Friday, March 05, 2010
Molecular Profiling Uncovers a p53-Associated Role for MicroRNA-31 in Inhibiting the Proliferation of Serous Ovarian Carcinomas and Other Cancers
Note: miR-31 (rna/genome/gene)
"Our findings reveal that loss of miR-31 is associated with defects in the p53 pathway and functions in serous ovarian cancer and other cancers, suggesting that patients with cancers deficient in p53 activity might benefit from therapeutic delivery of miR-31."
p53 Autoantibodies as Potential Detection and Prognostic Biomarkers in Serous Ovarian Cancer
CONCLUSIONS: Antibodies to p53 are detected in the sera of 42% of patients with advanced serous ovarian cancer.
Impact: Although their utility as a preoperative diagnostic biomarker, beyond CA 125 and HE4, is limited, p53-AAb are prognostic for improved overall survival.
Cancer Epidemiol Biomarkers Prev
Renal outcomes with different fixed-dose combination therapies in patients with hypertension at high risk for cardiovascular events (ACCOMPLISH)
Renal outcomes with different fixed-dose combination therapies in patients with hypertension at high risk for cardiovascular events (ACCOMPLISH): a prespecified secondary analysis of a randomised controlled trial.
INTERPRETATION: Initial antihypertensive treatment with benazepril plus amlodipine should be considered in preference to benazepril plus hydrochlorothiazide since it slows progression of nephropathy to a greater extent.
FUNDING: Novartis
Prospective Multicenter Cohort Study to Refine Management Recommendations for Women at Elevated Familial Risk of Breast Cancer: The EVA Trial.
CONCLUSION: In women at elevated familial risk, quality-assured MRI screening shifts the distribution of screen-detected breast cancers toward the preinvasive stage. In women undergoing quality-assured MRI annually, neither mammography, nor annual or half-yearly ultrasound or CBE will add to the cancer yield achieved by MRI alone.
Lasofoxifene in postmenopausal women with osteoporsis
CONCLUSIONS: In postmenopausal women with osteoporosis, lasofoxifene at a dose of 0.5 mg per day was associated with reduced risks of nonvertebral and vertebral fractures, ER-positive breast cancer, coronary heart disease, and stroke but an increased risk of venous thromboembolic events. (ClinicalTrials.gov number, NCT00141323.) 2010 Massachusetts Medical Society"
The clinicopathological characteristics of ‘triple-negative’ epithelial ovarian cancer -- JCO (China)
Note: other cell types of ovarian cancer were also compared in this study
"Conclusions: A novel (new) subtype of ovarian carcinoma, which is negative for ER, PR and HER2 expression, has been identified; this specific ovarian subtype tends to have aggressive characteristics and a poor prognosis, which is similar to triple-negative breast cancer in most respects. TNEOC should be considered in future investigations of informative classification of ovarian cancer."
U.S. FDA Recalls Flavor Enhancer Because of Salmonella Risk - in Public Health & Policy, Public Health from MedPage Today
Products on the recall list -- which can be found at http://www.accessdata.fda.gov/scripts/HVPCP/ -- include Earth Island's Sweet and Sour Tofu, T. Marzetti's Southwest Ranch Veggie Dip, Trader Joe's Creamy Ranch Dressing and Dip, and Hawaiian brand potato chips.
full access: Challenges with engaging participants in behavioral intervention research
Summary and conclusions The challenges and recommendations outlined in this paper are informed by clinical trials of behavioral interventions in the context of HIV-infected populations. Although the specific nature of this trial may restrict the generalizability of the recommendations to other populations, illnesses, trial designs and intervention modalities, the general concepts are likely applicable across settings and are consistent with the limited literature on this topic.8,13 For example, there is a documented need to address expectations, motivations, and barriers to clinical trial participation across gender, race and ethnicity.12,13,16,17 The few sources that address these issues often do so in the context of engagement in treatment rather than clinical trials,18,19 and while there may be some attention to the needs of special populations such as homeless persons,20 this literature typically fails to consider issues unique to a research setting such as altruism and desire for financial incentives.17 Without effective techniques to maximize adherence to innovative health promotion interventions, investigators will struggle to compile empirical evidence of the intervention’s efficacy and eventual effectiveness.
Thursday, March 04, 2010
BioMed Central Blog : Calculating genetic risk from multiple loci
"As we learn more about the many kinds of mutations that are associated with genomic disease, so we can evaluate and model the ways that they interact to cause a phenotype."
Obstetrics/Gynecology Residents' Knowledge of Hereditary Breast and Ovarian Cancer and Lynch Syndrome.
"Although there have been many studies regarding physicians' knowledge of hereditary cancer syndromes, very little information exists regarding medical residents' knowledge of hereditary cancer syndromes. Obstetrics/gynecology residents completed a test which evaluated their knowledge of hereditary breast and ovarian cancer and Lynch syndrome.
Endocyte Announces DSMB Supports Continuation of Phase 2 PRECEDENT Study - EC145 combo
"The PRECEDENT study is a randomized phase 2 clinical trial comparing the company's drug EC145 in combination with pegylated liposomal doxorubicin (PLD/Doxil(R)) to PLD alone for women with platinum-resistant ovarian cancer."
Gynecologic Oncology Group (GOG) Notifies CTI That Continuation of GOG-212 Pivotal Trial of OPAXIO Maintenance Therapy in Front Line Ovarian Cancer Remains High Priority - MarketWatch
press release
March 4, 2010, 1:30 a.m. EST
Gynecologic Oncology Group (GOG) Notifies CTI That Continuation of GOG-212 Pivotal Trial of OPAXIO Maintenance Therapy in Front Line Ovarian Cancer Remains High Priority
GOG-218 Bevacizumab Results Do Not Influence Importance of GOG-212
SEATTLE, March 4, 2010 /PRNewswire via COMTEX/ -- Cell Therapeutics, Inc. ("CTI") (Nasdaq and MTA: CTIC) announced today that CTI received a statement on March 1, 2010 from the Gynecologic Oncology Group (GOG) leadership that the phase III GOG-212 clinical trial of CTI's OPAXIO(TM) used as maintenance therapy for ovarian cancer remains a high priority and enrollment will continue. The GOG made the statement to clarify that the recent results of the GOG-218 clinical trial bevacizumab in maintenance therapy for ovarian cancer has not influenced the importance of completing the GOG-212 clinical trial.
Patients should be "unafraid" to seek second opinion: Canadian news item
Patients who question medical test results or diagnoses from their doctors should be "unafraid" to ask for a second opinion, because mistakes, although uncommon, can be made, according to the Canadian Medical Association.
Randomized phase II trial of paclitaxel plus carboplatin therapy versus irinotecan plus cisplatin therapy as first-line chemotherapy for clear cell ad
"INTRODUCTION: Paclitaxel plus carboplatin (TC) is generally considered to be the "gold standard" regimen for treatment of epithelial ovarian carcinomas. Little data are available, however, on the use of this regimen in patients with clear cell adenocarcinoma of the ovary (CCC). ...Randomized phase II trial of paclitaxel plus carboplatin therapy versus irinotecan plus cisplatin therapy as first-line chemotherapy for clear cell adenocarcinoma of the ovary: a JGOG study.
Progression-free survival (PFS) showed no significant difference between the 2 treatment groups. Because there were more patients with large residual disease in the CPT-P arm, we performed a subset analysis by removing those patients, and then compared the PFS with that of patients without residual disease or with residual disease less than 2 cm.
The PFS tended to be longer in the CPT-P group, although the difference was not statistically significant.
CONCLUSIONS: A phase III randomized trial is required to elucidate the effectiveness of CPT-P combination chemotherapy for CCC."
Washington, DC: Cancer Survivorship Research: Mapping the New Challenges NOTE THE DEADLINE
NOTE: Application deadline April 9th, 2009
Survivor Advocate Research Program Now Open! (2/22/10)
The Survivor Advocate program provides travel scholarships for 20 advocates to attend the conference, learn first-hand about key research in cancer survivorship, and to interact with other advocate leaders and survivorship researchers.
Program participants will be selected on the basis of their research advocacy experience and the potential impact conference attendance will have on their future advocacy work. Priority will be given to applicants who have not participated in the program previously.
Conference registration fees, as well as hotel and transportation costs will be covered for Survivor Advocate program participants who are selected. In addition, food expenses incurred outside of conference meals will be reimbursed"....cont'd
Wednesday, March 03, 2010
2010 abstract:Restless legs syndrome and its relationship with anxiety, depression, and quality of life in cancer patients undergoing chemotherapy.
