Saturday, May 19, 2012
Microscopic Hematuria Not Predictive of Cancer
Microscopic Hematuria Not Predictive of Cancer
"In 4414 patients with asymptomatic microscopic hematuria, the rate of urinary tract cancer was 2.1%, (compared with the 0.43% the researchers previously found)."
American Urological Association (AUA) 2012 Annual Scientific Meeting: Abstract 62. Presented May 19, 2012
Canadian breast implant cohort: Extended follow-up of cancer incidence - Pan - 2012 - International Journal of Cancer - Wiley Online Library
Canadian breast implant cohort: Extended follow-up of cancer incidence - International Journal of Cancer
Abstract
Cosmetic
breast implants are not associated with increased breast cancer
incidence, but variations of risk according to implant characteristics
are still poorly understood. As well, the assessment of cancer risk for
sites other than breast needs to be clarified. The purpose of this study
was to fill these research gaps. This study presents an extended
analysis of 10 more years of follow-up of a large Canadian cohort of
women who received either cosmetic breast implants (n = 24,558)
or other cosmetic surgery (15,893). Over 70% of the implant cohort was
followed for over 20 years. Cancer incidence among implant women was
compared to those of controls using multivariate Poisson models and the
general female population using the standardized incidence ratios
(SIRs). Women with breast implants had reduced rates of breast and
endometrial cancers compared to other surgery women. Subglandular
implants were associated to a reduced rate of breast cancer compared to
submuscular implants [incidence rate ratio (IRR) = 0.78, 95% confidence
interval (CI) = 0.63–0.96] and this reduction persisted over time. We
observed a sevenfold increased rate (IRR = 7.36, 95% CI = 1.86–29.12) of
breast cancer in the first 5 years after the date of surgery for
polyurethane-coated subglandular implant women but this IRR decreased
progressively over time (p value for trend = 0.02). We also
observed no increased risk of rarer forms of cancer among augmented
women. A reduction in breast cancer incidence was observed for women
with subglandular implants relative to women with submuscular implants.
Possible increase of breast cancer incidence shortly after breast
augmentation with polyurethane implants needs to be verified.
paywalled: Quality of Life After Surgery for Colon Cancer in Patients With Lynch Syndrome: Partial Versus Subtotal Colectomy.
Quality of Life After Surgery for Colon Cancer in Patients With Lynch Syndrome: Partial Versus Subtotal Colectomy
BACKGROUND:: Lynch syndrome is a disorder caused by mismatch repair gene mutations. Mutation carriers have a high risk of developing colorectal cancer. In patients with Lynch syndrome in whom colon cancer has been diagnosed, in general, subtotal colectomy instead of partial colectomy is recommended because of the substantial risk of metachronous colorectal cancer. However, the effect of more extensive surgery on quality of life and functional outcome is unknown.
paywalled: Antigen-specific immunotherapy in ovarian cancer and p53 as tumor antigen.
Antigen-specific immunotherapy in ovarian cancer and p53 as tumor antigen.:
Abstract
Immunotherapy for ovarian cancer is one of the new treatment strategies currently investigated in epithelial ovarian cancer. This review discusses the results of different immunization strategies, identifies possible drawbacks in study design and provides potential solutions for augmentation of clinical efficacy. A potential target for cancer immunotherapy is p53, as approximately 50% of ovarian cancer cells carry p53 mutations. Therefore we review the immunological and clinical responses observed in ovarian cancer patients vaccinated with p53 targeting vaccines in particular. In most studies antigen-specific vaccine-induced immunological responses were observed. Unfortunately, no clinical responses with significant reduction of tumor-burden have been reported. Based on the currently available results we emphasize the necessity of multimodality treatment of ovarian cancer, combining classical cytoreductive surgery, (neo) adjuvant chemotherapy, immunotherapy and/or targeted therapy.
paywalled: Models of care in outpatient cancer centers [Nurs Econ. 2012 Mar-Apr] - PubMed - NCBI
Nurs Econ. 2012 Mar-Apr;30(2):108-16.
