Thursday, January 19, 2012

US Deaths Resulting From Inpatient Surgery Decline

"January 18, 2012 — The number of surgical procedures performed in the United States increased between 1996 and 2006, whereas inpatient postsurgical deaths within 30 days of admission dropped significantly, according to a national, population-level analysis published (abstract) in the February issue of Surgery....."

".....In 2006, more patients had sepsis or pneumonia than in 1996, and the absolute number of deaths resulting from complications increased. However, the failure-to-rescue rate declined during the study period for both groups (sepsis, from 18.69% to 14.03%; pneumonia, from 8.54% to 7.34%). Meanwhile, the number of deaths resulting from deep venous thrombosis or pulmonary embolism, upper gastrointestinal bleeding, and shock declined during the study period.
Overall, the number of patients with 1 to 5 complications increased, but the failure-to-rescue rate for patients with an identified complication decreased from 12.10% to 9.84% (P < .001)
"The decline in the number of deaths may have occurred through reduced mortality of individual procedures, reductions in the volume of high-risk procedures, and the rescue of patients who had a complication," the authors write.
They estimate that 51,000 fewer people died in 2006 than would have with the 1996 mortality rate. However, they also note that some portion of the decline in mortality "may represent the effect of premature discharge as opposed to an actual improvement in survival." Data were not linked across admissions, and a patient discharged postoperatively who was later readmitted with a complication and died would not be counted as a death in this study."

abstract: Exposure to and Intention to Discuss Cancer-Related Internet Information Among Patients With Breast Cancer (Sloan Kettering)

Patients and Methods:
We asked 558 patients with breast cancer who were waiting to see their physicians about their experiences reading cancer-related information from the Internet and their intent to discuss the information in their current visit.

Conclusion:
The proportion of patients with breast cancer planning to discuss Internet information during their current physician visit was relatively small. Few characteristics were associated with recent Internet use or intent to discuss.

abstract: Variation and Consternation: Access to Unfunded Cancer Drugs in Canada

".... The majority of respondents felt all methods of accessing unfunded intravenous cancer drugs should be available (76% in their own center; 60% in private clinics) and used these methods to access these medications (81% in their own institution; 62% in private clinics)...."

Conclusion:
Access to effective but unfunded cancer drugs varies across Canada. Policymakers need to consider whether this is consistent with articulated values of the system and whether currently planned processes address these inconsistencies. Key stakeholders need to consider the merits of the different means of accessing these drugs to appropriately and fairly integrate access into publically funded health care systems like that of Canada and other systems like that of the United States, which could face similar limits in the future.

abstract: Prevalence of Self-Reported Memory Problems in Adult Cancer Survivors: A National Cross-Sectional Study

Conclusion:
Cancer history independently predicted SRM impairment. Prevalence of SRM (self-reported memory) impairment in people with a history of cancer/cancer treatment is substantial and increasing. Health care providers should assess and be ready to treat memory impairment in patients with a history of cancer.

Improving Wait Time for Chemotherapy in an Outpatient Clinic at a Comprehensive Cancer Center (MDA)

"Purpose:
We conducted our study at the Ambulatory Treatment Center (ATC) of the MD Anderson Cancer Center, a network of six outpatient treatment units for patients receiving infusion therapies. Excessive patient wait time for chemotherapy was a primary source of ATC patient dissatisfaction. ATC employees expressed frustration, because often, patients arrived physically on time but were not treatment ready. Additionally, ATC staff emphasized challenges associated with obtaining finalized treatment orders for prescheduled appointments (ie, placeholder appointments without associated physician treatment orders). We aimed to decrease mean patient wait time from check-in to treatment in one ATC unit by 25%."

JMIR-Results of an Online Community (FORCE) Needs Assessment for Psychoeducational Interventions Among Partners of Hereditary Breast Cancer Previvors and Survivors (specifically breast cancer)

Clinical Characteristics

"Clinical characteristics assessed included whether respondents’ partners had a diagnosis of breast cancer, had been tested for a BRCA1/2 genetic mutation, and had surgery to remove her breasts (ie, prophylactic mastectomy) or ovaries (ie, prophylactic oophorectomy), or for breast reconstruction. Based on these items, 3 variables were created to indicate whether each respondent’s partner had (1) a diagnosis of breast cancer, (2) received BRCA1/2 genetic testing, and (3) undergone any of the 3 surgery types we inquired about."

abstract: RAS Mutations Are Associated With the Development of Cutaneous Squamous Cell Tumors in Patients Treated With RAF Inhibitors (vemurafenib/sorafenib/secondary malignancies)

"Purpose

RAF inhibitors are effective against melanomas with BRAF V600E mutations but may induce keratoacanthomas (KAs) and cutaneous squamous cell carcinomas (cSCCs). The potential of these agents to promote secondary malignancies is concerning. We analyzed cSCC and KA lesions for genetic mutations in an attempt to identify an underlying mechanism for their formation.

