Coping with Cancer: Prognosis Resources - National Cancer Institute

National Cancer Institute

1) Prognosis Resources

2) Understanding Your Cancer Prognosis

 

'Dead Man Walking': A Too Common Cancer Patient

'Dead Man Walking'

"As oncologists around the world know, the United States is the home of an enviable amount of cancer research and clinical innovation.
Physicians here and abroad also know that the New England Journal of Medicine often serves as a showcase for great clinical triumphs in American oncology.
The venerable publication regularly publishes groundbreaking cancer studies funded by the National Institutes of Health and American pharmaceutical companies that change practice.
However, a different kind of American cancer story was published online October 23 in the New England Journal of Medicine.
It even shocked 2 physicians who admit to being "accustomed" to disturbing patient tales.....
 

Coordinated Care - The Commonwealth Fund (video 2.32 min.)

Coordinated Care 

Search of: ponatinib | Adult - List Results - ClinicalTrials.gov - FDA warning Ponatinib

Search of: ponatinib | Adult - List Results - ClinicalTrials.gov


 Oct 31st:

FDA Asks Ariad to Halt Sale of Leukemia Drug

Age at Onset Should Be a Major Criterion for Subclassification of Colorectal Cancer

Abstract

Purchase $31.50

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An important proportion of early-onset colorectal cancer (CRC) does not show a hereditary component, generally Lynch syndrome, with limited knowledge about its molecular basis and features. We analyzed a subset of patients with early-onset CRC and compared them with patients with late-onset CRC. We analyzed the microsatellite instability and CpG island methylator phenotype (CIMP) in both populations and classified them into four molecular subtypes. We analyzed the differential features between groups. Only 12 of 81 early-onset cases (15%) showed microsatellite instability, 10 of which (83%) were Lynch syndrome cases; microsatellite instability cases in elderly patients were sporadic. Early-onset microsatellite-stable cases showed different tumor locations and more family history of cancer than the elderly. Microsatellite instability/CIMP-high early-onset CRC was associated with Lynch syndrome, whereas the elderly cases were associated with BRAF mutations. Early-onset microsatellite-stable/CIMP-high CRCs were more frequently mucinous and right sided than elderly cases, with a high incidence of Lynch syndrome neoplasms; early-onset microsatellite stable/CIMP-low/0 differed from elderly cases in location, stages, incidence of multiple primary neoplasms, and the familial component. The clinical and familial differences observed between early- and late-onset CRC when considering the different carcinogenetic pathways underline that the age at onset criterion should be considered when classifying CRC.

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Herpes Zoster — NEJM (vaccine - article/commentaries)

Herpes Zoster 

Talking with Patients about Other Clinicians' Errors — NEJM

open access

Re: Risks of Colorectal and Other Cancers After Endometrial Cancer for Women With Lynch Syndrome

no abstract

J Natl Cancer Inst. 2013 Oct 29. [Epub ahead of print]

Oktay AA, Alpay SN, Sahin IH.

Source

Affiliations of authors: Department of Internal Medicine, Saint Francis Hospital, Evanston, IL (AAO); Department of Experimental Therapeutics (SNA) and Department of Gastrointestinal Medical Oncology (IHS), University of Texas MD Anderson Cancer Center, Houston, TX.

PMID:

24168969

[PubMed - as supplied by publisher]

 

Pooled cohort study on height and risk of cancer and cancer death

open access

Conclusion
Height was associated with risk of cancer and cancer death indicating that factors related to height such as hormonal and genetic factors stimulate both cancer development and progression.

Introduction
Adult height, determined by genetics and by nutrition in
childhood, has been associated with an increased risk of
some cancers such as cancer of the prostate [1], breast [2],
colorectum [3], ovary [4, 5], pancreas [6], kidney [7], testis
[8], endometrium [9], malignant melanoma [2, 10, 11], and
with lymphohematopoietic malignancies [12]. However,
there are only a few studies on all cancer sites, [2, 13–15]
and only one of these studies included men as well as
women [13]. Height has also been associated with an
increased risk of cancer death in contrast to the decreased
risk of total mortality and mortality from cardiovascular
diseases [16, 17]. To the best of our knowledge, no large
study to date has analyzed risk of cancer at all sites and
cancer death in the same study......

2014 Progress and Controversies in Gynecologic Oncology Conference (notice)

Conference

 

Seth's Blog: On owning it

Seth's Blog

Impact of anesthesia for cancer surgery

abstract

PURPOSE:

A number of original publications and review articles have addressed the issue of perioperative immune modulation and cancer outcome. The objective of this module is to review current understanding surrounding the pathways involved and the evidence implicating commonly used anesthetic agents.

PRINCIPAL FINDINGS:

Drugs commonly used in anesthetic practice have been shown to affect various components of the immune system in laboratory animal and human in vitro models. It has been hypothesized that these effects may favour tumour recurrence and metastasis formation. Inhalational agents and opiates have potential negative immunomodulatory effects; on the other hand, regional anesthesia and propofol may have positive effects on immune function modulation. However, the clinical relevance of these studies to human cancer outcome is unknown since clinical trials are equivocal, and results of in vitro and animal model studies cannot be extrapolated to clinical practice. Furthermore, there is a lack of rigorous clinical trials demonstrating clinical outcome benefit for one technique over another. It remains unclear how anesthetic drugs influence the immune system in relation to tumour cell elimination and clinical cancer outcome.

