American Institute for Cancer Research (AICR): 2012 Research Conference on Food, Nutrition, Physical Activity and Cancer

2012 AICR Annual Research Conference
on Food, Nutrition, Physical Activity and Cancer

November 1-2 / Washington, DC

About the Conference:

This conference is a unique forum that brings together researchers and clinicians for a two-day program that is dedicated to increasing knowledge, stimulating research and promoting prevention and treatment of cancer through nutrition, physical activity and weight management.

Who Should Attend:

Basic scientists, clinical investigators, epidemiologists, dietitians, nutritionists, policy makers and other health professionals interested in food, nutrition, physical activity and weight management in relation to cancer.

Clinical Oncology News - Study Details Risks for Contralateral Cancer in BRCA1/2

"For years, researchers have known that the risk that a woman will develop CBC is higher than an average woman’s risk for developing a first cancer and that this risk is even greater if the woman carries the BRCA1/2 mutation."


Table. 10-year Risk for Contralateral Breast Cancer: Key Stats



"Dr. Van Poznak said the information in the study would help doctors counsel patients. “The analysis performed in this large database of European women under the age of 50 suggests that risks for contralateral breast cancer within 10 years may be estimated based on age and BRCA1/2 status,” she said.

Ms. van den Broek said that if the results are confirmed in other studies, age criteria and receptor status of the first breast cancers might be included in guidelines for prophylactic measures and screening in the follow-up of BRCA1/2 mutations carriers."

Clinical Oncology News - Applying Clinical Trial Results to ‘Real-World’ Care - Markman/Editorial

"A far less frequently discussed aspect of transitioning trial results into routine care is the realistic potential that when the strategy in question is undertaken by individuals without the same level of clinical expertise, the actual outcome may not be as favorable as the one demonstrated in the investigative setting."

 "Finally, it should be noted that the scenario presented is simply one of many that could have been provided as a word of caution in this important and complex discussion, that has relevance for both individual patients and society at large."

The POWER Study (Project for an Ontario Women's Health Evidence-based Report) Social Determinants of Health and Populations at Risk chapter

The POWER Study (Project for an Ontario Women's Health Evidence-based Report) Social Determinants of Health and Populations at Risk chapter is now available for download. 
 
 Using a community-engaged research model and integrated KT approach, the POWER Study has examined a comprehensive set of evidence-based indicators bridging population health and health system performance. The Women's Health Equity Report is serving as an evidence-based tool for policy makers, providers and consumers in their efforts to improve health and reduce health inequities in Ontario. POWER has examined gender differences in access to care, as well as quality and outcomes of care for the leading causes of morbidity and mortality in the province and how they differ by gender, socioeconomic status, ethnicity, and geography. 
 
The Social Determinants of Health and Populations at Risk chapter examines the social determinants of health among Ontario's women and men including: low income, low education, indicators of employment, lone-parent families, and food insecurity. We also summarize the POWER Study indicators across all chapters as they relate to low-income populations, providing a synthesis of health functional status, risk factors and prevention, access to health care services, clinical management, and health outcomes of lower-income adults. The final section re-examines and synthesizes the POWER Study findings in relation to immigrant and minority populations, as well as reporting three indicators of immigrant women's health that have not previously been reported in the POWER Study. Based on our analyses, identified opportunities to improve health and health care and reduce inequities, together with broad community consultation and dialogue, we developed the POWER Health Equity Road Map. The 
 aim of the Road Map is to help move us forward to the goal of achieving health equity in Ontario. The time to move forward is now. What is needed is the will and commitment.
 
 To download a copy of the full chapter or the highlights document (which outlines the chapter's key findings and messages): http://powerstudy.ca/the-power-report/the-power-report-volume-2/social-determinants-of-health-and-populations-at-risk
 
The French translation of the Social Determinants of Health and Populations at Risk Highlights document will be available on our website soon.
 
Also available for download from www.powerstudy.ca: Introduction to the POWER Study (Ch 1); The POWER Study Framework (Ch 2); Burden of Illness (Ch 3); Cancer (Ch 4); Depression (Ch 5), Cardiovascular Disease (Ch 6), Access to Health Care Services (Ch 7), Musculoskeletal Conditions (Ch 8), Diabetes (Ch 9), Reproductive and Gynaecological Health (Ch 10), HIV Infection (Ch 11), Older Women's Health Report.
 