"The prevalence of RLS in patients undergoing chemotherapy is 18.3%, about double of that expected in the general population. The occurrence of RLS is much more frequent in female patients and with longer-term chemotherapy."
Restless Legs Syndrome Fact Sheet: National Institute of Neurological Disorders and Stroke (NINDS)
What causes restless legs syndrome?
In most cases, the cause of RLS is unknown (referred to as idiopathic). A family history of the condition is seen in approximately 50 percent of such cases, suggesting a genetic form of the disorder. People with familial RLS tend to be younger when symptoms start and have a slower progression of the condition.
In other cases, RLS appears to be related to the following factors or conditions, although researchers do not yet know if these factors actually cause RLS.
Efficacy of Annual Colonoscopic Surveillance in Individuals With Hereditary Nonpolyposis Colorectal Cancer (Lynch Syndrome) - MS status
Note: MS - microsatellite status
Methods:In a prospective, multicenter cohort study, 1126 individuals underwent 3474 colonoscopies. We considered individuals from 3 groups of HNPCC families: those with a pathogenic germline mutation in a mismatch repair gene (MUT group), those without a mutation but with microsatellite instability (MSI group), and those who fufilled the Amsterdam criteria without microsatellite instability (MSS group).
Conclusions:
Annual colonoscopic surveillance is recommended for individuals with HNPCC. Less intense surveillance might be appropriate for MSS families.
Risk assessment, genetic testing, and management of Lynch syndrome-abstract
"...Genetic test results, when conclusive, can guide management for patients and their families. However, indeterminate test results may provide false reassurance to patients who should be managed as being at higher-than-average risk...."
Distribution of second primary malignancies suggests a bidirectional effect between breast and endometrial cancer: a population-based study - abstract
Note: the study included Tamoxifen use; risks of other cancers including ovarian (% risk)
Hereditary Ovarian Cancer: Molecular Genetics, Pathology, Management, and Heterogeneity
Future Prospects: DNA Variants Modify HBOC and LS (Lynch Syndome) Cancer Risk:
What does the future hold with respect to molecular genetics and cancer control in hereditary cancer, inclusive of HBOC and Lynch syndrome?
This projection relates to the truism that cancer-causing mutations do not act in a vacuum, since they are likely to be impacted by additional low-penetrant modifier genes in concert with myriad environmental events.
PLoS ONE: An Epigenetic Signature in Peripheral Blood Predicts Active Ovarian Cancer
Note: in research; included all major subtypes of epithelial ovarian cancer (see table 1)
full access: PLoS ONE: The Prognostic Value of BRCA1 mRNA Expression Levels Following Neoadjuvant Chemotherapy in Breast Cancer
Background:
A fraction of sporadic breast cancers has low BRCA1 expression. BRCA1 mutation carriers are more likely to achieve a pathological complete response with DNA-damage-based chemotherapy compared to non-mutation carriers. Furthermore, sporadic ovarian cancer patients with low levels of BRCA1 mRNA have longer survival following platinum-based chemotherapy than patients with high levels of BRCA1 mRNA.
Conclusions/Significance:
We provide evidence for a major role for BRCA1 mRNA expression as a marker of time to progression and overall survival in sporadic breast cancers treated with anthracycline-based chemotherapy. These findings can be useful for customizing chemotherapy.
Administrative Outcomes Five Years after Opening an Acute Palliative Care Unit at a Comprehensive Cancer Center.
"Purpose:.....In keeping with targets set at the unit's opening, our primary hypotheses were that outpatient admissions, admissions for symptom control, and discharges home would increase over the study period; secondary hypotheses were that length of stay and inpatient death rate would decrease.....Results: There were 1748 admissions during the study period: the median age was 64, 54% were women, and the most common cancer sites were gastrointestinal (24%), lung (20%), and gynecologic (13%)....Conclusion: Setting and adhering to administrative targets for an APCU is possible with appropriate admission criteria, adequate community resources, and education of patients, families and health professionals regarding the model of care."
Ovarian Intestinal Type Mucinous Borderline Tumors: Are We Ready for a Nomenclature Change?
"At a National Cancer Institute-sponsored workshop it was proposed that the borderline category of ovarian intestinal-type mucinous tumors (OInMTs) could be eliminated if the apparent benign behavior of these tumors could be confirmed.....Caution dictates retaining the current nomenclature to ensure the follow-up of patients affected by this disease until uncertainty regarding the extent of sampling needed to exclude the presence of carcinoma is resolved."
Study on cancer incidence through the Cancer Registry Program in 11 Cities and Counties, China (1988-2002 cancer registries data)
"The leading cancer sites were lung, stomach, liver, esophagus, breast, colon, rectum, pancreas, bladder and leukemia. The sixteen key cancers accounted for 85.56% of all the cancer cases. The crude incidence rate of all cancers had been significantly increased from 1988 to 2002. Among them, prostate ranked the fastest growing one followed by cancers of the gallbladder, breast, colon, ovarian, lymphoma, bladder, pancreas, rectum, lung, leukemia and liver. The one that had reduced the most was cervix uteri, followed by esophagus, stomach and nasopharynx."
Building a better understanding of the intracellular tyrosine kinase PTK6 - BRK by BRK.
"PTK6 expression is also increased in a number of other epithelial tumors, including ovarian and colon cancer."
Three New Technologies for Beating Breast Cancer - Women's Health Online
* Intensity Modulated Radiation Therapy (IMRT)
* DyNeMo (analyzes networks of proteins in cancer cells)
* Automated Breast Volume Scanner (ABVS)
Breast Cancer - Women's Health Online
"Genes that can predict which breast cancer patients will respond to the anti-cancer drug paclitaxel have been identified by an international team of scientists.
They analyzed 829 genes in breast cancer cells and pinpointed 6 that had an impact on whether the drug was effective, BBC News reported.
Taxol (Paclitaxel) Drug Information: Uses, Side Effects, Drug Interactions and Warnings at RxList
definition: Neuromotor: A term that describes a process involving both nerves and muscles Note the terms: neurotoxicity/neuromotor/neurosensory (relating to restless leg syndrome, neuropathy as examples)
Tuesday, March 02, 2010
Cochrane Review: Retroperitoneal drainage versus no drainage after pelvic lymphadenectomy for the prevention of lymphocyst formation in patients with
Retroperitoneal drainage versus no drainage after pelvic lymphadenectomy for the prevention of lymphocyst formation in patients with gynaecological malignancies.
CONCLUSIONS: Placement of retroperitoneal tube drains has no benefit in prevention of lymphocyst formation after pelvic lymphadenectomy in patients with gynaecological malignancies. When the pelvic peritoneum is left open, the tube drain placement is associated with a higher risk of short and long-term symptomatic lymphocyst formation.
The Associated Press: AstraZeneca shuffles, eliminates Del. R&D jobs
"While continuing research on cancer and infection drugs and therapies for cardiovascular, gastrointestinal, respiratory, inflammatory and neurological conditions, AstraZeneca said it will cease disease-specific research on drugs to treat thrombosis, acid reflux disease, ovarian and bladder cancers, systemic scleroderma, schizophrenia, bipolar disorder, depression, anxiety, and hepatitis C."
Supercomputer to benefit Rice, Medical Center | Houston & Texas News | Chron.com - Houston Chronicle
"As part of this effort Kim Worley, a Baylor geneticist, said the college has sequenced the DNA in the healthy cells of 50 patients, and the DNA in tumor cells of these same patients with ovarian cancer......But Baylor doesn't want to just store the information, it wants to cross reference each of these 100 DNA sequences with the originally sequenced version of human DNA to see which gene mutations might contribute to ovarian cancer...."
IAPO: Patient Involvement in Health Policy, Systems and Delivery | A global voice for patients
IAPO press release: A Call from IAPO’s 4th Global Patients Congress on Strengthening Healthcare Systems Globally | A global voice for patients
"Patients call for greater support for meaningful involvement in healthcare decision making as a means to ensure equitable distribution of limited health resources
London, United Kingdom, 1 March 2010 – Patient advocates have called for more meaningful engagement in healthcare design and delivery at the International Alliance of Patients’ Organizations (IAPO) 4th Global Patients Congress in Istanbul, Turkey."Cancer Research Center of Hawaiii: Cancer: Thriving and Surviving
The Cancer Research Center of Hawaii and Stanford School of Medicine are conducting a study testing a new online workshop for people who have survived cancer.