CONCLUSIONS:

Recommendations for a specific anesthetic technique based on cancer outcome alone cannot be made. A pragmatic solution would be to offer regional anesthesia in isolation or combined with propofol infusion to cancer patients if appropriate and if local expertise is available. Regional anesthesia offers excellent analgesia, a low incidence of postoperative nausea and vomiting, and a favourable immunological profile based on current understanding of laboratory evidence.

Purchase on Springer.com

$39.95 / €34.95 / £29.95

 

Americans will have an extra six weeks to buy health coverage before facing penalty

The Washington Post

Hormone Therapy’s Protection Against Endometrial Cancer Persists in Women’s Health Initiative Follow-Up Study

 Blogger's Note: post WHI studies have been published in recent years which have 'clarified' some of the original study's findings, such as this:

PracticeUpdate (requires registration to view - free)

"...Dr. Marcia Hall, a consultant medical oncologist at the Mount Vernon Cancer Centre in greater London, provided independent comment on the results. “The combination of estrogen plus progestin does indeed protect against endometrial cancer,” she said, noting that the results are in line with those of observational studies, such as the U.K.’s Million Women Study (Lancet 2007;369:1703-10)....

Scientists voice fears over ethics of drug trials remaining unpublished

media - UK

Drug companies and other organisations that carry out clinical trials are violating their ethical obligation to the people who take part by failing to publish the results, scientists will argue on Wednesday.
Almost one in three (29%) large clinical trials in the United States remain unpublished five years after they are finished, according to scientists writing in the British Medical Journal. Of those, 78% have no results at all in the public domain.
The scientists calculate about 250,000 people took part in the unpublished trials and have therefore been exposed to all the risks involved in research without the benefits to society they were led to believe would ensue. This "violates an ethical obligation that investigators have towards study participants", say Christopher Jones from the Department of Emergency Medicine, Cooper Medical School of Rowan University, New Jersey, and colleagues. They call for additional safeguards "to ensure timely public dissemination of trial data."
The researchers looked at trials registered in the United States, but some of that research will have taken place in Britain and the issue is global....
 

Marriage Is As Protective As Chemotherapy in Cancer Care

open access

See accompanying article on page 3869 

Pharmacologic Ovarian Preservation in Young Women Undergoing Chemotherapy

abstract

The prognosis of malignancies in young women undergoing chemotherapy has dramatically improved recently, and more attention is given to the long term quality of life, including fertility and reproductive function preservation. Some chemotherapeutic drugs are known to be associated with gonadal toxicity (cyclophosphamide, L-phenylanine mustard, busulfan and nitrogen mustard) and others have less or un-quantified effects (doxorubicin, bleomycin, vinca alkaloids, as vincristine and vinblastin, cisplatin, nitrosoureas, cytosine arabinoside). Women are in need to identify best options to minimize ovarian damage during chemotherapy through the administration of protective drugs, better choice of therapy and with advocating oncofertility preservation. We reviewed the possible options focusing on the most studied gonadotrophin-releasing hormone agonists (GnRH-a) and the psychologically promising oral contraceptives (OC). Controversy exist on the benefit of gonadotrophin releasing hormone agonist (GnRH-a) or combined oral contraceptive administered at time of cancer therapy in preventing premature ovarian failure in women and the available data from both human and animal studies have been mixed. The best way to preserve fertility and ovarian function in young women undergoing chemotherapy still remains to be determined. In the absence of a best approach, each case should be evaluated individually, considering patient's wishes and expectations, the type of chemotherapy, age, obstetric history, ovarian reserve (combining multiple indicators such as basal hormone profile, anti müllerian hormone -AMH- and antral follicle count), family history of premature ovarian failure. We present a review of the available evidence on the value of administering GnRH-a and OC use to minimize or prevent the effect of chemotherapy agents on reproductive function.

 

Intraperitoneal chemotherapy: Rationale, applications, and limitations (Saudi Arabia)

abstract

 

Intraperitoneal chemotherapy, involving the administration of certain chemotherapeutic agents directly to the intraperitoneal cavity, was developed as a novel therapeutic strategy early in the 1950s. Intraperitoneal administration of chemotherapy results in higher intraperitoneal concentration of the cytotoxic medications and minimal systemic exposure than observed with intravenous administration, which in turn may increase the efficacy of these agents with substantial reduction in systemic toxicity. Intraperitoneal chemotherapy was used successfully in peritoneal surface malignancies, including malignant peritoneal mesothelioma, pseudomyxoma peritonei, malignant ascites, sarcomatosis, and peritoneal carcinomatosis from gastrointestinal and ovarian cancers. Pharmacists may play a major role in optimizing intraperitoneal chemotherapy through verification of chemotherapy order for proper doses, dilution, preparation, and administration. Moreover, pharmacists are medication experts who can provide other health care professionals with the necessary drug information.

Despite the local application of chemotherapy, intraperitoneal chemotherapy is not free of systemic side effects and can be associated with serious complications. The benefits of intraperitoneal chemotherapy should be weighed against its potential harm to maximize efficacy and to minimize morbidity and mortality as much as possible. The aim of this article is to review the current available literature regarding the safety and efficacy of intraperitoneal chemotherapy in cancer treatment.