The POWER Study's concluding chapter 'Achieving Health Equity in Ontario: Opportunities for Intervention and Improvement' is forthcoming and will be available on our website soon. 
 
Arlene S. Bierman, MD, MS
Echo's Ontario Women's Health Council Chair in Women's Health
Lawrence S. Bloomberg Faculty of Nursing, University of Toronto and
Keenan Research Centre in the Li Ka Shing Knowledge Institute, St. Michael's Hospital
30 Bond Street (209 Victoria Street, Room 219)
Toronto, ON  M5B 1W8
Phone:  (416) 864-3041
Fax:    (416) 864-5641
 
Web: www.powerstudy.ca 
 
The POWER Study is funded by Echo: Improving Women's Health in Ontario, an agency of the Ministry of Health and Long-Term Care. This report does not necessarily reflect the views of Echo or the Ministry. 
_______________________________________________

Canadian Scientists Develops World’s Most Advanced Drug to Protect the Brain After a Stroke (PSD95 inhibitor)

“There is hope that this new drug could be used in conjunction with other treatments, such as thrombolytic agents or other means to restore blood flow to the brain, in order to further reduce the impact of stroke on patients,” said Dr. Tymianski. “These findings are extremely exciting and our next step is to confirm these results in a clinical trial.”

abstract: Borderline ovarian tumour: pathological diagnostic dilemma and risk factors for invasive or lethal recurrence : The Lancet Oncology

The Lancet Oncology, Volume 13, Issue 3, Pages e103 - e115, March 2012

doi:10.1016/S1470-2045(11)70288-1

Borderline ovarian tumour: pathological diagnostic dilemma and risk factors for invasive or lethal recurrence

Summary

By comparison with ovarian carcinomas, borderline ovarian tumours are characterised clinically by superior overall survival, even in women with peritoneal spread.

In this Review, we aimed to clarify the histological and clinical factors potentially defining a high-risk group in whom disease is likely to evolve to invasive disease. Invasive peritoneal implants (in serous borderline ovarian tumours) and residual disease after surgery were the two factors clearly identified.

Other factors are controversial owing to increased risk of invasive recurrence: micropapillary patterns in serous borderline ovarian tumour, intraepithelial carcinoma in mucinous lesions, stromal microinvasion in serous lesions, and use of cystectomy in mucinous borderline ovarian tumours.

The pathologist has a pivotal role in assessment of the borderline nature of ovarian tumours and in identification of high-risk criteria, most of which are histological. But, reproducibility of the histological interpretation of some of these potential criteria—eg, classification of peritoneal implants (particularly in desmoplastic subtype), stromal microinvasion, micropapillary patterns, and intraepithelial carcinoma in mucinous borderline ovarian tumours—remains unclear, and should be investigated.

abstract: Inflammatory Pseudotumor: The Great Mimicker

Abstract:

OBJECTIVE. The purpose of this review is to describe the pathophysiologic findings, differential diagnosis, imaging features, and management of inflammatory pseudotumor in various locations throughout the body.

CONCLUSION. Inflammatory pseudotumor is a rare benign process mimicking malignant processes and has been found in almost every organ system. Radiologists should be familiar with this entity as a diagnostic consideration to avoid unnecessary surgery.

( Italy) Hyperthermic Intra-peritoneal Chemotherapy (HIPEC) in Ovarian Cancer Recurrence - Full Text View - ClinicalTrials.gov

Official Title:
Surgery Plus Hyperthermic Intra-peritoneal Chemotherapy (HIPEC) Versus Surgery Alone in Patients With Platinum-sensitive First
Recurrence of Ovarian Cancer: a Prospective Randomized Multicenter Trial

Hyperthermic Intra-peritoneal Chemotherapy (HIPEC) in Ovarian Cancer Recurrence (HORSE)

Purpose

The purpose of this study is to determine the role of surgery followed by hyperthermic intra-peritoneal chemotherapy (HIPEC) versus surgery

alone in patients with platinum-sensitive first recurrence of ovarian cancer. Moreover it is a prospective randomized multicenter trial, aimed

to investigate the prognostic role of surgery plus HIPEC versus surgery alone in terms of progression free interval, overall survival, morbidity

and mortality, second recurrence pattern, quality of life with EORTC QLQ-C30 and QLQ OV28 questionnaires.

