Monday, February 27, 2012
Clinical Obstetrics & Gynecology:
March 2012 - Volume 55 - Issue 1 - p 65–74
Treatment of Ovarian Cancer in Young Women
GERSHENSON, DAVID M. MD
Ovarian cancer accounts for approximately 22,000 cases annually in the United States.
Although the vast majority of ovarian cancers occur in postmenopausal women and are of advanced stage, a significant subset occurs in young women.
Among those subtypes having a predisposition for young women are malignant ovarian germ cell tumors, sex cord-stromal ovarian tumors, and tumors of low malignant potential.
However, invasive epithelial ovarian cancers may also occur in young women, particularly the subtypes of low-grade serous carcinoma and mucinous carcinoma. This article details the diagnosis and optimal treatment of ovarian cancers subtypes in young women.
OxyContin delisting is not the answer - media
"The decision by some provinces to remove public funding for OxyContin and its newer harder-to-abuse formulation, OxyNEO, is being cast by many politicians and health professionals as a significant victory in the battle against the scourge of painkiller addictions.
If it were only that simple....."
"OxyNEO will be available for those who had existing prescriptions for the old drug and for cancer and palliative-care patients.
Yet, even if provincial plans won’t cover Purdue’s notorious product, individuals whose private insurance covers the drugs will still be able to get them...."
ALBUQUERQUE, N.M.--(BUSINESS WIRE)--
"The National Foundation for Cancer Research has awarded a grant to Dr. Robert C. Bast, Jr. of The University of Texas MD Anderson Cancer Center to work with Senior Scientific LLC, a company owned by Manhattan Scientifics (OTCBB: MHTX), to apply Senior Scientifics’ technology to the early detection of ovarian cancer.
Senior Scientific has pioneered a novel technology using special magnetic sensors and magnetic nanoparticles for a highly sensitive and very specific approach to cancer detection.
The new grant, entitled “SQUID Imaging for Detection of Early Stage Ovarian Cancer,” will augment Dr. Bast’s ongoing program at The University of Texas MD Anderson Cancer Center with this emerging technology. Dr. Bast is a world leader in the early detection of ovarian cancer and was responsible for the discovery of the most accurate marker for this disease, CA-125......."
NIH Highlights & Headlines
Weekly media tip sheet of health research, discoveries, and science
Dateline: Monday, February 27, 2012
Information below is designed for credentialed journalists and under embargo per the date on each item. Item dates are as accurate as possible as of today.
Coming this week:
Monday, 2/27 – Information about an NIH collaboration to examine the repurposing of known medications
Wednesday, 2/29 – A statement from the National Eye Institute on Rare Disease Day
Wednesday, 2/29 – NIH introduces database of genetic tests
Thursday, 3/1 – An update on the GuLF STUDY: over 10,000 participants enrolled
More news and events: www.nih.gov/news/
Observational study miscommunication of the week: citrus & 'women's) stroke (risk) - HealthnewsReview.org
A spin around the Web today will give you many stories about citrus fruits and women’s stroke risk.
Neat, Plausible and Wrong: The Myth of Health Care Unsustainability
The “Sustainability” Myth The assertion that Medicare is “unsustainable” has been repeated so many times that in some circles it has become accepted as indisputable fact. Critics of...
[+] Read full story
[+] Read full story
Are Hematopoietic Colony-Stimulating Factors
Over- or Underused?
"Since their introduction, there has been debate about the benefits,
risks, and costs of hematopoietic colony-stimulating factors
(CSFs). We suggest that the use of CSFs to allow dose maintenance of
chemotherapy for common metastatic solid tumors is unsupported
by evidence, and we should reconsider using a $3,500-per-cycle injection
for a supportive care drug without major benefit......."
Comments and Controversies -
A Way Forward on the Medically Appropriate Use of White Cell Growth Factors
JCO published online on February 27, 2012; DOI:10.1200/JCO.2011.39.9980.
Table 1. Comparison of Major Guidelines
How Did We Arrive at Widespread Use Without
Clinical Trial Justification?
Clinical Trial Justification?
The Way Forward to Evidence-Based Use of CSFs
"Increased concern about escalating costs 46-48 should cause us to
examine each component of current care. Oncology professional societies have demanded some demonstrable improvement in an important outcome before adoption of a new technology.49 The lack of
proven benefit from CSFs in support of therapy in common advanced
solid tumors, the high cost, the disparate US and world use patterns
with no difference in mortality, 50 and the potential for or appearance
of economic self-interest should give the oncology community pause.
There are concrete steps the US oncology community can take to
foster more evidence-based care. The Quality Oncology Practice Initiative 51 could add overuse as a quality criterion 52 and report CSF use in palliative-intent regimens when there is less than a 20% risk of FN. The major guideline groups (European Organisation for Research and Treatment of Cancer,6 National Comprehensive Cancer Network,5
and ASCO4) should endorse dose modification as an equally appropriate and preferred strategy in the absence of proven benefit."