 Purchase Short-Term Access

• Pay per Article - You may purchase this article for US$32.00. 

Feasibility, acceptability and preferences for intraperitoneal chemotherapy with paclitaxel and cisplatin after optimal debulking surgery for ovarian and related cancers: an ANZGOG study

open access

Abstract

Objective: Intraperitoneal (IP) chemotherapy in women with optimally debulked stage III ovarian cancer has been reported to prolong overall survival, but has not been widely adopted due to concerns about its toxicity, inconvenience and acceptability to patients. The purposes of this study were to determine the regimen's feasibility, adverse events, catheter-related complications, progression-free survival, health-related quality of life (HRQL), and patients' preferences for IP versus intravenous (IV) chemotherapy.
Methods: We conducted a single arm, multi-center study of IP chemotherapy with IV paclitaxel 135 mg/m2 (D1) over 3 hours, IP cisplatin 75 mg/m2 (D2), and IP paclitaxel 60 mg/m2 (D8) for 6 cycles in women with optimally debulked stage III ovarian or related cancers.
Results: Thirty-eight eligible patients were recruited from 12 sites between July 2007 and December 2009. Seventy-one percent (n=27) completed at least 4 cycles and 63% (n=24) completed all 6 cycles. Grade 3 or 4 adverse events included nausea (n=2), vomiting (n=2), abdominal pain (n=2), and diarrhea (n=1), but not febrile neutropenia, neurotoxicity, or nephropathy. There were no treatment-related deaths. Catheter-related complications were the most frequent cause of early discontinuation of treatment (16 patients, 21%). Apart from neurotoxicity HRQL which worsened over time, HRQL was stable or improved with time. Most patients (≥50%) judged moderate benefits (e.g., an extra 6 months survival time or a 5% improvement in survival rates) necessary to make IP chemotherapy worthwhile.
Conclusion: IP chemotherapy was feasible, tolerable, and most participants considered moderate survival benefits sufficient to warrant the adverse effects and inconvenience.

 

PDF open access

 

The roles of ARID1A in gynecologic cancer

 open access




 Received Aug 6, 2013, Accepted Aug 7, 2013
This article was solicited and has not been peer reviewed

CONCLUSION
Disorganized chromatin structure is known to be associated
with the appearance of various abnormal phenotypes,
including cancer [53,54]. ARID1A , a gene participated in
chromatin remodeling, is an emerging tumor suppressor
gene. Accumulating evidence has reported somatic inactivating
mutations of ARID1A and loss of its expression in many
types of human cancers, especially in endometrium-derived
tumors, including ovarian clear cell carcinomas, ovarian endometrioid
carcinomas and uterine endometrioid carcinomas.
The high prevalence of somatic mutations in those ovarian
and endometrial cancers indicates a pivotal role of ARID1A in
their development. Understanding the roles of ARID1A in the
pathogenesis of endometrium-derived tumors is fundamental
for future translational studies aimed at designing new
diagnostic tests for early detection and identifying critical
molecular targets for new therapeutic interventions.

Parameters that Define A Successful Colonoscopy

open access (see tables 1 & 2)

Dose-dense effect: other contributors – Author's reply : The Lancet Oncology

abstract

"Kesikli and colleagues argued that results shown by the JGOG 3016 study for dense-dense paclitaxel in ovarian cancer 1 were caused by a higher cumulative dose received by the dose-dense group and by antiangiogensis effects of paclitaxel rather than by the dose-dense administration of the drug. However, increased dose of paclitaxel in ovarian cancer has shown no survival benefit in previous studies. Bolis and colleagues 2 compared standard-dose paclitaxel 175 mg/m 2 plus carboplatin with increased dose ... (to read further requires $$$)

 

Untangling BRCA mutations, sex hormones, and cancer risk : The Lancet Oncology

open access

Understanding basic disease mechanisms might allow development of novel strategies for the primary prevention of breast and ovarian cancer. For carriers of BRCA1/2 mutations, options for primary prevention are limited to bilateral salpingo-oophorectomy and prophylactic mastectomy. In The Lancet Oncology, Martin Widschwendter and colleagues1 compare ovarian and endometrial function in carriers of the BRCA1/2 mutation with high-risk, mutation negative women in the UK Familial Ovarian Cancer Screening Study. BRCA1/2 mutations are thought to cause cancer via a defect in DNA damage response or in the DNA repair pathway, but this does not explain organ-specific cancer penetrance. These novel data suggest that end-organ response might have a role..... 

The CONSORT Patient-Reported Outcome (PRO) extension: implications for clinical trials and practice

open access

Health and Quality of Life Outcomes (multi-national)

To inform clinical guidelines and patient care we need high quality evidence on the relative benefits and harms of intervention. Patient reported outcome (PRO) data from clinical trials can "empower patients to make decisions based on their values" and "level the playing field between physician and patient". While clinicians have a good understanding of the concept of health-related quality of life and other PROs, evidence suggests that many do not feel comfortable in using the data from trials to inform discussions with patients and clinical practice. This may in part reflect concerns over the integrity of the data and difficulties in interpreting the results arising from poor reporting.The new CONSORT PRO extension aims to improve the reporting of PROs in trials to facilitate the use of results to inform clinical practice and health policy. While the CONSORT PRO extension is an important first step in the process, we need broader engagement with the guidance to facilitate optimal reporting and maximize use of PRO data in a clinical setting. Endorsement by journal editors, authors and peer reviewers are crucial steps. Improved design, implementation and transparent reporting of PROs in clinical trials are necessary to provide high quality evidence to inform evidence synthesis and clinical practice guidelines. 

