Friday, April 20, 2012
abstract: High scores on the Edmonton Symptom Assessment Scale identify patients with self-defined high symptom burden.
High scores on the Edmonton Symptom Assessment Scale identify patients with self-defined high symptom burden.
Abstract:
The terms symptom burden and symptom distress are frequently seen in palliative care literature yet are used in multiple ways ranging from addition of symptom scores to more in-depth assessments of interference in function. Patient input to date has had little role in these varied definitions yet previous reviews have suggested the importance of such input. This mixed qualitative and quantitative prospective study was conducted to seek patient input into the definition of 'symptom burden' and to correlate burden self-ranked scores with symptom scores on the Edmonton Symptom Assessment Scale (ESAS).
Results suggest that patients with advanced disease followed by palliative care providers are a group with a high level of self-defined burden. Further, any patient rating one or more symptoms on the ESAS ≥7 is at high risk of self-defined burden and likely to be experiencing significant impact on physical, emotional and social functioning. Further work should look at which aspects of symptom management best promote a lessening of perceived burden.
Medscape: Colonoscopy No Help in Finding Melena Source - in Gastroenterology, General Gastroenterology
Wiki: Melena
Medical News: Colonoscopy No Help in Finding Melena Source - in Gastroenterology, General Gastroenterology
"Colonoscopy had a lower-than-expected yield when used after a negative upper endoscopy in stable patients with melena, researchers found.
The procedure diagnosed a suspected source of the bleeding in just 4.8% of patients with melena in a retrospective case-control study by Jason P. Etzel, MD, of Oregon Health and Science University, Portland, and colleagues......
Medscape: (Avastin) Bevacizumab: First-Line Therapy in Ovarian Cancer?: Evidence for First-Line Therapy Dr's Markman, Burger, Swenterton
Bevacizumab: First-Line Therapy in Ovarian Cancer?: Evidence for First-Line Therapy
Editor’s Note:
Two phase 3 trials published in the New England Journal of Medicine on December 29, 2011, found bevacizumab to be active as first-line therapy in advanced ovarian cancer. Although both trials showed an increase in progression-free survival [PFS], not enough time has elapsed to determine whether the drug extends overall survival. Furthermore, it is unclear whether bevacizumab in ovarian cancer is best used as first-line or second-line therapy. Recently, Drs. Robert Burger and Kenneth Swenerton participated in a Medscape virtual debate via email to address this question: "Should bevacizumab be used as first-line therapy in patients with advanced ovarian cancer?" Dr. Maurie Markman served as moderator. What follows is their conversation......
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Ovarian Cancer and Us - Blogger's Note:
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abstract: Preoperative PET/CT in early-stage breast cancer (including ovarian cancer primary/metastases)
Preoperative PET/CT in early-stage breast cancer
Abstract
Background: The aim of this study was to assess the diagnostic and therapeutic impact of preoperative positron emission tomography and
computed tomography (PET/CT) in the initial staging of patients with early-stage breast cancer.
Patients and methods: A
total of 103 consecutive patients with newly diagnosed operable breast
cancer with tumors ≥2 cm were independently examined
preoperatively with conventional assessment
(mammography, breast/axillary ultrasound, chest X-ray and blood samples)
and PET/CT with no prior knowledge of the other.
Results: PET/CT identified a primary tumor in all but three patients (97%). PET/CT
solely detected distant metastases (ovary, bones and lung) in 6
patients and new primary cancers (ovary, lung) in another
two patients, as well as 12 cases of
extra-axillary lymph node involvement. In 15 patients (15%),
extra-axillary malignancy
was detected by PET/CT only, leading to an upgrade of initial staging in 14% (14/103) and ultimately a modification of planned treatment in 8% (8/103)
of patients.
Conclusions: PET/CT is a valuable tool to provide information on extra-axillary lymph node involvement, distant metastases and other occult primary
cancers. Preoperative 18F-fluorodeoxyglucose–PET/CT has a substantial impact on initial staging and on clinical management in patients with early-stage breast cancer with tumors
≥2 cm.
