Sunday, March 27, 2011
Saturday, March 26, 2011
audio interview - critical discussion: CBC.ca | Q | Does "Pink" Serve the Breast Cancer Cause? (and discusses other cancers)
(cbc blog) http://www.cbc.ca/q/blog/2010/10/06/what-do-you-think-about-pink/
Risk assessment for recurrent venous thrombosis – The Lancet (as it applies to transdermal oestrogens)
Note: author's response to commentaries on the original research article, links included to the discussion
The case for a global rare-diseases registry
Friday, March 25, 2011
Thursday, March 24, 2011
worth reading especially the viewpoint: 2 items: editorial (patient consent/genetics) + viewpoint (breaching patient privacy)
Rapid Online Publications Editorial
Alerting genetic relatives to a risk of serious inherited disease without a patient’s consent Graeme K Suthers, Elizabeth A McCusker and Samantha A Wake MJA Rapid Online Publication — 24 March 2011 http://www.mja.com.au/public/issues/194_11_060611/sut11435_fm.html Viewpoint (blogger's opinion - excellent article) Doctors breaching patient privacy: Orwell redux David J Handelsman, Leo A Turner and Ann J Conway MJA Rapid Online Publication — 24 March 2011 http://www.mja.com.au/public/issues/194_11_060611/han10307_fm.html
Combinations of analgesics, antisecretory drugs, and antiemetics can provide acceptable symptom relief.
A venting gastrostomy should be considered if drug therapy fails to reduce nausea and vomiting to an acceptable level.
A nasogastric tube should be used only as a temporizing measure, until symptoms are controlled medically or a venting gastrostomy is placed.
Total parenteral nutrition is beneficial only in patients with intermediate life expectancy who may otherwise die of starvation rather than the cancer itself.
Will Open Government make Canada's health agencies more transparent? -- Canadian Medical Association Journal
"But secrecy and lack of public involvement undermine accountability and the credibility of public institutions and their decisions. They diminish
public trust and feed conspiracy theories."
Note: a similar paper regarding splenectomy - posted on this blog Sept 6, 2010
We sought to examine how splenectomy as part of up-front cytoreductive surgery in ovarian cancer influences the postoperative course and affects survival.
The addition of splenectomy to up-front cytoreductive surgery was feasible and safe. However, it appears to carry with it a shortened survival that is unrelated to postoperative morbidity. Our data raise the questions that splenectomy is needed for optimal cytoreduction in more biologically aggressive disease and that splenectomy may be an independent prognostic factor related to depressed immune function.
of interest: "HE4 was not elevated in endometriosis"
The major advantage of HE4 lies in its specificity and improved detection of borderline tumors and early stage ovarian and tubal cancers. HE4 is superior to CA125 with or without RMI and ROMA indices. However, we see no benefit from combining both markers in clinical practice.
Adequacy of risk-reducing gynaecologic surgery in BRCA1 or BRCA2 mutation carriers and other women at high risk of pelvic serous cancer
"...Four serous ovarian cancers and one endometrioid endometrial cancer were detected during surgery or pathological examination.
In conclusion Australasian women attending a specialist gynaecologic oncologist for RRGS (risk reducing gynaecologic surgery) are most likely to have adequate surgery and pathological examination.
Additional education of clinicians and consumers is needed to ensure optimal surgery and pathology in these women."
Improved 5-year disease-free survival for FIGO stage I epithelial ovarian cancer patients without tumor rupture during surgery
Objective.To investigate the impact of perioperative capsule rupture on disease-free survival (DFS) and cancer-specific survival (CSS) in patients with FIGO stage I epithelial ovarian cancer (EOC I).
Methods.This prospective population-based study enrolled all 279 patients with EOC I diagnosed in Norway between 2002 and 2004. All patients underwent primary surgery. The data were collected from notification reports to the Norwegian Cancer Registry and included medical, surgical and histopathological records. Kaplan–Meier plots were used to show differences in DFS and CSS. Cox regression analyses were used to show the effect of prognostic factors on survival, expressed as hazard ratios (HRs).
Results.Significantly more patients in the capsule rupture group (Cr group) had clear cell tumors (28%) than in the FIGO stage IA and IB (AB group: 14%) groups, and the FIGO stage IC (C group: 17%; p < 0.05) group. Despite adjuvant chemotherapy (AC), these patients had a poor 5-year DFS, 94% in the non-AC group and 81% in the AC group (p < 0.01).
After five years of follow-up, there was a lower DFS among patients in the Cr group (79%) and the C group (81%), compared with patients in the AB group (91%; p < 0.05). Independent prognostic factors at the time of diagnosis were grade, histological type, ascites, adhesions, performance status, CA125 and DNA ploidy.
After correcting for the four most important prognostic factors (grade, histological type, ascites, and DNA ploidy), the HR for recurrence was 4.0 (95% CI 1.3–12.7; p < 0.05) for the Cr group and 1.8 (95% CI 0.5–6.1; p = 0.3) for the C group, compared with the AB group.
Conclusions.Improvement was observed in the 5-year DFS for EOC I patients without tumor rupture during surgery compared with those with tumor rupture. Since AC did not improve the long-term DFS and CSS rates, it is of utmost importance that surgeons avoid tumor rupture during surgery.
Research Highlights► Impact of perioperative capsule rupture on DFS and CSS in stage I epithelial ovarian cancer.
► The study was prospective and population-based.
► Stage I epithelial ovarian cancer without tumor rupture during surgery has improved at the 5-year DFS.
Our professional staff members intervene by making conference calls when needed, assisting with appeals to insurance
companies or the Social Security Administration, negotiating with providers in medical debt situations or securing access to care.
Our staff strive for positive resolutions whenever possible.
Wednesday, March 23, 2011
Women's Health - Full Text: Preventing familial breast and ovarian cancer: major research advances with little implication
|Rare BRCA mutations|
|Genome-wide association studies|
|Next generation of GWAS|
|Whole-genome & exome sequencing|