Opaxio (XYOTAX) - New FDA Date for Cell Therapeutics: media item
Note: Lots of unanswered questions
"....Meantime, Cell Therapeutics also disclosed another setback for its experimental cancer drug Opaxio. The Gynecologic Oncology Group (GOG) turned down Cell Therapeutics' request to conduct an interim analysis of the phase III study of Opaxio in patients with advanced ovarian cancer,
Monday, March 01, 2010
Avastin Treatment Overview for Healthcare Professionals - Avastin
Genentech's website: note section on serious side effects
FAQ: ClinicalTrials.gov - What is "Expanded Access"?
Answer:
Expanded access is a means by which manufacturers make investigational new drugs available, under certain circumstances, to treat a patient(s) with a serious disease or condition who cannot participate in a controlled clinical trial....cont'd
Abstract: A link between mir-100 and FRAP1/mTOR in clear cell ovarian cancer
Although miRNAs have been implicated as oncogenes and tumor suppressors in a variety of human cancers, functional roles for individual miRNAs have not been described in clear cell ovarian carcinoma..... We performed deep sequencing to comprehensively profile miRNA expression in 10 human clear cell ovarian cancer cell lines compared with normal ovarian surface epithelial cultures and discovered 54 miRNAs that were aberrantly expressed.....Our experiments have revealed strong candidate miRNAs and their target genes that may contribute to the pathogenesis of clear cell ovarian cancer, thereby highlighting alternative therapeutic strategies for the treatment of this deadly cancer.
Australia news item: Most women don't know ovarian cancer symptoms
Louise Bayne, Chief Executive of Ovacome said: "In the last 20 years, there has been a transformation in the way ovarian cancer is treated - but public awareness of the symptoms has not kept up with this medical progress.
"Women are becoming more aware of other common female cancers and how to spot them - but ovarian cancer has been left behind."
The
UK Cochrane Centre is pleased to announce that we will broadcast the
plenary sessions from the Annual Meeting of UK and Ireland-based
Contributors to The Cochrane Collaboration live on the internet on
Tuesday and Wednesday of this week (details of the speakers are below).
The broadcasts will be free to view at www.cochrane.tv. The site does not require a login or any special software. We will also make recordings of the sessions available later.
We
are doing this in an effort to improve access to the sessions and we
apologise in advance if technical problems mean that it does not work
well. However, please be assured that we will be working hard to
resolve any problems that arise during the broadcasts.
First plenary from 13.00 to 14.00 GMT on March 2 2010
Chair: Jane Noyes
Director of the Centre for Health-Related Research atBangor University
The importance of The Cochrane Collaboration.
Tony Jewell, Chief Medical Officer, Welsh Assembly Government
Sense about science
Tracey Brown, Managing Director, Sense About Science
Hunting for snarks: The challenge of getting evidence into guidelines
Fergus Macbeth, Director of the Centre for Clinical Practice, National Institute for Health and Clinical Excellence
Director of the Centre for Health-Related Research at
The importance of The Cochrane Collaboration.
Tony Jewell, Chief Medical Officer, Welsh Assembly Government
Sense about science
Tracey Brown, Managing Director, Sense About Science
Hunting for snarks: The challenge of getting evidence into guidelines
Fergus Macbeth, Director of the Centre for Clinical Practice, National Institute for Health and Clinical Excellence
Second plenary from 13.30 to 15.00 GMT on March 3 2010
Chair: Julian Higgins
Co-Editor, Cochrane Handbook for Systematic Reviews of Interventions
Addressing reporting bias
Jonathan Sterne, Department of Social Medicine, University of Bristol
Co-Convenor, Bias Methods Group
The risk of bias tool
Doug Altman, Director, Centre for Statistics in Medicine; Co-Convenor, Bias Methods Group
Summary of findings tables
Phil Wiffen, Operations and Training Director, UK Cochrane Centre
Including non-randomized studies
Barney Reeves, Bristol Heart Institute, University of Bristol; Co-Convenor, Non-randomised Studies Methods Group
Incorporating economics
Miranda Mugford, School of Medicine, Health Policy and Practice, University of East Anglia; Chair of Convenors, Campbell and Cochrane Economics Methods Group
The role of qualitative evidence
Jane Noyes, Noreen Edwards Chair in Nursing Research; Director of the Centre for Health-Related Research, Bangor University; Co-Convenor, Qualitative Methods Research Group
How can we improve the quality of reviews?
David Tovey, Editor in Chief, The Cochrane Library
Correspondence: Defining the surgical management of suspected early-stage ovarian cancer by estimating patient numbers through alternative management
Correspondence: Defining the surgical management of suspected early-stage ovarian cancer by estimating patient numbers through alternative management strategies
refers to original article (abstract):
Defining the surgical management of suspected early-stage ovarian cancer by estimating patient numbers through alternative management strategiesfull access:Gynaecological oncology Impact of bowel obstruction at the time of initial presentation in women with ovarian cancer
"This is a small, single institution, retrospective study. The limitations imposed by these attributes have to be borne in mind when interpreting or using the findings of this study."
full access: Surgical training in gastrointestinal procedures within a UK gynaecological oncology subspecialty programme
"Table 4 also includes comparison with the published literature of gynaecological oncologists performing colorectal procedures on women with gynaecological cancers and of colorectal surgeons performing colorectal procedures on women with primary colorectal problems........Previous publications from various countries, including the USA, Australia, Japan, France, Italy, South Africa, Singapore, China and Turkey, show similar rates of performance of gastrointestinal procedures in the management of gynaecological malignancies with similar complication rates."
Recovery Act Funding at NCI - NCI (30 new)
Note: see website for list
Clinical Trials Supported by Accelerating Clinical Trials of Novel Oncologic PathWays (ACTNOW) Initiative
ACTNOW is an early-phase clinical trial program designed to help shorten the time it takes to move new cancer treatments from the discovery phase, to drug development, and, ultimately, to approval and safe use by cancer patients.
The table below lists the ACTNOW trials by cancer type, and contains links to descriptions of the drugs being studied, the trial objectives, patient enrollment criteria, and locations where patients receive treatment. Investigators interested in collaborating on these trials can contact the Study Chair listed on the trial description.
Is the subject of this story going to kill you or cure you? - Gary Schwitzer's HealthNewsReview Blog
Note: see website for the link
Is the subject of this story going to kill you or cure you?
By Gary Schwitzer on February 26, 2010 9:20 AM
There's now a website that actually tracks The Daily Mail of London to categorize its stories as either "kill or cure" stories. The site quotes British physician-author Ben Goldacre: "The Daily Mail, as you know, is engaged in a philosophical project of mythic proportions: for many years now it has diligently been sifting through all the inanimate objects in the world, soberly dividing them into the ones which either cause - or cure - cancer."
Visitors to the site can vote on the stories.
BBC News - Gene test aid to cancer treatment
"Starting with 829 genes in breast cancer cells, the team whittled down the possibilities to six genes which had an impact on whether a drug worked."
full free access: Clinical relevance of extent of extreme drug resistance in epithelial ovarian carcinoma (repost from Jan 2010)
Note: also note reference materials included in this paper
Sunday, February 28, 2010
Research Advocacy Network - Advancing Patient-Focused Research
Now accepting nominations for the Focus on Research class for 2010
Advocates would you like to:
* Have a greater understanding of concepts in oncology research?
* Be able to relate these concepts to specific research results?
* Be more effective in understanding and communicating research results that will change how cancer is treated?
Complete the nomination form today to participate in the Focus on Research class for 2010.
Deadline for receipt of nomination forms to participate in the course is March 25, 2010.
Nomination/Application form:
https://www.surveymonkey.com/s.aspx?sm=lJwbeo8%2f5DVgtGmGhpLHFrbeSxow21GN0tVx5Xoro6c%3d&
INQUIRIES
Questions concerning the Focus on Research program should be addressed to Research Advocacy Network, Elda Railey email: erailey@researchadvocacy.org or by voice message on the Research Advocacy Network central number at 877.276.2187.
Bioethics Forum - Choosing Paternalism?
Note: 2007
"....The article described the case of a 39-year-old patient with ovarian cancer that had metastasized to her liver. She was asked to decide whether to undergo a novel chemotherapy regimen about which five oncologists disagreed. When she asked her doctor what she should do he said he didn’t know, that she would have to make the decision based on her own values. The patient, “bald, tumor-ridden and exhausted from chemotherapy was reeling. ‘I’m not a doctor!’ she shouted, ‘I’m a criminal defense lawyer! How am I supposed to know?’” The story illustrates the frustration, anxiety, and loneliness of being a “modern patient” attempting to cope with medical uncertainty."