Background
Randomized controlled clinical trials (RCTs) can provide high-quality data regarding the impact of study interventions on patient outcomes, and remain the ‘gold standard’ of evidence regarding both the benefits and harms associated with an intervention. Over the last twenty years, the number of clinical trials that assess patient reported outcomes (PROs) has
substantially increased [1]. PROs can be defined as a “measurement of any aspect of a patient’s health status that comes directly from the patient (i.e. without the interpretation of the patient’s responses by a physician or anyone else” [2] and include health-related quality
of life (HRQL), symptoms, satisfaction and adherence to medication. These subjective measures of outcome help evaluate the burden of disease and treatment from the patients’ perspective. In the conceptual framework developed by Till and colleagues adapted in (Figure 1) [3], PRO data from clinical trials may directly inform patients and practitioners, or may indirectly inform clinical practice through evidence synthesis into clinical practice guidelines.....

The complete article is available as a provisional PDF. The fully formatted PDF and HTML versions are in production.

 

Choosing Wisely Campaign: American Society of Clinical Oncology 2013 Top Five List in Oncology

ASCO - open access

Medical News |

Physician's First Watch

October 30, 2013

5 Cancer Tests and Treatments with Little or No Value

By Joe Elia

The American Society of Clinical Oncology has identified a second group of commonly used tests and treatments in cancer medicine that have little or no benefit. The list, part of the American Board of Internal Medicine's "Choosing Wisely" initiative, appears in the Journal of Clinical Oncology.

Briefly, here are this year's "top five" items:

• Don't give antiemetics to patients starting chemotherapies that have low-to-moderate potential for causing symptoms.
• In treating metastatic breast cancer, avoid combination chemotherapy unless the patient's cancer burden needs to be reduced quickly.
• Avoid PET scanning in routine follow-up unless there's "high-level" evidence that the imaging will improve outcomes.
• Don't do PSA testing in asymptomatic men when life expectancy is under 10 years.
• Don't use therapy targeted against a specific genetic aberration unless the patient has specific biomarkers that predict effective response.

Link(s):

Journal of Clinical Oncology article (Free PDF)

Background: ASCO's 2012 choices (Free)

Choosing Wisely home page (Free)

- See more at: http://www.jwatch.org//fw108085/2013/10/30/5-cancer-tests-and-treatments-with-little-or-no-value#sthash.E2u68UGy.dpuf

Medical News |

Physician's First Watch

October 30, 2013

5 Cancer Tests and Treatments with Little or No Value

By Joe Elia

The American Society of Clinical Oncology has identified a second group of commonly used tests and treatments in cancer medicine that have little or no benefit. The list, part of the American Board of Internal Medicine's "Choosing Wisely" initiative, appears in the Journal of Clinical Oncology.

Briefly, here are this year's "top five" items:

• Don't give antiemetics to patients starting chemotherapies that have low-to-moderate potential for causing symptoms.
• In treating metastatic breast cancer, avoid combination chemotherapy unless the patient's cancer burden needs to be reduced quickly.
• Avoid PET scanning in routine follow-up unless there's "high-level" evidence that the imaging will improve outcomes.
• Don't do PSA testing in asymptomatic men when life expectancy is under 10 years.
• Don't use therapy targeted against a specific genetic aberration unless the patient has specific biomarkers that predict effective response.

Link(s):

Journal of Clinical Oncology article (Free PDF)

Background: ASCO's 2012 choices (Free)

Choosing Wisely home page (Free)

- See more at: http://www.jwatch.org//fw108085/2013/10/30/5-cancer-tests-and-treatments-with-little-or-no-value#sthash.E2u68UGy.dpuf

Medical News |

Physician's First Watch

October 30, 2013

5 Cancer Tests and Treatments with Little or No Value

By Joe Elia

The American Society of Clinical Oncology has identified a second group of commonly used tests and treatments in cancer medicine that have little or no benefit. The list, part of the American Board of Internal Medicine's "Choosing Wisely" initiative, appears in the Journal of Clinical Oncology.

Briefly, here are this year's "top five" items:

• Don't give antiemetics to patients starting chemotherapies that have low-to-moderate potential for causing symptoms.
• In treating metastatic breast cancer, avoid combination chemotherapy unless the patient's cancer burden needs to be reduced quickly.
• Avoid PET scanning in routine follow-up unless there's "high-level" evidence that the imaging will improve outcomes.
• Don't do PSA testing in asymptomatic men when life expectancy is under 10 years.
• Don't use therapy targeted against a specific genetic aberration unless the patient has specific biomarkers that predict effective response.