Methods
Four international centers contributed 237 KA or cSCC tumor samples from patients receiving an RAF inhibitor (either vemurafenib or sorafenib; n = 19) or immunosuppression therapy (n = 53) or tumors that developed spontaneously (n = 165)........."

abstract: Longitudinal Assessment of Chemotherapy-Induced Structural Changes in Cerebral White Matter and Its Correlation With Impaired Cognitive Functioning

Conclusion
We report evidence of longitudinal changes in cognitive functioning and cerebral WM (white matter) integrity after chemotherapy as well as an association between both.

open access: JCO - “Doctor, Will the Treatment You Are Recommending Cause Chemobrain?”

"For more than a decade, patients and their oncologists have been sharing conversations about cognitive complaints after chemotherapy treatment.¹ Early on, only occasional patients complained of trouble with concentration and memory during treatment, with a minority noting persistence beyond the end of treatment. The oncologist, who rarely heard this complaint, could be dismissive, saying that the drugs the patient received did not cross the blood-brain barrier, and therefore, it was unlikely that the difficulties were related to the cancer treatment........."

press release: Novel gene mutations associated with bile duct cancer (a Lynch Syndrome associated cancer)

"...Cancers of the gallbladder and bile duct are diagnosed in 12,000 patients in the U.S. each year, the authors note; but only 10 percent are discovered early enough to allow successful surgical treatment. Chemotherapy is modestly effective, leading to an average survival time of less than one year....."

open access: Managing pregnant women with cancer: personal considerations and a review of the literature

selected section:

Gynecological tumours

Cervical and less commonly ovarian cancers have been diagnosed in women during their pregnancy course. Given their anatomical location, their treatment represents a major challenge. Pelvic surgery remains very challenging during pregnancy as the access is impaired and thus an optimum oncological resection is technically very difficult to achieve [19]. Thus, surgery should not be considered outside centres with experience dealing with pregnant cancer patients. Pelvic radiotherapy should be avoided during gestation, as the risk of foetal loss or malformations are significant [8]. Elective abortion should thus be considered during the first trimester, if the clinical situation mandates a prompt treatment.

A recent systematic review has identified 16, 18, and 20 patients treated with chemotherapy for cervical, non-epithelial and epithelial ovarian cancer, respectively [8]. Concomitant cisplatin and radiotherapy was frequently considered in cervical cancer patients, but spontaneous abortion was encountered in all patients exposed to radiotherapy; cases treated with weekly cisplatin alone had a normal pregnancy outcome. For non-epithelial ovarian cancer, 15/18 cases did not show any signs of pregnancy complications. In the remaining three cases, pregnancy complications were successfully managed with no foetal abnormalities documented. The most frequently used regimen was BEP (bleomycin, etoposide, and cisplatin), which is also considered as the gold standard treatment for non-pregnant women. The combination of paclitaxel and carboplatin was also frequently reported in managing epithelial ovarian cancer during pregnancy, with no serious complications reported.

What Is the Current Standard of Care for Anti-HER2 NEOADJUVANT Therapy in Breast Cancer?

Researchers find discordance between standard human epidermal growth factor receptor 2 (HER2) testing and HER2 status reported on Oncotype DX

"“Our study on HER2 discordance highlights the fact that one test cannot provide all the answers [regarding optimal treatment for women with breast cancer]. The oncology community needs to continue using the validated HER2 assays in clinical treatment decisions and reexamine their overreliance on the Oncotype DX test,” Dr. Bhargava says.

Dr. Hayes agrees, noting that the Oncotype DX HER2 assay was not developed, validated, or approved as a predictive test to determine which patients should receive anti-HER2 therapies."

Women of Teal: HopeNet Social Network to be Discontinued- 1/1/12

Myriad Genetics Gets (Worldwide) Rights To RAD51C Gene

"...Through this agreement, Myriad has obtained an exclusive, world-wide license, with co-exclusivity in Germany, to provide commercial testing for RAD51C."

Hereditary ovarian cancer: Beyond the usual suspects - abstract (Fanconi anemia–BRCA,PARP, RAD51C, RAD51D,BRIP1

Blogger's Note: see post Myriad Genetics rights/RAD51C

.....With at least 16 genes implicated in hereditary ovarian cancer to date, comprehensive testing for ovarian cancer risk will require assessment of many genes........ In addition, identifying inherited mutations in a variety of FA–BRCA pathway genes may aid in identifying individuals who will selectively benefit from PARP inhibitors."

Highlights

► Newly identified hereditary ovarian cancer genes include RAD51C, RAD51D, and BRIP1.
► Many genes in the Fanconi anemia–BRCA pathway may increase risk of ovarian cancer.
► New genomic technologies make comprehensive genetic assessment feasible.