Saturday, February 27, 2010
Cochrane Menstrual Disorders and Subfertility Group: Clomiphene citrate for unexplained subfertility in women
Plain English Summary: "Clomiphene citrate for unexplained subfertility in women Clomiphene citrate is a fertility drug that can increase the number of eggs released for possible fertilisation. It is used by women who do not ovulate regularly and by some who do but still have not become pregnant. Clomiphene citrate does not appear to increase the chance of pregnancy in women who ovulate regularly but have failed to conceive after more than a year of unprotected intercourse and so are considered to be subfertile. An associated risk of treatment with clomiphene citrate is a 10% chance of multiple pregnancy. The results of this review of trials should be used with caution due to the heterogeneity between some of the studies."
Management of drainage for malignant ascites in gynaecological cancer
Authors' conclusions:
Since no relevant studies were identified, we are unable to make recommendations regarding the management of drains for malignant ascites in women with gynaecological cancer. Large, multi-centre RCTs are required to evaluate the efficacy and safety of the management of ascitic drains when in situ and their impact on QOL.
Friday, February 26, 2010
Some people just won’t take death for an answer
e-patients blog: "We often talk here about empowered patients’ struggles to get – or even create – the care they need. Usually we’re talking about it in a medical sense. But as far too many people know, sometimes there are other obstacles. Laurie Todd is, to me, an outstanding example of someone who wouldn’t take death for an answer – neither from doctors....."
CK7, CK20, CDX2 and MUC2 Immunohistochemical Staining Used To Distinguish Metastatic Colorectal Carcinoma Involving Ovary from Primary Ovarian Mucinous Adenocarcinoma
Objective: Colorectal adenocarcinoma, the most common tumor that metastasizes to the ovary, is often difficult to distinguish from primary ovarian mucinous adenocarcinoma (POMA). Obtaining the correct diagnosis is difficult but crucial to treatment and prognosis.
new book: Editor's comment (Jason Marsh) "The Compassionate Instinct": Uncovering the New Science of Human Goodness
"Taken together, this research challenges some long-held notions about human nature, revealing that the good in us is just as intrinsic to our species as the bad. Empathy, gratitude, compassion, altruism, fairness, trust, and cooperation, once thought to be aberrations from the tooth-and-claw natural order of things, are actually core features of primate evolution.
For too long a view of humans has prevailed that assumes we are wired to compete, to act aggressively, to pursue unbridled self-interest. These are no doubt facets of human nature, but they represent only half of the story.
"The Compassionate Instinct" reveals another story, one that places goodness at the center of human nature. The book doesn't deny the existence of the violence and selfishness we see in the world around us. But it offers scientific evidence that another world is possible."
press release: Precision Therapeutics- Chemosensitivity/Resistance Assay Included as Part of the NCCN Principles of Chemotherapy - MarketWatch
Note: as per just published NCCN guidelines 2/2010 Ovarian Cancer section (read the guidelines for further explanation) http://www.nccn.org
Laboratory Product News: Manhattan Scientifics Acquires Exclusive Rights to Nanomedicine Technology for Early Cancer Detection and Treatment
"Manhattan Scientifics Inc. (OTCBB: MHTX), a nanomedicine technology transfer and commercialization pioneer, today announced completion of its agreement to acquire all commercial rights to the body of work of nuclear physicist Edward R. Flynn, PhD and his company, Senior Scientific LLC. The breakthrough technology focuses on the emerging field of nanomedicine, with an emphasis on the early detection and localization of cancer and other diseases, and providing image-guided therapy for treatment."Financial details of the agreement were not disclosed. Early detection of cancer can be critical to effective treatment. For example,
Thursday, February 25, 2010
Genomics - Funding 2010 CDC and NIH New Genomics Funding Opportunity Announcement
Systematic evidence reviews will examine the validity and utility of various health-related genomic tests (e.g., DNA, RNA, and proteomic tests; family health history tools; other health-related genomic services), including information on contextual factors and ethical, legal, and social issues. These evidence reviews will be conducted using the methods developed by the Evaluation of Genomic Applications in Practice and Prevention (EGAPP™) Working GroupExternal Web Site Icon and CDC. Some of these reviews will be used by the EGAPP™ Working Group to make recommendation statements on the use of the genomic tests and other services.
The center will collaborate with CDC to develop brief evidence summaries (topic briefs) on the validity and utility of selected genomic applications and related issues.
Evidence reviews and topic briefs, along with recommendation statements and other resources, will be made publicly available in an online knowledge repository. This repository is being developed by NOPHG, NIH’s National Cancer InstituteExternal Web Site Icon, and the National Center for Biotechnology InformationExternal Web Site Icon of the National Library of MedicineExternal Web Site Icon and will be released later this year.
The European Medicines Agency is in Overall Agreement with OncoGenex Pharmaceuticals' Development Plan for OGX-011 - financial news
"Since increased clusterin production is observed in many human cancers, including prostate, non-small cell lung, breast, ovarian, bladder, renal, pancreatic, anaplastic large cell lymphoma and colon cancers and melanoma, OGX-011 may have broad market potential to treat many cancer indications and disease stages."
updated (annual) February 2010: NCCN Clinical Practice Guidelines in Oncology
Note: the NCCN website requires registration/password but is free. It is an excellent resource for ovarian cancer(s) as well as genetic syndrome guidelines.
Page 4 indicates changes over prior guidelines.
Genentech Announces Positive Results of Avastin Phase III Study in Women with Advanced Ovarian Cancer
In the three-arm study, known as Gynecologic Oncology Group (GOG) 0218, women with newly diagnosed advanced ovarian cancer who already had surgery to remove as much of the tumor as possible were randomized to receive one of the following:
-- Arm 1: Placebo in combination with carboplatin and paclitaxel chemotherapy followed by placebo alone, for a total of up to 15 months of therapy
-- Arm 2: Avastin in combination with carboplatin and paclitaxel chemotherapy followed by placebo alone, for a total of up to 15 months of therapy
-- Arm 3: Avastin in combination with carboplatin and paclitaxel chemotherapy followed by the maintenance use of Avastin alone, for a total of up to 15 months of therapy.
The study showed that women who continued maintenance use of Avastin alone, after receiving Avastin in combination with chemotherapy (Arm 3), lived longer without the disease worsening compared to those who received chemotherapy alone. Women who received Avastin in combination with chemotherapy, but did not continue maintenance use of Avastin alone (Arm 2), did not live longer without the disease worsening compared to chemotherapy alone.
Ontario, Canada: Hospitals: Public consultations needed - Welland Tribune - Ontario, CA
"It's up to a lobby group to bring democracy to discussions about changes to Ontario's hospitals.
That's because the provincial government refuses to do so, said Ontario Health Coalition executive director Natalie Mehra. Despite repeated requests to the Ministry of Health, asking that its public Rural and Northern Health Care Panel hold public consultations, Mehra said the government has "refused to hold public consultations."
She said the government's panel will only be consulting with select organizations including Ontario Hospital Association, the Ontario Medical Association, Registered Nurses Association of Ontario and an emergency medical service organization.
"There's not a single patient group, no municipality, no seniors group, or advocacy groups, or public interest groups, nobody," she said in an interview Tuesday....."
Outcomes after conservative treatment of advanced-stage serous borderline tumors of the ovary.
"Eighteen pregnancies (nine spontaneous) were observed in 14 patients."
Aberrant expression of p27(Kip1)-interacting cell-cycle regulatory proteins in ovarian clear cell carcinomas and their precursors with special consideration of two distinct multistage clear cell carcinogenetic pathways.
"These data suggest that accumulated alterations of p27(Kip1)-interacting proteins may accelerate the development of CCAs regardless of their carcinogenetic pathways, but that tumor cells in the CCAF-associated pathway appear to show slower cell-cycle progression than those in the endometriosis-associated pathway, possibly accounting for the distinct clinicopathological features of the two CCA subtypes."
full access: DNA Methylation Profiles of Ovarian Epithelial Carcinoma Tumors and Cell Lines
Table 1
Histology and clinical
characteristics of primary ovarian tumors. (serous, endometrioid, clear cell - CA125 levels, menopausal status,patient age)
Background
Epithelial ovarian carcinoma is a significant cause of
cancer mortality in women worldwide and in the United States. Epithelial
ovarian cancer comprises several histological subtypes, each with
distinct clinical and molecular characteristics. The natural history of
this heterogeneous disease, including the cell types of origin, is
poorly understood.
Occult ovarian cancers identified at risk-reducing salpingo-oophorectomy in a prospective cohort of BRCA1/2 mutation carriers.