Models of care in outpatient cancer centers.
Abstract
While rapid changes in the treatment of cancer have been driven by research-based evidence, innovations in cancer care delivery have lagged behind that seen in cancer treatment. A literature review and ten semi-structured interviews were conducted to identify models of care in the ambulatory oncology setting to be adopted by a comprehensive cancer center. Four models were identified from the literature review but none were widely recognized or adopted by administrators. Findings suggested some common themes that should be included in an optimal model of care. These themes are in support of the burgeoning efforts seen in the promotion of interprofessional education and practice for quality improvement. Unique challenges related to the contextual factors in the ambulatory oncology settings suggest quality improvement interventions should be tailored to meet the specific needs of the care facility and its workforce.2nd report: Stats Canada - Conditional survival analyses across cancer sites
Blogger's Note: html version; stop reading if looking for ovarian cancer specfic references
Conditional survival analyses across cancer sites
For this article...
Survival estimates are typically presented as the probability—or the ratio of observed and expected probabilities in the case of relative survival—of surviving a given length of time (for example, five years) after diagnosis. However, these estimates are less informative for people who have survived one or more years, as the risk of death due to cancer is often greatest in the first few years. After this initial period, the prognosis can improve substantially, so the earlier estimates no longer apply.6 The outlook for such people can be estimated more appropriately using conditional survival.
For the first time in Canada, predicted conditional relative survival estimates are presented for a large number of cancers. Cancers with the greatest relative improvement in prognosis since diagnosis are highlighted. Cancers showing less improvement are also identified. (See The data)
2012 Canadian trends in cancer prevalence - Stats Canada
Blogger's Note: aside from 2 lines of stats, there is no specific reference/s to ovarian cancer (use search term: ovary)
(html version) http://www.statcan.gc.ca/pub/82-003-x/2012001/article/11616-eng.htm
pdf - Canadian trends in cancer prevalence
"In Canada, the rate at which new cancer cases are diagnosed continues to
rise,4 and survival is also increasing.5-7 A recent study provided a detailed report of cancer prevalence in Canada as of January 1, 2005.8 However, cancer prevalence trends are rarely published, and until now, have not been reported for Canada......
Conclusion
This study presents the f rst Canadian cancer prevalence trend estimates to be reported. Trends in prevalence for an extensive list of cancers by time since diagnosis, sex and age group signachanges in the extent of disease in the Canadian population. Rising cancer prevalence proportions are due to increases in incidence, which partly result from the aging of the population, and to improvements in survival. Information about the degree to which changes in prevalence are occurring, and for which cancers in particular, is valuable for
resource planning
Chapter 22: Integration of Herbal Medicine into Evidence-Based Clinical Practice - Herbal Medicine - NCBI Bookshelf
Integration of Herbal Medicine into Evidence-Based Clinical Practice - Herbal Medicine - NCBI Bookshelf
- INTRODUCTION
- CURRENT STATUS AND MAJOR ISSUES OF INTEGRATION OF HERBAL MEDICINE IN EVIDENCE-BASED MEDICAL THERAPY
- FACTORS RELEVANT TO/AFFECTING INTEGRATION OF HERBAL MEDICINE INTO MODERN MEDICAL PRACTICES
- RESEARCH NEEDS
- CONCLUSIONS
- REFERENCE
"....However, proof of efficacy or safety for the vast majority of herbal medicine has not been fully established through an evidence-based approach. Further, other issues, such as scientific, cultural, educational, economical, and legal, need to be addressed. In this chapter, we examine the current status and major scientific issues or factors that affect the integration of herbal medicine into evidence-based medical therapy."
The
authors wish to thank the WHO Collaborating Centre for Traditional
Medicine at the School of Health Sciences, RMIT University, Bundoora,
Victoria, Australia, and the WHO Collaborating Centre for Traditional
Medicine at the College of Pharmacy, University of Illinois at Chicago,
Chicago, Illinois, for their consent and encouragement to undertake the
present collaboration.
