Correspondence: Neoadjuvant Chemotherapy (ovarian cancer) Is Rarely the Easy Way Out + references +discussion on gyn specialists/general surgeons

Blogger's Note: worthwhile reading/pondering...
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Neoadjuvant Chemotherapy Is Rarely the Easy Way Out

 To the Editor:

I appreciate the thoughtful analysis by Chi et al¹ in the November 1 issue of Journal of Clinical Oncology, in the article entitled, “Is the Easier Way Ever the Better Way?” Chi et al make a very literate argument against using neoadjuvant chemotherapy (NACT) for ovarian cancer, continuing a discussion that has lingered among oncologists for more than 25 years. The argument has heated up recently as a result of several prospective studies, particularly that of Vergote et al,² which showed no difference in survival in patients treated with either primary surgery or NACT.

I must, however, disagree with Chi et al¹ on two points. The first of these is the suggestion by the authors that patients with stage IIIC/IV ovarian cancer should routinely be referred to ultraspecialist centers that are capable of performing advanced upper abdominal surgery. In reality, the great majority of patients with ovarian cancer in the United States have been and will be treated in community settings for the foreseeable future. The professional societies that represent gynecologic oncology have for years strongly recommended that ovarian cancer be handled by fellowship-trained gynecologic oncologists. This effort has met with mixed success; in many communities it is still the norm for women with advanced ovarian cancer to be operated on by physicians with no special oncologic surgical training.......

plus references:

REFERENCES

1. ↵
   1. Chi DS,
   2. Bristow RE,
   3. Armstrong DK,
   4. et al.

   (2011) Is the easier way ever the better way? J Clin Oncol 29:4073–4075.

   FREE Full Text
2. ↵
   1. Vergote I,
   2. Tropé GC,
   3. Amant F,
   4. et al.

   (2010) Neoadjuvant chemotherapy or primary surgery in stage IIIC or IV ovarian cancer. N Engl J Med 363:943–953.

   CrossRefMedline
3. ↵
   1. Tiersten AD,
   2. Liu PY,
   3. Smith HO,
   4. et al.

   (2009) Phase II evaluation of neoadjuvant chemotherapy and debulking followed by intraperitoneal chemotherapy in women with stage III and IV epithelial ovarian, fallopian tube or primary peritoneal cancer: Southwest Oncology Group Study S0009. Gynecol Oncol 112:444–449.

   CrossRefMedline

paywalled: Data for cancer comparative effectiveness research - Meyer - 2012 - Cancer - Wiley Online Library

Data for cancer comparative effectiveness research

Abstract

Comparative effectiveness research (CER) can efficiently and rapidly generate new scientific evidence and address knowledge gaps, reduce clinical uncertainty, and guide health care choices. Much of the potential in CER is driven by the application of novel methods to analyze existing data. Despite its potential, several challenges must be identified and overcome so that CER may be improved, accelerated, and expeditiously implemented into the broad spectrum of cancer care and clinical practice. To identify and characterize the challenges to cancer CER, the authors reviewed the literature and conducted semistructured interviews with 41 cancer CER researchers at the Agency for Healthcare Research and Quality's Developing Evidence to Inform Decisions about Effectiveness (DEcIDE) Cancer CER Consortium. Several data sets for cancer CER were identified and differentiated into an ontology of 8 categories and were characterized in terms of strengths, weaknesses, and utility. Several themes emerged during the development of this ontology and discussions with CER researchers. Dominant among them was accelerating cancer CER and promoting the acceptance of findings, which will necessitate transcending disciplinary silos to incorporate diverse perspectives and expertise. Multidisciplinary collaboration is required, including those with expertise in nonexperimental data, statistics, outcomes research, clinical trials, epidemiology, generalist and specialty medicine, survivorship, informatics, data, and methods, among others.

Recommendations highlight the systematic, collaborative identification of critical measures; application of more rigorous study design and sampling methods; policy-level resolution of issues in data ownership, governance, access, and cost; and development and application of consistent standards for data security, privacy, and confidentiality.

Tort Reform Arrives to Healthcare - Sue the Patient - Forbes

Tort Reform Arrives to Healthcare - Sue the Patient - Forbes

paywalled: Developing a useful, user-friendly website for cancer patient follow-up: users' perspectives on ease of access and usefulness - European Journal of Cancer Care

Developing a useful, user-friendly website for cancer patient follow-up: users' perspectives on ease of access and usefulness  - European Journal of Cancer Care 
 

Developing a useful, user-friendly website for cancer patient follow-up: users' perspectives on ease of access and usefulness

UK cancer survival has improved, leading to an increase in review patients and pressure on clinics......  Acceptability: Final evaluation (n= 103) was positive although many would like to maintain face-to-face hospital contact. User involvement in website design can ensure patient needs are met. A website model for follow-up will suit some patients but others will prefer clinical contact.

paywalled: First-line treatment of advanced ovarian cancer with paclitaxel/carboplatin with or without epirubicin (TEC versus TC)—a gynecologic cancer intergroup study of the NSGO, EORTC GCG and NCIC CTG

 Epirubicin (Brand name: Ellence)

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First-line treatment of advanced ovarian cancer with paclitaxel/carboplatin with or without epirubicin (TEC versus TC)—a gynecologic cancer intergroup study of the NSGO, EORTC GCG and NCIC CTG

Background: The addition of anthracyclines to platinum-based chemotherapy may provide benefit in survival in ovarian cancer patients. We evaluated the effect on survival of adding epirubicin to standard carboplatin and paclitaxel.

Conclusion: The addition of epirubicin to standard carboplatin and paclitaxel treatment did not improve survival in patients with advanced ovarian, tubal or peritoneal cancer.