Link(s):

Journal of Clinical Oncology article (Free PDF)

Background: ASCO's 2012 choices (Free)

Choosing Wisely home page (Free)

- See more at: http://www.jwatch.org//fw108085/2013/10/30/5-cancer-tests-and-treatments-with-little-or-no-value#sthash.E2u68UGy.dpuf

Fruit and vegetable consumption associated with reduced risk of epithelial ovarian cancer in southern Chinese women

abstract

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Highlights

•

First report on fruit and vegetable intake and ovarian cancer in southern China.

•

High fruit and vegetable consumption appears protective against ovarian cancer.

•

Intakes of nutrients derived from fruits and vegetables are inversely associated with the ovarian cancer risk.

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Objective

To investigate the association between fruit and vegetable consumption and the risk of epithelial ovarian cancer in southern Chinese women.

Methods

A case-control study was undertaken in Guangzhou, Guangdong Province, between 2006 and 2008. Participants were 500 incident ovarian cancer patients and 500 hospital-based controls. Information on habitual fruit and vegetable consumption was obtained by face-to-face interview using a validated and reliable food frequency questionnaire. Unconditional logistic regression analyses were performed to assess the association between fruit and vegetable intakes and the ovarian cancer risk.

Results

The mean fruit and vegetable daily intakes of ovarian cancer patients (324.2 g (SD 161.9) and 582.7 g (SD 250.2)) were significantly lower (p < 0.001) than those of controls (477.3 g (SD 362.1) and 983.3 g (SD 739.9)). The adjusted odds ratios were 0.30 (95% confidence interval (CI) 0.21 to 0.44) and 0.07 (95% CI 0.04 to 0.12) for more than 490 g of fruits and 970 g of vegetables per day, relative to at most 320 g and 690 g per day, respectively. With the exception of lycopene, substantial risk reductions were evident for a variety of nutrients derived from fruits and vegetables.

Conclusion

Consumption of fruits and vegetables was inversely associated with the incidence of epithelial ovarian cancer in southern Chinese women.

 

Pelvic MRI as the “gold standard” in the subsequent evaluation of ultrasound-indeterminate adnexal lesions: A systematic review

abstract

Review

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Highlights

•

The preponderant contribution of MRI in adnexal mass evaluation is its specificity.

•

Pelvic MRI provides confident diagnosis of a plethora of benign adnexal lesions.

•

Contrast-MRI provides the highest post-test probability of ovarian cancer detection.

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Objective

Incidentally discovered adnexal masses are common, posing a challenging diagnostic problem due to overlapping imaging features of benign and malignant. Thus, once an adnexal lesion has been detected, the primary goal of further imaging is accurate tissue characterization resulting in surgery only for lesions that are indeterminate or frankly malignant. This study aims to conduct a systematic review, following the PRISMA guidelines, and critically appraise pelvic MR Imaging as the preferred advanced second imaging test, as regards detection of ovarian cancer and assessment of indeterminate adnexal masses, with respect to pre-operatively improving the assignment of these patients to the appropriate level of care.

Methods

A comprehensive computerized systematic literature search of English language studies was performed (from 2002 to 2012) of PubMed, EMBASE, Scopus, Evidence Based Medicine Reviews (Cochrane Database and Cochrane Central Register of Controlled Trials), and Google Scholar. Relevant article reference lists were hand searched.

Results

Computerized database search revealed 37 citations of relevance, 10 of which fulfilled the inclusion/exclusion criteria. From the aforementioned, 8 articles were acquired (2 authors were contacted but did not respond) as well as assessed with AHRQ, QUADAS, and STARD evaluation tools. Finally, 6 papers (5 prospective and 1 retrospective) were included in the systematic review.

Conclusions

MRI with intravenous (IV) contrast administration provides the highest post-test probability of ovarian cancer detection. However, the preponderant contribution of MRI in adnexal mass evaluation is its specificity because it provides confident diagnosis of many benign adnexal lesions.

 

The Role and Timing of Palliative Medicine Consultation for Women with Gynecologic Malignancies: Association with End of Life Interventions and Direct Hospital Costs (NY)

abstract

Open Access (pdf)

"Palliative care is often confused with hospice care."

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Highlights

•

Timely palliative medicine consultation is associated with improved quality of end of life care.

•

Decreased direct hospital costs are associated with timely palliative medicine consultation.

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Objective

Aggressive care interventions at the end of life (ACE) are reported metrics of sub-optimal quality of end of life care that are modifiable by palliative medicine consultation. Our objective was to evaluate the association of inpatient palliative medicine consultation with ACE scores and direct inpatient hospital costs of patients with gynecologic malignancies.

Methods

A retrospective review of medical records of the past 100 consecutive patients who died from their primary gynecologic malignancies at a single institution was performed. Timely palliative medicine consultation was defined as exposure to inpatient consultation ≥ 30 days before death. Metrics utilized to tabulate ACE scores were ICU admission, hospital admission, emergency room visit, death in an acute care setting, chemotherapy at the end of life, and hospice admission < 3 days. Inpatient direct hospital costs were calculated for the last 30 days of life from accounting records. Data were analyzed using Fisher’s Exact, Mann–Whitney U, Kaplan-Meier, and Students T testing.