Multiple VEGF Family Members are Simultaneously Expressed in Ovarian Cancer: a Proposed Model for Bevacizumab Resistance
Multiple VEGF Family Members are Simultaneously Expressed in Ovarian Cancer: a Proposed Model for Bevacizumab Resistance.:
Curr Pharm Des. 2012 May 14;
Abstract
Objective Insight into the expression of multiple vascular endothelial growth factor (VEGF) family members can support the implementation of anti-angiogenic therapy. This study aimed to assess VEGF family member expression in ovarian cancers and related omental metastases.
Methods Tissue microarrays encompassing 270 primary cancers and 112 paired metastases were immunostained for VEGF-A, VEGF-B, VEGF-C and VEGF-D. Staining intensities were categorized as absent, weak, moderate or strong. Expression was related to clinicopathological characteristics and survival.
Results Immunohistochemical positivity (defined as moderate or strong expression) was observed for VEGF-A in 90%, VEGF-B in 4%, VEGF-C in 41% and VEGF-D in 55% of the primary ovarian cancers. ....... VEGF family member expression showed no independent prognostic significance in multivariate survival analysis.
Conclusion VEGF-A, VEGF-C and VEGF-D are widely and often simultaneously expressed in ovarian cancer, which may contribute to bevacizumab resistance. Measuring their expression could support a rational, individualized choice of anti-angiogenic therapy and might be of predictive value. Studies are warranted to determine whether combinatorial analysis of VEGF family member expression can be used to predict anti-angiogenic drug efficacy.
The role of bevacizumab in advanced epithelial ovarian cancer.
The role of bevacizumab in advanced epithelial ovarian cancer.:
Curr Pharm Des. 2012 May 14;
Abstract
Background: There is a strong rationale for usage of anti-angiogenic agents in epithelial ovarian cancer. Bevacizumab is the most widely investigated anti-VEGF agent and has shown promising results in recent clinical trials.
Objective: To review the rationale and usage of bevacizumab in advanced epithelial ovarian cancer; as mono-therapy, in combination with chemotherapy both as first line and for recurrent ovarian cancer as well as in combination with other targeted therapies.
Results: In epithelial ovarian cancer, angiogenesis promotes tumor growth, ascites formation and metastasis. Targeting VEGF in ovarian cancer patients may have indirect and direct cytotoxic effects. Results of placebo controlled phase III trials, the GOG-218 and ICON7, of carboplatin-paclitaxel alone or combined with bevacizumab in chemo-naive patients and the OCEAN trial comparing carboplatin-gemcitabine with or without bevacizumab in women with recurrent platinum-sensitive epithelial ovarian cancer all suggest a benefit for the addition of bevacizumab on progression free survival. Additionally, bevacizumab in combination with other targeted therapies, such as sorafenib and everolimus are under investigation in phase II trials and the current knowledge of molecular predictors is discussed.
In conclusion: Until now no survival benefit has been observed, but bevacizumab is the first anti-angiogenic agent demonstrating a progression free survival benefit in addition to standard chemotherapy regimens in advanced epithelial ovarian cancer, both in the upfront and recurrent setting. Mature overall survival data and the search for predictive biomarkers are important for the future role of bevacizumab in epithelial ovarian cancer.
paywalled: Guideline-Based Peer-to-Peer Consultation Optimizes Pegfilgrastim Use With No Adverse Clinical Consequences [Original Contributions]
Guideline-Based Peer-to-Peer Consultation Optimizes Pegfilgrastim Use With No Adverse Clinical Consequences [Original Contributions]:
Purpose:
Practice guidelines do not recommend the routine use of colony-stimulating factors when there is a low risk (< 10%) of febrile neutropenia (FN). We prospectively determined whether expert peer-to-peer consultation with prescribing oncologists would improve adherence to guidelines and whether there would be any adverse events associated with that adherence.