Aspirin and cancer risk: a quantitative review to 2011
Aspirin and cancer risk: a quantitative review to 2011:
Background:
Aspirin has been associated to a reduced risk of colorectal and possibly of a few other common cancers.
Methods:
To provide an up-to-date quantification of this association, we conducted a meta-analysis of all observational studies on aspirin and 12 selected cancer sites published up to September 2011.
Results:
Regular aspirin is associated with a statistically significant reduced risk of colorectal cancer and of other digestive tract cancers, for squamous cell esophageal cancer, for esophageal and gastric cardia adenocarcinoma,, for gastric cancer), with somewhat stronger reductions in risk in case–control than in cohort studies. Modest inverse associations were also observed for breast and prostate cancer, while lung cancer was significantly reduced in case–control studiesbut not in cohort ones. No meaningful overall associations were observed for cancers of the pancreas, endometrium, ovary, bladder, and kidney.
Conclusions:
Observational studies indicate a beneficial role of aspirin on colorectal and other digestive tract cancers; modest risk reductions were also observed for breast and prostate cancer. Results are, however, heterogeneous across studies and dose–risk and duration–risk relationships are still unclear.
2011 Dec open access: Nuclear Medicine and Radiation Therapy - 18FDG-PET/CT Definition of Clinical Target Volume for Robotic Stereotactic Body Radiosurgery Treatment of Metastatic Gynecologic Malignancies
Blogger's Note: investigative research; study of 27 gyn patients of whom 15 were ovarian cancer patients
18FDG-PET/CT Definition of Clinical Target Volume for Robotic Stereotactic Body Radiosurgery Treatment of Metastatic Gynecologic Malignancies
"As stereotactic body radiosurgery for abdominopelvic sites
of metastatic gynecologic cancers becomes more mainstream,
accumulated 18F-FDG PET and CT data will better guide treating
physician target contouring. Future research directions by our group
will study better radiosurgical target delineation, as modified by the
extent of respiratory motion, by four-dimensional (4D)-CT scanners
or by single 18F-FDG PET-magnetic resonance imaging (PET/MRI)
scanners."
A prospective multicenter (phase IIIb) trialstudy of Treosulfan in elderly patients with recurrent ovarian cancer: results of a planned safety analysis
A prospective multicenter study of treosulfan in elderly patients with recurrent ovarian cancer: results of a planned safety analysis
This open-label multicenter phase-IIIb trial was conducted at 47 German institutions; the first 25 patients analyzed in this safety analysis were recruited in 10 centers.
Background
Treosulfan,
an alkylating agent, has demonstrated activity in recurrent ovarian
carcinoma. It is equieffective as oral (p.o.)
and intravenous (i.v.) formulation. To explore the
preference and compliance of elderly patients regarding p.o. or i.v.
treosulfan
for the treatment of relapsed ovarian carcinoma, women
aged 65 years or older were included in this prospective multicenter
study. Since elderly patients usually have several
concomitant diseases and experience more treatment toxicity, an interim
safety analysis was planned and performed after 25
patients finished therapy to assess the tolerability of the treatment
regimens.
Table 1 - 6
Conflict of interest The trial was supported by Medac GmbH.
Table 1 - 6
- Patient characteristics
- Concomitant diseases
- Treatment delivery
- Reasons for early therapy discontinuation [less than 12 cycles (i.v.) or 12 months of therapy
- Non-hematological toxicities: highest grade per patient (in alphabetic order)
- Hematological toxicities: highest grade per patient
"In summary, the observed toxicities were in the same range as reported in previous studies with significantly younger patients
and less comorbidity or with old women having received fewer previous lines of chemotherapy.
There were no unexpected hematological or
non-hematological toxicities. Based on this safety analysis, treosulfan
proved to
be a safe and tolerable therapeutic option in elderly,
heavily pretreated patients and the next step of study recruitment
was initiated. Of note, the majority of patients in the
interim safety population chose i.v. treosulfan over the oral
application.
Detailed analysis after completion of the trial will
hopefully yield new insight into therapy preference and compliance of
elderly patients with recurrent ovarian cancer."
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