Monday, January 16, 2012
BMJ Group blogs: Liz Wager: Do we need to rethink our approaches to research misconduct and research integrity?
"....Having failed to start a reasonable conversation about research integrity, based on major scandals, we see no point in trying to address so-called “minor” offences. But as Iain Chalmers said at the meeting, “lesser offences,” such as failing to publish research and publishing welcome results more often than disappointing results, harms many more patients than the high profile scandals (since it distorts the evidence on which guidelines and clinical practice are based). While plagiarism may be a nasty symptom of a sick system, it has probably never killed anybody while unreliable guidelines and misguided research undoubtedly have....."
abstract: Prevalence of BRCA1 and BRCA2 mutations in Ashkenazi Jewish families with breast and pancreatic cancer
BACKGROUND:
Germline mutations in the BRCA2
cancer susceptibility gene are associated with an increased risk of
pancreatic cancer (PC). Breast-pancreas cancer families with BRCA1 mutations have also been observed. The influence of a family history (FH) of PC on BRCA mutation prevalence in patients with breast cancer (BC) is unknown.
CONCLUSIONS:
BRCA1 and BRCA2 mutations are observed with nearly equal distribution in AJ breast-pancreas cancer families, suggesting that both genes are associated with PC risk. In this population, a FH of PC was found to have a limited effect on mutation prevalence.Major Cancer Societies to Support New Wiley Open Access Journal
January 16, 2012 – Wiley-Blackwell, the scientific, technical, medical and scholarly publishing business of John Wiley & Sons, Inc., today announced the launch of Cancer Medicine, a new Wiley Open Access journal. Cancer Medicine is a peer reviewed, open access, interdisciplinary journal providing rapid publication of cutting edge research from global biomedical and clinical researchers across all the oncologic specialties in cancer biology, clinical cancer research and cancer prevention. The journal’s promise of full global reach is reinforced by its editorial leadership and support from prestigious journals and societies. Cancer Medicine has unprecedented support from three major cancer societies......
Dr. Wei (Editor in Cheif) comments, “I am delighted to introduce Cancer Medicine, which will allow readers to have fast access to the most up to date global collaborations in cancer research and international approaches in practicing cancer medicine, as well as highlighting key achievements from the integration of basic, clinical and preventive research of cancer. In the years to come, I will work closely with the Wiley-Blackwell Cancer Medicine team to provide timely and impartial service to all contributors and readers, who will, without a doubt, make Cancer Medicine a success.”
The journal is open to submissions now and aims to publish its first content online in Spring 2012. Please visit the journal’s website www.cancermedicinejournal.com for further information and future updates.
Resources for Health Care Providers [NCCAM] - Complimentary and Alternative Medicine
Evidence-Based Medicine
- Results of NCCAM Research
- Literature Reviews from PubMed®
- Evidence Reports from AHRQ
- Cochrane Reviews (The Cochrane Collaboration)
Clinical Practice Guidelines
For Your Patients
Printable fact sheets and links to more resources.Abstract: Training Surgeons and the Informed Consent Process: Routine Disclosure of Trainee Participation and Its Effect on Patient Willingness and Consent Rates
Patients
Three hundred sixteen individuals scheduled for elective surgery.
Conclusions
Most patients expressed approval of teaching facilities and resident education. However, consent rates were significantly altered when more detailed information was provided and they declined with increasing levels of resident participation. Providing detailed informed consent is preferred by patients but it could adversely affect resident participation and training.
Million Women Study Wrong, Group Says - in Endocrinology, Menopause from MedPage Today
"A study long used to establish causal links between hormone replacement therapy (HRT) and breast cancer is severely flawed, a group of epidemiologists have charged. The observational Million Women Study (MWS), conducted in the U.K., doesn't adequately satisfy several criteria for causality -- including information bias, detection bias, and biological plausibility -- and thus can't be used to conclude that HRT causes breast cancer, according to Samuel Shapiro, PhD, of the University of Cape Town in South Africa, and colleagues.