Methods:
Commencing in March 2010, we reviewed requests for pegfilgrastim from 22 community oncology practices comprising 78 physicians providing service to approximately 97,000 Medicare members. Paid claims data on all chemotherapy and supportive care medications were reviewed from fourth quarter (Q4) 2009 through third quarter (Q3) 2010. In total, 82 patients received pegfilgrastim. If the prescribed chemotherapy was associated with a low risk (< 10%) for FN, then a peer review was initiated. The treating physician made the final decision to use, or not use, pegfilgrastim, and no denials were issued.
Results:
A total of 245 units (1 unit = 6 mg) of pegfilgrastim were administered during the four quarters analyzed. Use in the low-risk category decreased from 52 units in Q4 2009 to 15 units in Q3 2010. The per-member per-month (PMPM) cost of pegfilgrastim decreased across quarters, with an average cost of $1.07 PMPM for Q4 2009 and $0.57 PMPM for Q3 2010. No studied patient was admitted for neutropenic fever.
Conclusion:
Active expert peer-to-peer consultation with prescribing oncologists can promote adherence to guidelines and potentially lead to significant cost reductions without significant risk of neutropenic fever, with or without hospitalization, for patients with cancer.
paywalled: Patient Out-of-Pocket Payments for Oral Oncolytics: Results From a 2009 US Claims Data Analysis [Original Contributions]
Patient Out-of-Pocket Payments for Oral Oncolytics: Results From a 2009 US Claims Data Analysis [Original Contributions]:
Purpose:
Oral oncolytics are an increasingly important treatment option for cancer. These agents often fall within the pharmacy benefit, with the potential for increased out-of-pocket (OOP) cost burden for patients. The purpose of this study was to evaluate patient OOP payments for oral oncolytic therapies in US managed care plans.
Conclusion:
Among 21 oral oncolytics, average OOP cost ranged from $15 to > $500. These results confirm previous findings showing OOP payments differing widely among oral oncolytic options. As cost for therapy becomes a greater part of treatment decisions, an understanding of patient OOP cost will be critical in informing choices.
paywalled: Visit Duration for Outpatient Physician Office Visits Among Patients With Cancer
Visit Duration for Outpatient Physician Office Visits Among Patients With Cancer
Conclusion:
Higher use of performance-based payment mechanisms and capitated arrangements are associated with a decrease in the amount of time physicians spend with their patients with cancer. It is unclear whether shorter visit times impact the quality of medical care provided or whether physicians in these settings have become more proficient in caring for their patients.
paywalled: Meat and fish consumption and risk of pancreatic cancer – results from the european prospective investigation into cancer and nutrition - International Journal of Cancer
Blogger's Note: implications for all cancers/research
Meat and fish consumption and risk of pancreatic cancer – results from the european prospective investigation into cancer and nutrition - Rohrmann - International Journal of Cancer
Conclusion:
Our
results do not support the conclusion of the World Cancer Research Fund
that red or processed meat consumption may possibly increase the risk
of pancreatic cancer. The positive association of poultry consumption
with pancreatic cancer might be a chance finding as it contradicts most
previous findings.
UPDATE: New Website Selling Miracle Mineral Solution Sodium Chlorite Solution Not Authorized for Oral Consumption by Humans
Blogger's Note: the website is still active as of the date of this positing
UPDATE: New Website Selling Miracle Mineral Solution Sodium Chlorite Solution Not Authorized for Oral Consumption by Humans
Information Update
2012-74
May 18, 2012
For immediate release
OTTAWA - Further to our previous communications, Health Canada is advising Canadians that a new website has been identified selling "MMS", also known as Miracle Mineral Solution or Miracle Mineral Supplement. The website is http://www.buymms.biz
When new websites or retailers are identified, Health Canada will continue to update our current list of MMS products. Canadians are advised to monitor this list of affected products for any possible updates.
Health Canada continues to remind Canadians that there are no therapeutic products containing sodium chlorite authorized for oral consumption by humans. MMS may cause serious health problems that include poisoning, kidney failure and harm to red blood cells that reduces the ability of the blood to carry oxygen. Additional health problems may also include abdominal pain, nausea, vomiting, and diarrhoea.