JCO: Neuropsychological Performance in Survivors of Breast Cancer More Than 20 Years After Adjuvant Chemotherapy (chemobrain)
Breast Cancer Neuropsychological Performance in Survivors of Breast Cancer More Than 20 Years After Adjuvant Chemotherapy
JCO published online on February 27, 2012; DOI:10.1200/JCO.2011.37.0189.
open access: Correspondence Breast Cancer Risk for Noncarriers of Family-Specific BRCA1 and BRCA2 Mutations: More Trouble With Phenocopies
Correspondence: Breast Cancer Risk for Noncarriers of Family-Specific BRCA1 and BRCA2 Mutations: More Trouble With Phenocopies
- D. Gareth Evans and
- Anthony Howell
A giant 'little step' in cancer treatment opening up new therapeutic horizons - (rechallenging with drugs which in the past did not work)
“The novelty factor does not lie in the combination itself, but in the combination of two drugs that had already been administered in the past and had each failed,” explained Dr Javier Cortés, the Head of the Breast Cancer Programme at the VHIO and main author of this work. This not only offers new alternatives for patients with advanced tumours –the most important aspect – but also opens up a parallel dimension of new therapeutic options to the existing treatments, given that it offers numerous combinations between existing pharmacological treatments that not only boost each other but also counteract patients’ resistance to them. “The study focused on HER2 positive breast cancer, although the concept could be applied to the treatment of other tumours”, continued Dr Cortés."
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open access: JTM - Absolute lymphocyte count is associated with survival in ovarian (SEROUS) cancer independent of tumor-infiltrating lymphocytes
lymphocytesplural of lym·pho·cyte
The immune system strongly influences outcome in patients with ovarian cancer. In particular, the absolute lymphocyte count in peripheral blood (ALC) and the presence of tumor-infiltrating lymphocytes (TIL) have each been associated with favourable prognosis. However, the mechanistic relationships between ALC, TIL and prognosis are poorly understood. We hypothesized that high ALC values might be associated with stronger tumor immunity as manifested by increased TIL, decreased tumor burden and longer survival.
Patients with high intrinsic ALC values show no clinical or survival advantage upon subsequent development of HGSC. ALC values at diagnosis are prognostic due to an association with disease burden rather than TIL. Therapeutic enhancement of ALC may be necessary but not sufficient to improve survival in HGSC.
The complete article is available as a provisional PDF. The fully formatted PDF and HTML versions are in production.
abstract: Surveillance for hereditary cancer: Does the benefit outweigh the psychological burden?—A systematic review
Surveillance for hereditary cancer: Does the benefit outweigh the psychological burden?—A systematic review
Individuals at risk for developing hereditary cancer are offered surveillance in order to improve the prognosis. An important question is whether the benefit of surveillance outweighs the psychological burden. In this review, we evaluated all studies that investigated psychological distress and the quality of life in individuals under surveillance for hereditary cancer of the breast, ovarian, prostate, pancreas, colorectum, melanoma, and various rare syndromes such as familial adenomatous polyposis, Li–Fraumeni and Peutz–Jeghers syndrome.Thirty-two studies were identified. Surveillance for most hereditary cancers was associated with good psychological outcomes. However, surveillance of individuals at high risk for developing multiple tumors appeared to be associated with increased distress and a lower quality of life. Common factors associated with worse psychological outcomes included a personal history of cancer, female gender, having a first degree relative with cancer, negative illness perceptions and coping style. The use of a simple screening tool to identify distressed individuals is recommended.
Patients and staff perceptions of cancer patients' quality of life
Discrepancies exist in estimation of quality of life (QL) by patients and caregivers but underlying factors are incompletely characterised.
QL of 153 patients was estimated by themselves, by 70 nurses and by 53 physicians in a cross-sectional study. Variables which could influence inter-rater agreement were evaluated.
Inter-rater agreement of QL was fair (r = .292) between patients and nurses and between patients and physicians (r = .154). Inter-rater agreement with nurses was significantly lower concerning fatigue and pain for patients with a Karnofsky Index <50 when compared to patients with a KI >50. Their inter-rater agreement with physicians was significantly lower for fatigue, pain and physical functioning. Agreement on the degree of anxiety was significantly (p = .009) better for female patients. Agreement on the need for social assistance (p = .01) and physical functioning (p = .03) was significantly better for male patients. Agreement with patients on their physical functioning was significantly (p = .03) better for male nurses and male physicians (r = .944) than for female nurses and female physicians (r = .674).
Our study showed that estimation of overall QL of patients by professional caregivers is inaccurate. Inter-rater agreement was influenced by KI of patients, by gender of patients and caregivers and by professional experience of nurses.