"HRT may or may not increase the risk of breast cancer, but the MWS did not establish that it does," they wrote in the Journal of Family Planning and Reproductive Healthcare.
Several experts not involved in the study, however, have emphasized that they're well aware of the limitations of observational studies such as the MWS, and that the totality of evidence thus far has shown a strong association between HRT and breast cancer....."
"The analysis of the Million Women Study is the latest in a series of four papers by the Shapiro group exploring the credibility of three studies -- the MWS, the Women's Health Initiative (WHI), and the collaborative reanalysis (CR) -- that causally linking HRT, particularly estrogen plus progestogen therapy, with breast cancer.
The earlier papers similarly found that neither the CR nor the WHI could satisfy criteria for establishing causality...."
Changes in tumor cells that lead to metastasis CTC's/circulating tumor cells)
ScienceDaily (Jan. 16, 2012) — Researchers at the Centro de Genómica e Investigación Oncológica (GENYO) -of which the University of Granada, Pfizer and the Andalusian Regional Government are members- have identified the genetic and phenotypic changes that cause tumor progression and metastasis. The process of metastasis -- which is the main cause of cancer death -- is caused by tumor cells invading distant organs with no direct anatomical relationship with the organ originally affected. For this to happen, it is necessary that these cells -which researchers call "circulating tumor cells" (CTCs) -, travel to these organs through blood....
"Biodynamics of Circulating Tumor Cell, Tumor Microenvironment and Metastasis," published in the journals Cancer Biology & Therapy, Clinical Translational Oncoly y Annals of Oncology.
abstract: Re-operation outcome in patients referred to a gynecologic oncology center with presumed ovarian cancer FIGO I-IIIA after sub-standard initial surgery
Blogger's Note:
1) this issue is not a new issue irrespective of country origin
2) it would be helpful if a timely comprehensive study be done (retrospective) on the fatality rates, stage and pathology, and according to surgeon/upstaging required via eg. national registries albeit the data bases most likely are lacking; until mandates are in place requiring specific surgical skills in surgical oncology these practices will continue (past and future decades)
Abstract
Background
Surgery is the mainstay of treatment for early ovarian cancer both as therapeutic and comprehensive staging. Only the latter allows appropriate tailoring of systemic treatment. However, the compliance with guidelines for comprehensive staging has been reported to be only moderate and, therefore, re-staging procedures are commonly indicated to avoid undertreatment. The purpose of our study was to evaluate re-operation (2nd surgery) in a tertiary gynecologic oncology unit after primary operation for presumably ovarian cancer FIGO I-IIIA in general gynecology departments. Only 5 patients (13%) were classified as having had a comprehensive staging by surgical records and pathology reports and 35 patients underwent comprehensive re-staging laparotomy after which 20 patients (50%) experienced an upstaging including 13 patients with final diagnosis of FIGO stage IIIC.Results
40 patients were enrolled of whom 53% came by self-referral. Only 18% were referred by the primary surgeon and the remaining patients were referred by their home gynecologist..........Conclusion
Comprehensive staging of presumed early ovarian cancer has been described as major problem especially outside gynecologic oncology units. Re-staging results in our department confirmed this deficiency by showing a considerable proportion of upstaging associated with alterations of recommendations for systemic treatment. However, series like this may even underestimate the problem, because incomplete staging is unfortunately accompanied by non-systematic referral practices not reflecting staging quality.Access : Open-label feasibility study of pazopanib, carboplatin, and paclitaxel in women with newly diagnosed, untreated, gynaecologic tumours: a phase I|[sol]|II trial of the AGO study group : British Journal of Cancer
"Severe myelotoxicity was reported in 6 of 12 patients."
Conclusion:
Conclusion:
Combining either 800 or 400 mg per day pazopanib with standard carboplatin/paclitaxel chemotherapy is not a feasible treatment option.