Consumers should consult their health care practitioner if they have used or are using MMS products and report any adverse reaction to Health Canada.
Health Canada has notified distributors identified to date that the sale of sodium chlorite for human consumption is in contravention of the Food and Drugs Act. We have also requested that identified distributors remove product from the Canadian market. As such, this website (http://www.buymms.biz) may or may not be operational. (Blogger's Note: is active)
May 21 Webinar: Steps to Addressing Health Disparities
May 21 Webinar: Steps to Addressing Health Disparities:
Michelle Yeboah of FDA's Office of Minority Health tells how the agency is addressing health disparities among minority populations in America.
Google goes cancer: Researchers use search engine algorithm to find cancer biomarkers
Google goes cancer: Researchers use search engine algorithm to find cancer biomarkers:
The strategy used by Google to decide which pages are relevant for a search query can also be used to determine which proteins in a patient's cancer are relevant for the disease progression. Researchers from Dresden University of Technology, Germany, have used a modified version of Google's PageRank algorithm to rank about 20,000 proteins by their genetic relevance to the progression of pancreatic cancer. In their study, published in PLoS Computational Biology, they found seven proteins that can help to assess how aggressive a patient's tumor is and guide the clinician to decide if that patient should receive chemotherapy or not.
read more
Cancerworld.org: GrandRound - A second opinion, because there’s no second chance
A second opinion, because there’s no second chance
Patients want the option of consulting a second doctor, and the evidence shows that, for a minority of them, treatment decisions have altered significantly as a result. But could granting every patient the legal right to a second opinion tie up precious resources as each one ‘shops around’ in search of the opinion they want to hear?.....
"The fear that many have about ‘upsetting’ their doctor should not be underestimated"
IN SHORT
- Women, especially breast cancer patients, are among the most likely to seek second opinions, probably because of the many different treatment options for breast cancer and its high visibility in the media.
- Computers networks are obvious second opinion enablers. The European Union’s e-Health
- action plan predicts that by 2008 the majority of European health organisations should have the technical capability to provide online teleconsultation services for second opinions and other needs.
- More than a quarter (29%) of US adults reported that they or a member of their family received a second medical opinion from a doctor in the past five years, according to a 2005 Harris Interactive survey. In 30% of these, the diagnosis differed from the original. Another Harris poll in 2006 found that 36% of US adults never get a second opinion and nearly one in ten (9%) ‘rarely or never understand’ their diagnosis.
- Australian researchers have found that ‘Googling’ symptoms on the Internet came up with the right diagnosis in 15 out of 26 cases (reported in the New England Journal of Medicine). At Duke University in the US, medical physicists are using a Google-like approach to compare mammograms with the most highly ranked images returned from a database.
Patient-Centered Outcomes Research Institute PCORI: What Is It? How Does It Work? The Director Explains
PCORI: What Is It? How Does It Work? The Director Explains
In this segment of Medscape One-on-One, Joseph Selby, MD, talks with Eli Adashi, MD, about his new role as head of the Patient-Centered Outcomes Research Institute, its mission, and how physicians might benefit from this institute created under the Affordable Care Act.
excerpt:
"How Does PCORI Differ From the Cochrane Collaboration?
Dr. Adashi: A question you almost certainly have heard before and that some of our viewers almost certainly contemplated has to do with the distinction between PCORI and other undertakings, such as the Cochrane Collaboration and programs that engage in systematic reviews or meta-analysis of data. In what way does PCORI stand out to other efforts? Where is it unique and distinct?
Dr. Selby: I think the most striking difference is that we are a research funding institution. The Cochrane Collaboration collects, disseminates, and guides the creation of evidence syntheses. We will fund some evidence syntheses, but we'll also fund a lot of empirical research, including observational research and randomized comparisons. So, we are a funding institute of substantial size in distinction to, as you mentioned, the Cochrane Collaboration and several European organizations that synthesize data and go beyond synthesis to supporting policymaking.
The other distinguishing characteristic is that we don't make policy; we generate information....
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