Results

49% of patients had a palliative medicine consultation, 18% had timely consultation. Median ACE score for patients with timely palliative medicine consultation was 0 (range 0–3) versus 2 (range 0–6) p = 0.025 for patients with untimely/ no consultation. Median inpatient direct costs for the last 30 days of life were lower for patients with timely consultation, $0 (range 0–28,019) versus untimely, $7729 (0–52,720), p = 0.01.

Conclusions

Timely palliative medicine consultation was associated with lower ACE scores and direct hospital costs. Prospective evaluation is needed to validate the impact of palliative medicine consultation on quality of life and healthcare costs.

Platelet-derived Growth Factor Receptor Alpha (PDGFRα) Targeting and Relevant Biomarkers in Ovarian Carcinoma (IMC-3G3)

abstract

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Highlights

•

Targeting PDGFRα with monoclonal antibody (IMC-3G3) significantly enhanced the efficacy of chemotherapy in ovarian cancer cells both in-vitro and in-vivo.

•

Ovarian cancer cells with high-PDGFRα expression showed significant antitumor effects with IMC-3G3 monotherapy, whereas those expressing low-PDGFRα did not.

•

MAPK and CCNB1 were associated with response to IMC-3G3 in high-PDGFRα cells that showed antitumor effects with IMC-3G3 monotherapy.

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Objective

Platelet-derived growth factor receptor alpha (PDGFRα) is believed to be associated with cell survival. We examined (i) whether PDGFRα blockade enhances the antitumor activity of taxanes in ovarian carcinoma and (ii) potential biomarkers of response to anti-PDGFRα therapy.

Methods

PDGFRα expression in 176 ovarian carcinomas was evaluated with tissue microarray and correlated to survival outcome. Human-specific monoclonal antibody to PDGFRα (IMC-3G3) was used for in vitro and in vivo experiments with or without docetaxel. Gene microarrays and reverse-phase protein arrays with pathway analyses were performed to identify potential predictive biomarkers.

Results

When compared to low or no PDGFRα expression, increased PDGFRα expression was associated with significantly poorer overall survival of patients with ovarian cancer (P = 0.014). Although treatment with IMC-3G3 alone did not affect cell viability or increase apoptosis, concurrent use of IMC-3G3 with docetaxel significantly enhanced sensitization to docetaxel and apoptosis. In an orthotopic mouse model, IMC-3G3 monotherapy had no significant antitumor effects in SKOV3-ip1 (low PDGFRα expression), but showed significant antitumor effects in HeyA8-MDR (high PDGFRα expression). Concurrent use of IMC-3G3 with docetaxel, compared with use of docetaxel alone, significantly reduced tumor weight in all tested cell lines. In protein ontology, the EGFR and AKT pathways were downregulated by IMC-3G3 therapy. MAPK and CCNB1 were downregulated only in the HeyA8-MDR model.

Conclusion

These data identify IMC-3G3 as an attractive therapeutic strategy and identify potential predictive markers for further development.

 

Health spending in Canada 2013 | CIHI (+comparisons to other countries/individual provinces)

 

infograph

  More information
To download the annual report,
presentation, methodological
notes or up-to-date data tables,
visit our website at www.cihi.ca/nhex.

Table of Contents — November 2013 Hereditary breast and ovarian cancers: lessening the burden

Table of Contents 

• Hereditary breast and ovarian cancers: lessening the burden

Volume 24 suppl 8 November 2013

introduction

• Select this article
  • F. Muggia,
  • S. Tommasi,
  • H. Lynch,
  • and A. Paradiso

  Hereditary breast and ovarian cancer: lessening the burden

  Ann Oncol (2013) 24 (suppl 8): viii5-viii6 doi:10.1093/annonc/mdt318
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Malignant Transformation from Endometriosis to Atypical Endometriosis and Finally to Endometrioid Adenocarcinoma within 10 Years

abstract

Atypical endometriosis is reported to possess a precancerous potential attributed to premalignant changes characterized by cytological atypia and architecture proliferation. Moreover, the coexistence of atypical endometriosis and neoplasms had been reported. However, cases of atypical endometriosis transformation to carcinoma are rarely reported.

We describe the case of a 33-year-old woman who had a long therapeutic history of endometriosis. Three laparoscopic surgeries were performed to treat endometriosis. After the third surgery, she was diagnosed as having grade 1 endometrioid adenocarcinoma. The histological review of the previous surgery confirmed the diagnosis of atypical endometriosis based on the second specimen. The patient's disease progressed from a benign endometriotic cyst to atypical endometriosis and finally to endometrioid adenocarcinoma within 10 years. When we encounter cases of atypical endometriosis, it is necessary to consider the possibility of ovarian cancer and carefully follow the patients for long periods.

 

It's the "Good" Cancer, So Who Cares? Perceived Lack of Support Among Young (Thyroid) Cancer Survivors

Blogger's Opinion: it is seriously pathetic, young or old, irregardless of type of cancer/prognosis that this mentality still exists and even though this study was few in numbers, larger social/human lessons have not been learned in many cancers

abstract
 
Purpose/Objectives: 

To describe the survivorship experience of young adult patients with thyroid cancer.

Research Approach:

A qualitative, descriptive study.

Setting:

Four Canadian provinces, with most participants from Ontario.

Participants:

12 young adult thyroid cancer survivors who participated in a larger study on follow-up care needs consisting of 55 young adult cancer survivors.