Seth's Blog: "Straight up"
Blogger's Note: a blog worth following
“On some positions, Cowardice asks the question, "Is it safe?" Expediency asks the question, "Is it politic?" And Vanity comes along and asks the question, "Is it popular?" But Conscience asks the question "Is it right?" And there comes a time when one must take a position that is neither safe, nor politic, nor popular, but he must do it because Conscience tells him it is right.”
Access : CA-125 can be part of the tumour evaluation criteria in ovarian cancer trials: experience of the GCIG CALYPSO trial : British Journal of Cancer
Background:
CA-125 as a tumour progression criterion in relapsing ovarian cancer (ROC) trials remains controversial. CALYPSO is a large randomised trial incorporating CA-125 (GCIG criteria) and symptomatic deterioration in addition to Response Evaluation Criteria in Solid Tumours (RECIST) criteria (radiological) to determine progression.
......In patients with CA-125 first progression who subsequently progressed radiologically, a delay of 2.3 months was observed between the two progression types......
......In patients with CA-125 first progression who subsequently progressed radiologically, a delay of 2.3 months was observed between the two progression types......
Conclusion:
CA-125 and radiological tests performed similarly in determining progression with C-PLD (carboplatin-pegylated liposomal doxorubicin) or C-P (carboplatin–paclitaxel). Additional follow-up with CA-125 measurements was not associated with overtreatment.
open access: Swallowing dysfunction in cancer patients (International study)
"Swallowing of food and liquids including saliva is a complex biomechanical interaction of physiology and anatomy that occurs in four stages: oral preparatory, oral, pharyngeal, and esophageal [1, 2]."
"Dysphagia and odynophagia (painful swallowing) are common in cancer patients. Most studies on this complication are performed in patients with head and neck cancers (HNC), but swallowing disorders may also develop in patients with other malignancies."
"Non-head and neck cancers
Acute as well as chronic dysphagia may develop in any cancer patient with oropharyngeal mucositis as a result of treatment toxicity to the esophagus or secondary infection..... Dysphagia may also develop in patients with a wide variety of malignancies treated with targeted therapies."
Concluding remarks and future directions
"Most studies are performed in HNC patients, but the heterogeneous nature
of studies with respect to design, inclusion criteria,
and dysphagia assessment makes it difficult to obtain a clear insight
in the prevalence and severity of dysphagia and
aspiration after different treatment modalities. These conditions are
likely
underreported [52, 98]."
Supportive Care: Daytime sleepiness and sleep duration in long-term cancer survivors and non-cancer controls: results from a registry-based survey study
Conclusions
Disturbances in daytime sleepiness and sleep duration persist among long-term cancer survivors and should be monitored in routine survivorship care. More research is needed to identify cancer survivors who are at increased risk for daytime sleepiness and disturbed sleep duration, as well as to identify causal mechanisms for, and interventions to mitigate, persistent differences.
open access: Evidence of constitutional MLH1 epimutation associated to transgenerational inheritance of cancer susceptibility - Human Mutation
Blogger's Note: see references in paper to ovarian cancer; BRAF mutations
Epimutation , epimutation meaning , definition of epimutation , what is epimutation - A heritable change in gene expression that does not affect the actual base pair sequence of DNA . The first sign of cellular abnormality in some tumors is an epimutation—a change in heritable chromatin marks , such as an increase or decrease in the density of DNA methylation.
................................................................
"In addition, two patients were included in the study because of personal medical past history (endometrial cancer at the age of 24, and multiple sebaceous tumors associated with ovary cancer at the age of 44, respectively) strongly suggesting Lynch syndrome. The mean age of patients at diagnosis of the first Lynch syndrome-related cancer was 46 years (range, 24–74)."
"In conclusion, we have shown that constitutional epimutations in MMR genes constitute a rare cause of Lynch syndrome. However, they are associated to a real risk of transgenerational inheritance of cancer susceptibility. Moreover, tumors from patients with constitutional MLH1 epimutation can display BRAF mutations, mimicking MSI-H sporadic tumors. Altogether, these findings may have important implications for future diagnostic strategies and genetic counseling."
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