"An unacceptably high proportion of pathologic examinations did not adequately examine ovaries and fallopian tubes obtained at RRSO."
Wednesday, February 24, 2010
2009 Safety of Bevacizumab in Advanced Ovarian and Müllerian Cancers: A Review: Bevacizumab (Avastin) and Ovarian Cancer
"To date, several investigators (Table 1) have explored bevacizumab as a single agent or in combination with metronomic chemotherapy in the management of advanced ovarian cancer. All studies to date with bevacizumab as a single agent or in combination with chemotherapy have shown promising responses...."
abstract: Combined oral cyclophosphamide and bevacizumab in heavily pre-treated ovarian cancer (Spain)
Conclusions: Combined bevacizumab and metronomic oral cyclophosphamide is a safe and effective regimen for heavily pre-treated ovarian cancer patients. Further research is needed on predictive factors to screen for those patients who will benefit from anti-angiogenic therapy.
2008 Phase II clinical trial of bevacizumab and low-dose metronomic oral cyclophosphamide in recurrent ovarian cancer: a trial of the California, Chic
Phase II clinical trial of bevacizumab and low-dose metronomic oral cyclophosphamide in recurrent ovarian cancer: a trial of the California, Chicago, and Princess Margaret Hospital phase II consortia.
Bevacizumab and Low-Dose Cyclophosphamide in Treating Patients With Recurrent Ovarian Epithelial or Primary Peritoneal Cancer - Full Text View - ClinicalTrials.gov
Bevacizumab and Low-Dose Cyclophosphamide in Treating Patients With Recurrent Ovarian Epithelial or Primary Peritoneal Cancer
This study has been completed.
First Received: November 4, 2003 Last Updated: February 6, 2009
Sponsor: California Cancer Consortium
Collaborator: National Cancer Institute (NCI)
Information provided by: National Cancer Institute (NCI)
ClinicalTrials.gov Identifier: NCT00072566
Cancer and the Family: The Silent Words of Truth -- JCO The Art of Oncology series
INCONCLUSIVE THOUGHTS: One of the aims of psycho-oncology is to explore, clarify, and accept different realities that are alluded to in the unspoken words of the family narrative, while also eliciting family stories of survival, adjustment, mutuality, belief, and hope. The psycho-oncologist is trained to understand the language of the patient and family members in their subjective appraisals of health and illness and then to encourage them to share their truths about being understood, heard, supported, and emboldened or discredited and stigmatized.
Ephraim McDowell - Wikipedia encyclopedia Ephraim McDowell (November 11, 1771 – June 25, 1830) was an American physician. He was the first to success
Ephraim McDowell (November 11, 1771 – June 25, 1830) was an American physician. He was the first to successfully remove an ovarian tumor.
Clinical Activity of Gemcitabine Plus Pertuzumab in Platinum-Resistant Ovarian Cancer, Fallopian Tube Cancer, or Primary Peritoneal Cancer - abstract
Conclusion: Pertuzumab may add activity to gemcitabine for the treatment of platinum-resistant ovarian cancer. Low HER3 mRNA expression may predict pertuzumab clinical benefit and be a valuable prognostic marker.
JCO - Relationship Between Plasma Estradiol Levels and Estrogen-Responsive Gene Expression in Estrogen Receptor-Positive Breast Cancer in Postmenopausal Women UK/US study
Purpose To determine whether plasma estradiol (E2) levels are related to gene expression in estrogen receptor (ER)–positive breast cancers in postmenopausal women.
Editorial: Whither HER2-Related Therapeutics? (breast cancer) -- Journal of Clinical Oncology
Note: references to solid tumours
"Evidence suggests that most solid tumors, regardless of their type, cannot grow beyond approximately 1 mm3 until they establish a blood supply by inducing new blood vessels from existing host capillaries, called tumor-induced angiogenesis......It follows then that tumor cells with low HER3 mRNA are more likely to respond to pertuzumab, given that these are the cells where the pathway is activated. We would conjecture that this signature does not apply exclusively in ovarian cancer, but may also be found in other solid tumors, such as non–HER2-positive breast, colorectal, and so on."
Prospective Multicenter Cohort Study to Refine Management Recommendations for Women at Elevated Familial Risk of Breast Cancer: The EVA Trial.
CONCLUSION: In women at elevated familial risk, quality-assured MRI screening shifts the distribution of screen-detected breast cancers toward the preinvasive stage. In women undergoing quality-assured MRI annually, neither mammography, nor annual or half-yearly ultrasound or CBE will add to the cancer yield achieved by MRI alone.
The Patient Factor: What Are Your Health Care Dollars Buying? | thepatientfactor.com
"Asking Canadians if they are getting value for their money when it comes to spending on health care is like asking a blind person if they can see better when the room light is turned on or off...."
The Patient Factor: (Canada) Blowing the Whistle on Patient Safety: Why Patients Need to Speak Out
"Patient safety is a hot topic in Canada and one that often leaves our politicians scrambling to maintain some semblance of action. They do so by creating more federal, provincial and territorial agencies and programs. Many of these government-funded initiatives are set-up as independent (arm’s length) non-profit organizations. Perhaps the biggest endeavour to date is the creation of the Canadian Patient Safety Institute (CPSI)...."
Long-term endometrial effects in postmenopausal women with early breast cancer participating in the Intergroup Exemestane Study (IES)—a randomised controlled trial of exemestane versus continued tamoxifen after 2–3 years tamoxifen
full access:
Conclusion: Switching from tamoxifen to exemestane significantly reverses endometrial thickening associated with continued tamoxifen.
free access: Impact of Medical Qigong on quality of life, fatigue, mood and inflammation in cancer patients: a randomized controlled trial - Australia
Unfortunately, most research evaluating Qigong has suffered from a lack of appropriate randomization and utilization of control groups. Studies have also tended to focus on limited numbers of biological and physical outcomes.
Drugmakers Join Forces to Improve Cancer Research - Press Release/news
INDIANAPOLIS, WHITEHOUSE STATION, N.J. & NEW YORK--Eli Lilly and Company, Merck (also known as Merck Sharp & Dohme (MSD) outside the USA and Canada), and Pfizer Inc. today announced the formation of the Asian Cancer Research Group, Inc., (ACRG), an independent, not-for-profit company established to accelerate research and ultimately improve treatment for patients affected with the most commonly-diagnosed cancers in Asia.
Intraperitoneal Paclitaxel as Consolidation Treatment in Ovarian Cancer Patients: A Case Control Study
Conclusion: Weekly IP consolidation chemotherapy with paclitaxel 60 mg/mq is well tolerated and, in this experience, a prolongation of progression-free survival was observed.
Tuesday, February 23, 2010
Financial news: HealthLinx Ltd launches ovarian cancer OvPlex™ test into UK market
HealthLinx (ASX: HTX) has reported that UK distribution partner Intus Healthcare is targeting a significant share of the potential 750,000 annual ovarian cancer diagnostic tests undertaken in the UK with the product launch of OvPlex™ on 25 February 2010.
The company obtained European Certification for OvPlex™ paving the way to market and sell the product within the European community.
Safety profile of new anticancer drugs; Expert Opinion on Drug Safety - abstract (solid tumors)
Take home message: The emergence of new targeted anticancer therapies promises more efficient and less toxic therapies. Generally, they are well tolerated, toxicities are commonly mild to moderate and can be handled rapidly. However, if most of these adverse events are manageable, life threatening and fatal complications can still occur.
Toxicity of sorafenib: clinical and molecular aspects; Expert Opinion on Drug Safety - abstract
Take home message: Although not life-threatening, toxicity of sorafenib can severely impact the physical, psychological and social well-being of patients. The management of this unusual toxicity highlights the particular need of new pluridisciplinarities linking oncologist, cardiologist and dermatologist
Drug interactions with antiretrovirals and warfarin; Expert Opinion on Drug Safety - abstract
Importance of the field: Antiretroviral therapy exhibits significant potential to alter the metabolism of other medications. Warfarin is widely used for the management of clotting disorders and is prone to drug–drug interactions that can result in subtherapeutic anticoagulation or over-anticoagulation. (warfarin, HIV, antiretroviral, drug interaction, protease inhibitor (PI), non-nucleoside reverse-transcriptase inhibitor (NNRTI), cytochrome P450 (CYP450), CYP2C9)
NCI Chemotherapy-induced Peripheral Neuropathy
"For preventing the onset of CIPN, the committee recommended further clinical testing of intravenous calcium and magnesium, which reduced CIPN symptoms by approximately half compared with a placebo in one trial
Avastin fails stomach-cancer trial - FiercePharma
"Data on Avastin use in ovarian cancer, expected sometime in the first half of this year."