Methodologic Approach:

Telephone interviews were conducted with cancer survivors who were diagnosed from age 18-39 years and were 1-5 years post-treatment.

Findings:

All 12 thyroid cancer survivors discussed the feeling that their cancer experiences often were downplayed because thyroid cancer is labeled as the "good" cancer. Many said that they were not considered real patients with cancer by healthcare providers and other patients with cancer, and they were unable or unwilling to access support programs or assistance from healthcare providers.

Conclusions:  

Cancer can have an impact on a person's life regardless of the prognosis. Being diagnosed with thyroid cancer at a young age can pose additional challenges because of the lack of available support to address needs specific to young adults.

Interpretation: 

Healthcare providers must recognize the needs of thyroid cancer survivors and encourage them to access supportive services.

Knowledge Translation:

Patients with thyroid cancer believe that their needs often are overlooked because of high survival rates, and they have difficulty accessing support resources and finding help. Young adults with cancer often have unique support needs. Support needs may not be the same for all young adult patients with cancer, and those needs should be recognized and addressed.
 

Excess of extracolonic non-endometrial multiple primary cancers in MSH2 germline mutation carriers over MLH1

abstract

BACKGROUND:

The lynch syndrome (LS) tumor spectrum involves colorectal cancer (CRC), endometrial cancer (EC), and less frequently various extracolonic non-endometrial cancers (non-EC). The organ-specific survival rates of these patients are well defined, however, the collective survival of all-cancers combined (CRC + EC + non-EC) are unclear.

METHODS:

Fifty-two MSH2 patients and 68 MLH1 patients were followed for a median of 6.3 years after diagnosis of first cancer, regardless of type. The proportions of CRC only, EC, non-EC, and multiple primary cancers were compared between the two genotypes. Kaplan-Meier curves were developed for survival comparisons.

RESULTS:

MSH2 patients present less frequently with only CRC (37% MSH2, 62% MLH1, P = 0.0096), manifest more multiple primary cancers (38% MSH2, 18% MLH1, P = 0.013), develop more extracolonic cancers (62% MSH2, 38% MLH1, P = 0.003), non-EC only cancers (46% MSH2, 24% MLH1, P = 0.028) and carry a greater risk for urinary tract cancer (UTC) (13.4% MSH2, 1.5% MLH1, P = 0.024). There was no difference in 10-year survival between the two groups (P = 0.4).

CONCLUSION:

The additional propensity for UTC in MSH2 carriers argues in favor of UTC screening in MSH2 individuals. Other types of cancer screening should be tailored to the expression history of the specific LS mutation.

 

protocol: Exercise for cancer cachexia in adults | Cochrane Summaries

Cochrane

Exercise for cancer cachexia in adults New

Grande A, Silva V, Maddocks M, Riera R, Medeiros A, Vitoriano SG P, Peccin MS

Published Online: 

October 27, 2013

This Cochrane Review is at the protocol stage and there is no abstract or plain language summary. The objectives for the review are as follows:

The primary objective is to determine the effectiveness of exercise, compared to usual care or no treatment, on biomarkers and outcomes of cachexia in adults with cancer. Secondary objectives, subject to the availability of data, are to examine the acceptability and safety of exercise in this setting and to compare effectiveness according to the characteristics of the exercise intervention or patient population.

Show Abstract (click to read)

More like this

• The effect of exercise on fatigue associated with cancer
• Megestrol acetate for treatment of anorexia-cachexia syndrome
• Efficacy of pharmacological treatments for fatigue associated with advanced disease
• Blood transfusion for anaemia in patients with advanced cancer
• Drugs for cancer-related fatigue

- See more at: http://summaries.cochrane.org/CD010804/exercise-for-cancer-cachexia-in-adults#sthash.3AdXH4Ei.dpuf

 

Exercise for cancer cachexia in adults New

Grande A, Silva V, Maddocks M, Riera R, Medeiros A, Vitoriano SG P, Peccin MS

Published Online: 

October 27, 2013

This Cochrane Review is at the protocol stage and there is no abstract or plain language summary. The objectives for the review are as follows:

The primary objective is to determine the effectiveness of exercise, compared to usual care or no treatment, on biomarkers and outcomes of cachexia in adults with cancer. Secondary objectives, subject to the availability of data, are to examine the acceptability and safety of exercise in this setting and to compare effectiveness according to the characteristics of the exercise intervention or patient population.

Show Abstract (click to read)

More like this

• The effect of exercise on fatigue associated with cancer
• Megestrol acetate for treatment of anorexia-cachexia syndrome
• Efficacy of pharmacological treatments for fatigue associated with advanced disease
• Blood transfusion for anaemia in patients with advanced cancer
• Drugs for cancer-related fatigue

- See more at: http://summaries.cochrane.org/CD010804/exercise-for-cancer-cachexia-in-adults#sthash.3AdXH4Ei.dpuf

Brazil: Hereditary cancer risk assessment: essential tools for a better approach

open access

Instituto do Câncer do Estado de São Paulo da Faculdade de Medicina da
Universidade de São Paulo, Av. Dr. Arnaldo, 251, Cerqueira César, São Paulo,
Brazil

High levels of omega-3 fatty acid consumption may lead to unintended health consequences

medical news

More Guidance For Hormone Replacement Therapy - National Institutes of Health (NIH)

