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

full free access: Malignant bowel obstruction: Individualized treatment near the end of life

Key points

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."

Prognostic Significance of Splenectomy as Part of Initial Cytoreductive Surgery in Ovarian Cancer

Note:  a similar paper regarding splenectomy - posted on this blog Sept 6, 2010




PURPOSE: 
 We sought to examine how splenectomy as part of up-front cytoreductive surgery in ovarian cancer influences the postoperative course and affects survival.

CONCLUSIONS: 
 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.

No benefit from combining HE4 and CA125 as ovarian tumor markers in a clinical setting

of interest: "HE4 was not elevated in endometriosis"
CONCLUSIONS:
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

Abstract

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.

(U.S.) Patient Advocate Foundation :: 1-800-532-5274

Patient Services

Patient Advocate Foundation offers patient services by telephone to those in need that fall under the scope of our services.
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.