This study is currently recruiting participants.

Verified February 2012 by Catholic University of the Sacred Heart

First Received on February 20, 2012. Last Updated on February 28, 2012 History of Changes

Sponsor:	Catholic University of the Sacred Heart
Information provided by (Responsible Party):	Prof. Giovanni Scambia, Catholic University of the Sacred Heart
ClinicalTrials.gov Identifier:	NCT01539785

not yet recruiting: phase 11/BRCA - Veliparib in Treating Patients With Persistent or Recurrent Epithelial Ovarian, Fallopian Tube, or Primary Peritoneal Cancer - Full Text View - ClinicalTrials.gov

Condition:
brca1 Mutation Carrier
brca2 Mutation Carrier
Fallopian Tube Cancer
Ovarian Cancer
Primary Peritoneal Cavity Cancer

Criteria

DISEASE CHARACTERISTICS:

• Patients must have recurrent or persistent epithelial ovarian, fallopian tube, or primary peritoneal carcinoma AND carry a germline mutation in BRCA1 or BRCA2 (confirmation required via Myriad test report); histologic documentation of the original primary tumor is required via the pathology report........

Veliparib in Treating Patients With Persistent or Recurrent Epithelial Ovarian, Fallopian Tube, or Primary Peritoneal Cancer

This study is not yet open for participant recruitment.

Verified February 2012 by National Cancer Institute (NCI)

First Received on February 22, 2012. No Changes Posted

Sponsor:	Gynecologic Oncology Group
Collaborator:	National Cancer Institute (NCI)
Information provided by:	National Cancer Institute (NCI)
ClinicalTrials.gov Identifier:	NCT01540565

Tutorials (2): Genetic Testing Registry (GTR) - YouTube

Tutorials: Genetic Testing Registry (GTR) - YouTube

Confused by genetic tests? NIH's new online tool may help, February 29, 2012 News Release - National Institutes of Health (NIH)

Confused by genetic tests? NIH’s new online tool may help

An online tool launched today by the National Institutes of Health will make it easier to navigate the rapidly changing landscape of genetic tests. The free resource, called the Genetic Testing Registry (GTR), is available at http://www.ncbi.nlm.nih.gov/gtr/

Stopping menopausal hormone therapy: If breast cancer really decreased, why did colorectal cancer not increase? Maturitas "Alternative explanations must be found."

Abstract

Objective

The Women's Health Initiative (WHI) study of postmenopausal hormone therapy (HT) found that estrogen plus progestogen therapy (EPT) decreased colorectal cancer risk. 

Thus, the decline in EPT use from 2002 to 2003 should have precipitated an increase in the incidence of colorectal cancer. We tested this prediction using the SEER 9 epidemiologic database.

Methods

We analyzed WHI data concerning the effects of EPT and estrogen therapy (ET) on colorectal cancer risks. We also examined HT prescription sales data, as well as SEER 9 colorectal cancer incidences from 2001 to 2004.

Results

In the WHI study, the incidence of colorectal cancer was comparable in EPT placebo-users, ET users, and ET placebo-users, but significantly lower in EPT users. Assuming that 30% of eligible women used HT in 2001, the decline in EPT sales from 2002 to 2003 of 63% should have increased the incidence of colorectal cancer by 2.8% in the overall population at risk. However, the SEER 9 colorectal cancer incidence fell by 5.9% in this population, which is comparable to the 6.7% decrease observed for invasive breast cancer from 2002 to 2003.

Conclusions

Declining EPT use from 2002 to 2003 should have precipitated an increase in the incidence of colorectal cancer, but the opposite trend was seen in the SEER 9 database during this time. The incidences of invasive breast cancer and colorectal cancer both declined by a similar amount from 2002 to 2003, despite the results of the WHI study predicting opposing trends for the two different types of cancer. Thus, the SEER 9 findings are fundamentally incompatible with expectations from the WHI findings. This implies that reductions in HT use from 2002 to 2003 cannot account for the contemporaneous changes in invasive breast cancer and colorectal cancer incidences. 