Ovarian cancer diagnoses drop slightly
Note: prophylatic surgeries??
"Dr Zorbas said the figure had remained "fairly stable" for years and the lower level could represent the start of a new plateau, though the reason for the small drop was not yet clear......."The number of women diagnosed with ovarian cancer is expected to increase, and that's because the population is increasing and we have an increasingly ageing population," Dr Zorbas told AAP."
Coronary heart disease risk profile in women who underwent salpingo-oophorectomy to prevent hereditary breast ovarian cancer.
CONCLUSIONS: Self-selection of women seeking risk-reducing salpingo-oophorectomy, changes in lifestyle after surgery, and survival bias may explain that the women who underwent risk-reducing salpingo-oophorectomy had a more favorable coronary heart disease risk profile compared with the controls. Longitudinal studies are needed to further clarify the associations observed in this cross-sectional study.
Ovarian intestinal type mucinous borderline tumors: are we ready for a nomenclature change?
Note: mucinous is not specific to ovarian cancer but found in other tumour sites and without expert pathology can be confused with mucinous gastrointestinal tumours
"At a National Cancer Institute-sponsored workshop it was proposed that the borderline category of ovarian intestinal-type mucinous tumors (OInMTs) could be eliminated if the apparent benign behavior of these tumors could be confirmed..."
Randomized phase II trial of paclitaxel plus carboplatin therapy versus irinotecan plus cisplatin therapy as first-line chemotherapy for clear cell ad
Randomized phase II trial of paclitaxel plus carboplatin therapy versus irinotecan plus cisplatin therapy as first-line chemotherapy for clear cell adenocarcinoma of the ovary: a JGOG study CONCLUSIONS: A phase III randomized trial is required to elucidate the effectiveness of CPT-P combination chemotherapy for CCC
Final Agenda: Health 2.0 Europe conference (note: ACOR)
Patients and Online Communities - The advancement and popularity of patient communities online is an international phenomenon. We’ll be examining communities in different cultures, languages and context, and see what impact they have on care delivery in different countries–and what the internationalization of information means for patients and doctors.
The patient perspective from:
- Roberto Ascione, PagineMediche.it Italy
- Gilles Frydman, ACOR america
- Ben Heywood, PatientsLikeMe america
- Neil Bacon, iWantGreatCare UK
- Christian Angele, imedo Germany
Monday, February 22, 2010
Sunday, February 21, 2010
Clinical Presentation of Endometrioid Epithelial Ovarian Cancer with Concurrent Endometriosis: A Multicenter Retrospective Study — Cancer Epidemiology, Biomarkers & Prevention
Conclusions: In this large series of patients with EEOC, the main presenting symptoms were pelvic pain followed by gastrointestinal symptoms, palpable mass, abdominal distension, vaginal bleeding, and newly developed or exacerbated dysmenorrhea and dyspareunia. Dyspareunia and dysmenorrhea were more frequently detected in patients with endometriosis. Normal CA-125 levels cannot be applied as a marker to exclude EEOC, particularly at the early stages. Cancer Epidemiol Biomarkers Prev; 19(2); 398–404
Your Doc Is In: North American Menopause Society Issues Guidelines on Hormone Therapy
Note: The actual guidelines will be published in the March/April issue of the Journal of the North American Menopause Society
Saturday, February 20, 2010
full access 2008: Systematic Review and Meta-analysis of Ovarian Cancers: Estimation of Microsatellite-High Frequency and Characterization of Mismatch Repair Deficient Tumor Histology
Translational Relevance:
This systematic review and meta-analysis estimates the frequency of high-level microsatellite instability (MSI-H) in unselected ovarian cancers as 12%, suggesting that defects in the mismatch repair (MMR) pathway account for a relatively large proportion of ovarian cancers. In the era of personalized medicine, MSI-H status may provide valuable etiologic and diagnostic information, which may eventually be of prognostic and therapeutic utility, as seen in MSI-H colorectal cancers.
The results of this meta-analysis also reveal an overrepresentation of nonserous histologies in MMR-deficient tumors. The clinical relevance of these findings is that they may increase clinical awareness of MMR-deficient tumors; such awareness may aid in the identification of this subtype of tumors, having potential implications for medical management.
European Medicines Agency (EMA): the Agency takes a further step in its interaction with patients and consumers | A global voice for patients
REFLECTION PAPER ON THE FURTHER INVOLVEMENT OF PATIENTS AND CONSUMERS IN THE AGENCY’S ACTIVITIES
New Joint Outpatient Chemotherapy Administration Standards - Cancer Journal for Clinicians
The guidelines were created largely in response to recent studies that have examined reports of chemotherapy administration errors among outpatients, and to reports of an increased risk of errors with the administration of new oral chemotherapeutics.
Difficulty Accepting a Terminal Prognosis Linked with Depression, Anxiety, and Suffering - A Cancer Journal for Clinicians
Dissenting Opinion:
"Not all clinicians agree with the foregoing interpretations of these findings. "I've certainly seen people who denied dying up to their last breath and somehow never accepted it," Dr. Holland tells CA. "Were they more upset? I'm not sure."
She cautioned against allowing the findings by Dr. Thompson and colleagues to set a tone in which nonaccepting patients are viewed as dysfunctional."
Q&A: Harvard's Steven Skates Describes Using Clinical Assays for Longitudinal Proteomics Research | ProteoMonitor | Proteomics | GenomeWeb
"Skates is involved in a number of longitudinal studies honing in on early detection for ovarian cancer. In proteomics, such studies are still uncommon.
The three best-known studies that have incorporated proteomics are the Framingham Heart Study, the Busselton Health Study, and the UK Collaborative Trial of Ovarian Cancer Screening, of which Skates is a member."
Friday, February 19, 2010
PLoS Genetics: Use of DNA–Damaging Agents and RNA Pooling to Assess Expression Profiles Associated with BRCA1 and BRCA2 Mutation Status in Familial Breast Cancer Patients
definition: heterogeneous - the quality of being diverse and not comparable in kind
full access:
"A large number of rare sequence variants of unknown clinical significance have been identified in the breast cancer susceptibility genes, BRCA1 and BRCA2. Laboratory
methods to identify which of these variants are mutations would have utility for counseling and clinical decision making when identified in patients with a family history of
breast cancer."
clinical trial search - new trials 2/01/2010-2/19/2010 - solid tumors phase 11-111
Search terms: solid tumors | Adult | Phase II III IV | has safety issue outcome measures | received from 02/01/2010 to 02/19/2010 - 2
Search of: ovarian cancer | received from 02/01/2010 to 02/19/2010 - List Results - ClinicalTrials.gov
Search terms: ovarian cancer, received between the dates of 02/01/2010 to 02/19/2010 - 8 results
Thursday, February 18, 2010
Correspondence/Reply: Central Institutional Review Board–Facilitated Review Metrics Omit Critical Components
1) CORRESPONDENCE
Central Institutional Review Board–Facilitated Review Metrics Omit Critical Components
Michael S. Katz, Mary L. Smith
Patient Representative Committee, Eastern Cooperative Oncology Group, Philadelphia, PA
To the Editor:
"As cancer survivors and patient advocates, we must take issue with calculations of the impact of the central institutional review board (CIRB) on local institutional review board (IRB) protocol review times and societal costs by Wagner et al.1 The authors' definitions of these metrics omit critical components......Thus, the net impact on IRB review times, which determine how quickly a protocol can move from National Cancer Institute approval to putting patients on-study are actually slower by 66 to 76 days than a stand-alone local review. The suggestion, therefore, that there are "benefits of a more predictable and faster approval process" is not accurate.""
2) CORRESPONDENCE - Reply to M.S. Katz et al
"Recent internal data from National Cancer Institute show that these changes have decreased the length of CIRB review, defined as application receipt to approval, from a median of 95.5 days in 2008 to 45 days for the six trials using the new processes."Author's Reply to Correspondence: Endocrine Effects of Aromatase Inhibitors Journal of Clinical Oncology
" It is somehow astonishing that after approximately 15 years from the first clinical article on anastrozole, exemestane, and letrozole, we still have insufficient or weak knowledge of some of the consequences of their long-term use."
Patient Opinion - NHS (UK) website
Your story can change the NHS * Tell people what happened * See what others are saying * Find out how patients are changing the NHS
Quest, Vermillion 'On Track' to Launch OVA1 in March | GenomeWeb
"OVA1 generates a numerical score based on five immunoassays that is intended to help physicians determine the likelihood of malignancy in women with pelvic mass for whom surgery is planned."