 Blogger's Note: the often quoted research from the WHI's initial study did not reflect some of the benefits as well as some of the discrepancies such as described in this post-WHI article including the significance of age (as one example)

(NIH)

"Women who took estrogen alone had overall rates of illness and death similar to those for women who took placebo pills. The results, however, differed by age. Women who took estrogen in their 50s had a 16% reduced risk of overall illness and death. In absolute terms, there were 19 fewer major illnesses or deaths per year for every 10,000 women in this age group compared to the same number taking a placebo..... 

e-eso: Thrombosis and cancer

Thrombosis and cancer
  ^{CME accredited}
e-grandround GR269 - 07 November 2013 - 18:15-19:00 CET

 

The live session starts in about 9 days

Access to the live session is open 15 minutes before the start of the session

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the Art of Oncology series: On Denying Denial (Terror management theory (TMT))

open access

"...“What exactly do you mean by ‘she is obviously
in denial?’” I asked somewhat pointedly....

World Journal of Stem Cells - Aiming to immune elimination of ovarian cancer stem cells

open access

Ovarian cancer accounts for only 3% of all cancers in women, but it causes more deaths than any other gynecologic cancer. Treatment with chemotherapy and cytoreductive surgery shows a good response to the therapy. However, in a large proportion of the patients the tumor grows back within a few years. Cancer stem cells, that are less responsive to these treatments, are blamed for this recurrence of disease. Immune therapy either cellular or humoral is a novel concept to treat cancer. It is based on the notice that immune cells invade the tumor. However, the tumor invest heavily to escape from immune elimination by recruiting several immune suppressive mechanisms. These processes are normally in place to limit excessive immune activation and prevent autoimmune phenomena. Here, we discuss current knowledge about the immune (suppressive) status in ovarian cancer. Moreover, we discuss the immunological targets of ovarian cancer stem cells.....     Core tip: Ovarian cancer harbors, at a low frequency, cancer stem cells. Those cancer stem cells express stem cell specific antigens. Natural immunity against those antigens exists but is hampered by the suppressive microenvironment that the tumor creates. Erasing this suppressive microenvironment will make immunological elimination of those cancer stem cells is an attractive treatment option.

 

Ready for Direct-to-Consumer Genetic & Genomic Testing?

medscape


 

Author Insights: Rapid Drug Approvals Leave Many Safety Questions Unanswered

 news@JAMA

"The US Food and Drug Administration (FDA) has created fast-track approval processes to speed certain drugs to market, but an analysis of these expedited approvals finds they often leave important safety questions unanswered. The analysis was published today in JAMA Internal Medicine.
To help expedite approval of drugs, the FDA has created processes that waive some of the requirements that are part of a standard drug approval. These expedited reviews, popular with industry and patient groups, are used for drugs that the FDA determines represent “a significant therapeutic advance” or that fill unmet needs. The Obama administration has also proposed additional ways to speed the pace of drug approval.
But an analysis of the differences between standard and fast-track reviews by Thomas J. Moore, AB, a senior scientist at the Institute for Safe Medication Practices (ISMP) in Alexandria, Virginia, and Curt Furberg, MD, PhD, of the Wake Forest School of Medicine in Winston-Salem, North Carolina, found that although fast-track approvals may shave about 2½ years off approval time, they also provide less information about the safety and efficacy of the drugs.....


 analysis

Full Content is available to subscribers

Original Investigation | October 28, 2013

"Development Times, Clinical Testing, Postmarket Follow-up, and Safety Risks for the New Drugs Approved by the US Food and Drug Administration"

 Conclusions and Relevance  For new drugs approved by the FDA in 2008, those that received expedited review were approved more rapidly than those that received standard review. However, considerably fewer patients were studied prior to approval, and many safety questions remained unanswered. By 2013, many postmarketing studies had not been completed.

 

death rates - United States Cancer Statistics (USCS) Data - 2010 Top Ten Cancers

death rates graph



 

US Cancer Statistics: An Interactive Atlas

Interactive

graph - United States Cancer Statistics (USCS) Data - 2010 Top Ten Cancers

 2010 Top Ten Cancers


 

Cancer - NPCR - USCS - United States Cancer Statistics (USCS)

Cancer - NPCR - USCS - View Data Online

View Data Online 1999–2010 Cancer Incidence and Mortality Data This Web-based report includes the official federal statistics on cancer incidence from registries that have high-quality data and cancer mortality statistics for each year and 2006–2010 combined. It is produced by the Centers for Disease Control and Prevention (CDC) and the National Cancer Institute (NCI), in collaboration with the North American Association of Central Cancer Registries (NAACCR).    ----------------------------   See Also • Help for new users • Contact information ----------------------------  Graphs Top Ten Cancers State vs. National Comparisons Selected Cancers Ranked by State      Maps The Interactive Cancer Atlas (InCA) shows USCS data from 1999–2010 in a dynamic format. Interactive Cancer Atlas (InCA)  Tables Cancer Types Grouped by Race and Ethnicity Cancers Grouped by State and Region Childhood Cancer Brain Cancers by Tumor Type  Cancer Data by State Use the dropdown menu to view cancer information for a selected state. (see website)