Alternative explanations must be found.

abstract : Hazard ratios in cancer clinical trials - a primer : Nature Reviews Clinical Oncology

Perspectives

Nature Reviews Clinical Oncology 9, 178-183 (March 2012) | doi:10.1038/nrclinonc.2011.217

Hazard ratios in cancer clinical trials—a primer

Abstract

The increase and diversity of clinical trial data has resulted in a greater reliance on statistical analyses to discern value. Assessing differences between two similar survival curves can pose a challenge for those without formal training in statistical interpretation; therefore, there has been an increased reliance on hazard ratios often to the exclusion of more-traditional survival measures. 

However, because a hazard ratio lacks dimensions it can only inform the reader about the reliability and uniformity of the data. It does not provide practitioners with quantitative values they can use, nor does it provide information they can discuss with patients. 

Motivated by a non-scientific poll of oncologists in training and those with board certification that suggested only a limited understanding of the derivation of hazard ratios we undertook this presentation of hazard ratios: a measure of treatment efficacy that is increasingly used and often misused.

Advanced Ovarian Cancer -- A Clinical Context Report - in Clinical Context, Ovarian Cancer from MedPage Today (overview: surgery, treatments, CA125...)

open access: PLoS ONE: Standard Colonic Lavage Alters the Natural State of Mucosal-Associated Microbiota in the Human Colon

Background & Aims

Past studies of the human intestinal microbiota are potentially confounded by the common practice of using bowel-cleansing preparations. We examined if colonic lavage changes the natural state of enteric mucosal-adherent microbes in healthy human subjects.

Conclusion

Standard bowel cleansing preparation altered the mucosal-adherent microbiota in all of our subjects, although the degree of change was variable. These findings underscore the importance of considering the confounding effects of bowel preparation when designing experiments exploring the gut microbiota.

"We recommend that future investigations of the human enteric microbiota include un-prepped subjects in whom the natural state of the colonic microbiota can be preserved and observed. Acquisition of left sided colon samples should not be a major problem, but obtaining right side colonic samples will be more technically demanding; potentially requiring conscious sedation and increasing risk and duration of colonoscopic procedures. Nonetheless, in the hands of an experienced endoscopist, full colonoscopy in un-prepped individuals is feasible. Our group has an 80% success rate reaching the cecum in un-prepped patients.

In summary, we report that the routine practice of colonic lavage may significantly alter the mucosa-associated microbiota of the distal human colon. While the effects are obvious in some individuals, the effects of colonic lavage can be unpredictable. Given that colonic lavage has the potential to distort the enteric microbiota, we recommend that future studies of the human enteric microbiota be performed on the un-prepped colon where the natural state of both luminal and mucosa-associated microbiota is most likely to be retained.

abstract: Priorities for cancer prevention: lifestyle choices versus unavoidable exposures

Priorities for cancer prevention: lifestyle choices versus unavoidable exposures:
Source: The Lancet Oncology

"Although cancer prevention in the USA and other developed countries focuses on disease attributable to lifestyle factors such as smoking, alcohol intake, sun exposure, and obesity, cancer caused by involuntary exposures is a concern. The term environmental is ambiguously used to distinguish between lifestyle and unavoidable exposures. The general community is said to be vulnerable to carcinogens encountered in pollution, contaminated food, and consumer products. In view of these concerns, assessments of the carcinogenicity of particular chemicals are of little assistance in prevention of cancer. Appraisal of cancer attributable to widespread and localised pollution, pesticides, endocrine disrupting chemicals, and consumer products yields diverse outcomes, from established causation to absence of harm. The precautionary principle is not a practicable approach for unknown carcinogenic risks. Procedures for individuals to reduce exposure to recognised or suspect carcinogens in consumer products are not effective measures for cancer prevention. Anxiety concerning insidious cancer causation could divert attention from proven means of cancer prevention."

abstract: Radiation Oncology Quality: Aggressiveness of Cancer Care Near the End of Life

Radiation Oncology Quality: Aggressiveness of Cancer Care Near the End of Life


Purpose
Quality in cancer care is an issue that has come to the forefront over the past decade. Although the American Society of Clinical Oncology has developed extensive quality metrics and goals, such as limiting chemotherapy being provided within the last 14 days of a patient's life, there are no similar quality metrics, and few data, in the field of radiation oncology.