HDAC Inhibitors in Cancer Care - Cancer Network
"What is more promising about this study was the utility in all of the cancers studied (ovarian, cervical, breast, testicular, and lung), demonstrating that combining HDAC inhibitors with other therapies may be clinically useful in multiple types of malignancies."
US Oncology picks up Cure magazine - Medical Marketing and Media
Cure magazine is located on the web at www.curetoday.com
Tumour Microenvironment The ‘low oxygen’ environment of solid tumours is leading to a new class of therapies and Measuring Tumour Hypoxia and Tumour Metabolism
Tumour Microenvironment The ‘low oxygen’ environment of solid tumours is leading to a new class of therapies and Measuring Tumour Hypoxia and Tumour Metabolism
Muslim women and medical students in the clinical encounter Medical Education
Medical Education 2010: 44 : 306–315
"Context Increasingly, male medical students report being refused by female patients, particularly in obstetrics and gynaecology, which is impacting on recruitment into the discipline. However, little has been documented in terms of Muslim patients and medical students in the clinical consultation."
Burnout and engagement among resident doctors in the Netherlands: a national study.
Conclusions: "As more than a fifth of the medical residents who responded could be diagnosed as suffering from burnout, we conclude that this problem needs addressing in the Dutch health care system, especially given that a relationship was proven between burnout and suboptimal patient care."
Variation at 8q24 and 9p24 and risk of epithelial ovarian cancer
"Abstract: The chromosome 8q24 region (specifically, 8q24.21.a) is known to harbor variants associated with risk of breast, colorectal, prostate, and bladder cancers. In 2008, variants rs10505477 and rs6983267 in this region were associated with increased risk of invasive ovarian cancer (p < 0.01); however, three subsequent ovarian cancer reports of 8q24 variants were null.........These results indicate that the SNPs studied here are not related to risk of this gynecologic malignancy and that the site-specific nature of 8q24.21.a associations may not include ovarian cancer."
Comment regarding Pelvic Exams while under Anesthesia
My comment: While Lynn's abstract is interesting, it is noteworthy again that these are not new issues as per the included references. I would disagree that further research is required. A root cause analysis is not going to add anything further to what has already been demonstrated. It is now a matter of policy.
“Come here. I want you to feel a normal rectum. Do it.”
Disposition of soy isoflavones in normal human breast tissue - American Journal of Clinical Nutrition
Background: Despite decades of research on the relation between soy and breast cancer, questions regarding the absorption, metabolism, and distribution of isoflavones in breast tissue largely remain unanswered.
Revisiting biographical disruption: Exploring individual embodied illness experience in people with terminal cancer
"Biographical accounts of illness offer useful insights into the social and adaptive processes of living with chronic illness. Yet there are concerns that the underlying theoretical assumptions of a reflexive self seeking to maintain meaning may not reflect the lived experience of individuals....We discuss the possibilities for new approaches to clinical assessment and management of need."
Wednesday, February 17, 2010
Research programs & studies - Cancer Prevention Institute of California
Research programs & studies
Studies of ovarian cancer
* Comorbidity and treatment for ovarian cancer / Survival following ovarian cancer
* Diet and risk of ovarian cancer
* Follow-up Care Us by Survivors (FOCUS study)
* Genetic epidemiology of ovarian cancer
The Most Outrageous Examples Of Health Insurers Denying Coverage - Huffington Post
"We compiled a list of some of the worst cases of insurance companies denying sick customers access to medical care. Check them out below -- and if you've been denied coverage, click "Participate" and tell us your story."
obituary/author: Karen Buhler-Wilkerson (ovarian cancer) nursing professor
"Karen Buhler-Wilkerson, 65, of Center City, who retired in 2006 as a professor of community health at the University of Pennsylvania School of Nursing, died Saturday at the university hospital of complications from ovarian cancer. The author of three books, Dr. Buhler-Wilkerson wrote her last paper, "Living With Cancer," with her life partner of 17 years, Dr. Neville Strumpf, for publication this summer in the quarterly journal Nursing Clinics of North America."
Disrupted lives and threats to identity: The experiences of people with colorectal cancer within the first year following diagnosis -- Hubbard et al. 14 (2): 131 -- Health:
Note: It's very unfortunate that this is not full access as it would apply across cancer domains.
"We conclude that universal application of the concept biographical disruption to the experience of cancer within the first year of diagnosis is not appropriate. This study has implications for cancer services, in particular, the findings call for the development of interventions to support those people who experience cancer as an assault on their identity."
Genome study shows what cancers have in common - news item
"The finding, based on a large-scale study of the genetic make-up of 26 different types of cancers, suggests cancer has less to do with where in the body it occurs, and more to do with the genetic changes that cause it to grow......What that means for treatment is that many treatments may be used across many different kinds of cancers."
Coherence and Completeness of Population-based Family Cancer Reports
Conclusions: These findings suggest that family history of cancer reports from the general population are generally complete and coherent.
Identification of Ovarian Cancer Symptoms in Health Insurance Claims Data
Conclusions:
"These results support previous findings that ovarian cancer symptoms were reported in health insurance claims and were more prevalent before diagnosis, but the symptoms may occur too close to the diagnosis date to provide useful diagnostic information. The passive screening approach should be reevaluated in the future using electronic medical records; if found to be effective, the method may be potentially useful for other incident diseases."
If only WHI was done well -- BMJ (Drug firm conflicting interests)
"Barrington claims that the women’s health initiative (WHI) trial had impeccable standards.1 We recently highlighted some of its shortcomings relating to hormone replacement therapy (HRT). The data and safety monitoring board used a global index of health which was modified on three occasions...."
Fluorescent probes light up cancerous tumors
In research:
"In a series of studies, working mainly in mice with implanted human tumors, the researchers showed that if tumors had spread to surrounding tissue, the ACCP-nanoparticle probes enabled them to visualize areas of tumors that they wouldn't ordinarily see -- either because the tissue was buried beneath other tissue or the tumor simply was difficult to distinguish from normal tissue."
Tuesday, February 16, 2010
WHI Study Data Confirm Short-Term Heart Disease Risks of Combination Hormone Therapy for Postmenopausal Women, February 15, 2010 News Release - National Institutes of Health (NIH)
Note: This is a re-analysis of the original study, however, between the time of the original publication and now, sub-analyses have been conducted. There continues to be wide debates on these issues.
"The NHLBI collaborates on the WHI with the National Cancer Institute, the National Institute of Arthritis and Musculoskeletal and Skin Diseases, the National Institute on Aging, and the Office of Research on Women’s Health, all parts of the NIH. Wyeth-Ayerst Research provided the medication and placebo for the hormone study."
Hormone replacement after gynaecological cancer
"However, the majority of the most common gynaecological malignancies like squamous cell carcinomas of the cervix, serous papillary epithelial ovarian carcinomas and squamous cell carcinomas of the vulva are not oestrogen dependent."
Mismatch repair status and outcomes after adjuvant therapy in patients with surgically staged endometrial cancer (Lynch Syndrome mutations)
OBJECTIVES: "To determine whether DNA mismatch repair (MMR) modifies the response to chemotherapy or radiotherapy in patients with endometrial cancer...... METHODS: Immunohistochemistry (IHC) for the DNA MMR proteins MLH1, MSH2, MSH6, and PMS2 was performed on a tissue microarray of specimens of primary endometrial cancer."
BRCA1 gene mutations may explain more than 80% of excess number of ovarian cancer cases after breast cancer - a population based study from the Wester
BRCA1 gene mutations may explain more than 80% of excess number of ovarian cancer cases after breast cancer - a population based study from the Western Sweden Health Care region.
abstract: Surveillance for the detection of recurrent ovarian cancer: Survival impact or lead-time bias?
OBJECTIVE: "To compare the survival impact of diagnosing recurrent disease by routine surveillance testing versus clinical symptomatology in patients with recurrent epithelial ovarian cancer (EOC) who have achieved a complete response following primary therapy.....
abstract: Decreased severity of ovarian cancer and increased survival in hens fed a flaxseed-enriched diet for 1 year
OBJECTIVE: "With the exception of the laying hen, no other animal model of spontaneous ovarian surface epithelial cancer replicates the human disease."
Monday, February 15, 2010
Reduced levels of hydroxylated, polyunsaturated ultra long-chain fatty acids in the serum of colorectal cancer patients: implications for early screening and detection
"There are currently no accurate serum markers for detecting early risk of colorectal cancer (CRC)."