Methods
In this study, morbidity and mortality records from 2008 to 2011 were reviewed for patients at Indiana University who received radiation therapy (RT) within 30 days of death; 63 patients met those criteria.


Results
Analysis showed that 22.2% of patients had Karnofsky Performance Status Scale scores >80, whereas 66.7% of patients had scores < 60. Just over half of patients (52%) were still on treatment at death, and more than half of patients (54%) had completed less than half of their original RT plans. Six patients had their final treatments on the days of their deaths, and another 43 patients had their last treatments within 10 days of death. Forty-eight percent of patients received RT for less than one-fifth of their final month of life and 21% for more than half of their last month alive.


Conclusions
These data are valuable in ongoing discussions of RT use at the end of life, especially as related to hospice underutilization.

abstManagement-changing errors in the recall of radiologic results — A pilot study Clinical Radiology

Management-changing errors in the recall of radiologic results — A pilot study

Aim

To evaluate the occurrence of alterations to diagnostic information from radiological studies, which are altered by person-to-person communication and/or faulty recall, and whether they affect patient management

Materials and methods

A structured telephone survey was conducted at a large tertiary care medical centre of house staff managing inpatients who had undergone chest, abdominal, or pelvic computed tomography (CT) or magnetic resonance imaging (MRI) and remained in the hospital at least 2 days later.  

Fifty-six physicians were surveyed regarding 98 patient cases. Each physician was asked how he or she first became aware of the results of the study. Each was then asked to recall the substance of radiological interpretation and to compare it with the radiology report. Each was then asked to assess the level of difference between the interpretations and whether management was affected. Results were correlated with the route by which interviewees became aware of the report, the report length, and whether the managing service was medical or surgical.

Results

In nearly 15% (14/98) of cases, differences between the recalled and official results were such that patient management could have been (11.2%) or had already been affected (3.1%). There was no significant correlation between errors and either the route of report communication or the report length.

Conclusion

There was a substantial rate of error in the recall and/or transmission of diagnostic radiological information, which was sufficiently severe to affect patient management.

Neoadjuvant chemotherapy, interval debulking surgery or primary surgery in ovarian carcinoma FIGO stage IV? 10.1016/j.ejca.2012.01.031 : European Journal of Cancer

Abstract

Objectives

The aim of this study was to investigate the impact of surgical approach, the extent of surgery and chemotherapy on overall survival in patients with ovarian carcinoma (OC) stage IV.

Methods

We retrospectively collected population-based data from the Norwegian Radium Hospital code registry on the diagnosis and surgery of 238 patients diagnosed with OC stage IV from 1996–2005. All patients received platinum-based chemotherapy. Surgical approach was registered as primary debulking surgery (PDS), interval debulking surgery (IDS) and delayed primary surgery (DPS). Surgery level was classified as radical surgery (RS), standard surgery (SS) or suboptimal surgery (SUBS). Univariate and multivariate analyses identified prognostic factors in PDS, IDS and DPS groups and subgroups.

Results

There were no differences in overall survival between the PDS, IDS and DPS groups. Surgery level was significantly associated with overall survival in the whole cohort (p < 0.001), the PDS and IDS groups, but not in the DPS group. More patients with RS achieved no residual tumour (RT), but overall survival was not superior compared to no RT in the SS group. In 66 patients with no RT there were no differences in overall survival between those who underwent PDS, IDS and DPS. Chemotherapy with platinum/paclitaxel tended to improve survival. RT, World Health Organisation (WHO) performance status and histology were prognostic factors for overall survival in the whole cohort.

Conclusion

No RT remains the objective, whether PDS, IDS or DPS is performed, and no differences in overall survival were found in the three treatment groups.