The impact of outcome reporting bias in randomised controlled trials on a cohort of systematic reviews -- Kirkham et al. 340: c365 -- BMJ
"Of the 42 meta-analyses with a statistically significant result only, eight (19%) became non-significant after adjustment for outcome reporting bias and 11 (26%) would have overestimated the treatment effect by 20% or more."
"Conclusions:
Outcome reporting bias is an under-recognised problem that affects the conclusions in a substantial proportion of Cochrane reviews. Individuals conducting systematic reviews need to address explicitly the issue of missing outcome data for their review to be considered a reliable source of evidence...."
Buchanan sees cancer fight as challenge - Martinsville Bulletin - stage 1C clear cell ovarian cancer (tumour rupture)
"Now, she knows that “unless you’ve truly been there and done that, you cannot truly understand what it is like,” she said. “I’m looking at this as a different phase in my life. If I turn that next corner, I will try to accept the things I cannot change and deal with it the best I know how. It will make me a stronger person.”
Confusing association with causation - common journalistic pitfall - Gary Schwitzer's HealthNewsReview Blog
"We've just posted a new guide on the importance of the language used to describe the results of observational studies. Day after day we see stories that use active powerful verbs like "prevent...boost...lower your risk...may cut death rate" to describe the results of these studies. That's misleading and inaccurate because such studies can't prove cause-and-effect. Read more about why in this detailed, thoughtful piece by Mark Zweig, MD, and Emily DeVoto, PhD. (It's actually a revision of a piece these two wrote for us two years ago. The new one fits nicely in our "Tips for Understanding Studies" section.)"
Switch that turns on the spread of cancer discovered - science news report
in research: "This is often the fatal process in breast, ovarian, pancreatic and colon-rectal cancers."
Quality of Healthcare in Canada : A Chartbook | CHSRF
Note: this rather large paper includes cancer and international comparisons
Social Science & Medicine : End of Life Care Policies: Do they make a difference in practice? (analysis - Saskatchewan, Canada)
"The findings of this study demonstrate a significant gap between institutional End of Life care policies and practice..."
table of contents - Surgical Oncology Clinics of North America focus on Pancreatic Cancer
Surgical Oncology Clinics of North America, Volume 19, Issue 2, Pages 235-462 (April 2010)
Pancreatic Cancer: Current Concepts in Treatment and Research
Posted Comments: Pelvic Exams Under Anaesthesia including abstract link
Sunday, February 14, 2010
2010 abstract Teaching Pelvic Examinations Under Anaesthesia: What Do Women Think? U of Calgary
Note:
This issue of pelvic exams while under anasethesia has been explored in the research in
the past (click on 'read
more' to see viewers comments)
Please take the poll and add your views on this issue.............................................
Conclusion: "The majority of patients wish to help medical students to learn but expect consent to be sought if medical students are to perform pelvic examinations on anaesthetized patients. Before introducing explicit consent in Canadian teaching centres, it will first be necessary to determine the feasibility of seeking consent specifically for this procedure."
Please take the poll and add your views on this issue.............................................
Conclusion: "The majority of patients wish to help medical students to learn but expect consent to be sought if medical students are to perform pelvic examinations on anaesthetized patients. Before introducing explicit consent in Canadian teaching centres, it will first be necessary to determine the feasibility of seeking consent specifically for this procedure."
February 15th, 2010: Results of (unscientific poll) Pelvic Exams while under Anaesethia
- I am happy to help with learning 24 (31%)
- I do not feel permission is need 0 (0%)
- Permission is needed sometimes 1 (1%)
- Permission is needed without except 71 (93%)
- I have no concerns with the ethics of this situation 1 (1%)
- I have great concerns with the ethics of this situation 68 (89%)
- Is this today common practice - pelvic exams while under anesthesia? 22 (28%)
- Yes (common practice) 6 (7%)
- No (common practice) 7 (9%)
- How would I know? (common practice) 29 (38%)
- Is this a trust issue? 17 (22%)
- I belong to the ACOR ovarian group 35 (46%)
- I am a medical professional 11 (14%)
- Yes, I read the article 47 (61%)
- No, I didn't read the article 15 (19%)
- Was this new information for patients? 15 (19%)
- Was this new information for healthcare professionals? 13 (17%)
The dark side of curcumin. International Journal of Cancer
a caution regarding Curcumin (partial abstract)
Sunday, February 14, 2010
Open Poll - Pelvic Exams While Under Anesthesia
please contribute your views (men & women)
Patients, Consumer and Health Care Professionals
2010 abstract Teaching Pelvic Examinations Under Anaesthesia: What Do Women Think? U of Calgary
Note: This issue of pelvic exams while under anasethesia has been explored in the research in the past (click on 'read more' to see viewers comments)
Please take the poll and add your views on this issue.............................................
media links to: Teaching Pelvic Examinations Under Anaesthesia
* research abstract: "Teaching Pelvic Examinations Under Anaesthesia: What do Women Think" by Sara Wainberg from the Journal of Obstetrics&Gynecology http://www.sogc.org/jogc/abstracts/2010
* "Time to end pelvic exams done without consent" The Globe&Mail http://www.theglobeandmail.com/life/health/time-to-end-pelvic-exams-done-without-consent/article1447337/
* "When unknowing, hardly implied" The Globe&Mail Editorials http://www.theglobeandmail.com/news/opinions/editorials/when-unknowing-hardly-implied/article1451312/
Saturday, February 13, 2010
news article: The popular test you don't need
"Does this mean you should avoid CT scans? No, don't swing from scan-a-mania to scan-a-phobia. These tests can be lifesavers, provided you and your doctor use them only when the benefits outweigh the risks....."
Subscribe to:
Posts
(
Atom
)
dg
Most patients aren't aware that they can be used as props in the operating room and I'm sure the hospitals and doctors want it that way. The operating room has always been known to medical students as a great place to "steal" their learning from the patient. I think what's unnerving is the vision of many students waiting their turn in line to practice on an unconscious patient.
How could this possibly be an issue or a problem? How could it NOT be feasible to require prior consent? Likely the feasibility question concerns the medical schools' fear that if they ask patients for consent, they'll get more refusals than they can abide.
I consider this practice to be extremely unethical and leaves women open to abuse.
Where are the ethics committees when it comes to issues like this?
If it is not ABSOLUTELY CLEAR to the patient that a specific exam is part of the process, AND that participation means a supervised student may do such an exam, then you don't have informed consent. Period.
And you sure don't get that by having the patient sign a pile of forms a few hours ahead of a procedure, or assuming they know what "participate" in operation means. Stand and watch? Help monitor? Hold a kidney? I don't object to being a learning tool, but I expect to be asked specifically, simply and clearly.
"is it common practice when women are undergoing any procedure to have pelvic exams while under anaesthesia?"
My heart sank when I read that question. I would love to know this too (while at the same time I dread the answer).
I'd also like to know, are men's bodies used in this experimental way? Do students practice examinations on men for testicular or prostate cancer while they are unconscious?
Sandi, I hope you'll keep us posted if you hear anything about this. Thank you.
My heart sank when I read that question. I would love to know this too (while at the same time I dread the answer).
I think from some of the poll responses and comments, it is common contrary to what may think. Surgical patients of any kind, male or female should be getting on the bandwagon on this issue. The best way to bring this issue forward is to blog,email,FB and Twitter the ethics of the issue in the public domain. I wonder what husbands/partners feel about this?
A lot of debates resulted from the expose, but the doctors and hospitals were defiant in their "right" to use patient bodies in the OR as teaching props with the reasoning that a doctor can't learn just by observing. And that the patient isn't harmed. In any debate, they were uniformly indignant at revealing anything that goes on in the OR to the public because of the fear "one foot in door, what next will they demand. And the threat that if there is interference, then patient care will suffer.
Here are a few news links addressing this issue.
http://www.washingtonpost.com/ac2/wp-dyn?pagename=article&node=&contentId=A36990-2003May9¬Found=true
http://papers.ssrn.com/sol3/papers.cfm?abstract_id=880120
(yes, men are used as props too)
http://www.menshealth.com/men/health/other-diseases-ailments/are-med-students-practicing-on-you/article/fb2a99edbbbd201099edbbbd2010cfe793cd
http://findarticles.com/p/articles/mi_m0CYD/is_13_38/ai_105514181/
http://jamwa.amwa-doc.org/index.cfm?objectid=C7EE5996-D567-0B25-50D3DA2B7834FEE5
1) http://upalumni.org/medschool/appendices/appendix-37.html
2) http://upalumni.org/medschool/appendices/appendix-49.html