Wednesday, January 18, 2012

Ovarian Cancer and Us - blacked out

blacked out

SOPA blackout: Who’s gone dark to protest anti-piracy bills?

http://latimesblogs.latimes.com/technology/2012/01/sopa-blackout-who-is-joining-the-protest.html

abstract: Extraperitoneal Metastases From Recurrent Ovarian Cancer (stage 111 ovarian cancer patients)

International Journal of Gynecological Cancer:

January 2012 - Volume 22 - Issue 1 - p 43–46

doi: 10.1097/IGC.0b013e31823532ce

Ovarian Cancer

Extraperitoneal Metastases From Recurrent Ovarian Cancer

Robinson, William R. MD^*; Beyer, Julie RN, BSN^†; Griffin, Stephen MD^†; Kanjanavaikoon, Paiyarut MD^‡

Abstract

Objectives: To identify patterns of metastasis in patients with recurrent ovarian cancer. The influence of the route of chemotherapy administration and sequence of agents on those patterns is also examined.

Results: Thirty-five subjects developed extraperitoneal recurrent ovarian cancer, with 26 subjects (74%) after IP treatment, and 9 subjects (26%) after IV treatment. Of these extraperitoneal recurrences, 26 were in the thoracic/pulmonary cavity, 7 were within the central nervous system (CNS), and 2 were in the cutaneous tissues. The CNS and cutaneous lesions were secondary recurrences, and all occurred in subjects who had initially received IP cisplatin/paclitaxel followed by IV BEV for recurrent disease.

Conclusions: Extraperitoneal recurrences were more common in women treated with IP chemotherapy for ovarian cancer. Specifically, women treated with IV BEV as secondary therapy after IP were at particularly high risk of extraperitoneal metastases, including in the CNS and cutaneous tissues. Physicians should be aware of the possibility of unusual metastases after the combination of IP chemotherapy and BEV, and future prospective studies of this population should carefully evaluate recurrence site patterns.

Firefox - Why is the Internet on strike today?‏

Today, Mozilla is joining the virtual strike against Internet censorship – along with others like Wikipedia and Google – to raise awareness of US Congress legislation that could fundamentally alter the Internet we know and love.

This harmful legislation, called the Stop Online Piracy Act (SOPA) in the House and the PROTECT IP Act (PIPA) in the Senate, will be voted on as early as January 24th in the Senate.

If you live in the US, there's still time to help stop these bills from becoming law. Please visit mozilla.org/sopa for information on the bill, and on ways you can reach out to your senators.

What makes this legislation so bad? Here's how it would change the Web:......

The Oncologist: Immunogenicity of an Inactivated Monovalent 2009 Influenza A (H1N1) Vaccine in Patients Who Have Cancer (prospective single site study + 2 related articles))

Blogger's Note: reminder - full access requires subscription ($$$); note also related articles

Abstract
Background. The immune response of patients who have cancer, who may be receiving immunosuppressive therapy, is generally considered to be decreased. This study aimed to evaluate the immune response of cancer patients to the 2009 influenza A (H1N1) vaccine.

COMMENTARY

Vaccination of Oncology Patients: An Effective Tool and an Opportunity Not to Be Missed

Camille N. Kotton, Mark C. Poznansky

Oncologist published 12 January 2012, 10.1634/theoncologist.2011-0383
http://theoncologist.alphamedpress.org/cgi/reprint/theoncologist.2011-0383v1
.......................................................................................

OUTCOMES RESEARCH: CASE REPORT
Immunogenicity of an Inactivated Monovalent 2009 Influenza A (H1N1) Vaccine in Patients Who Have Cancer: Yiqing Xu, Nanda Methuku, Praveena Coimbatore, Theresa Fitzgerald, Yiwu Huang, Ying-Yi Xiao, Murali Pagala, Shachi Gupta, William Solomon, Philip Rubin, John Treanor, Alan Astrow, Howard Minkoff, Jay S. Cooper; Oncologist published 12 January 2012, 10.1634/theoncologist.2011-0220
http://theoncologist.alphamedpress.org/cgi/content/abstract/theoncologist.2011-0220v1

ecancernews: Researchers defend HRT breast cancer (The Million Women Study)study

open access: Thoracic metastasis in advanced ovarian cancer: comparison between computed tomography and video-assisted thoracic surgery

Blogger's Note: click on 'pdf' to access full paper

Objective: To determine which computed tomography (CT) imaging features predict pleural malignancy in patients with advanced epithelial ovarian carcinoma (EOC) using video-assisted thoracic surgery (VATS), pathology, and cytology findings as the reference standard.

A Risk-Adapted Strategy of Adjuvant Paclitaxel/Carboplatin in Early-Stage Ovarian Cancer: Time-Dependent Effect of 4 versus 6 Cycles on Outcome.

Abstract

Objective:
We investigated the efficacy of risk-adapted adjuvant paclitaxel/carboplatin chemotherapy in early-stage ovarian carcinoma.

Methods: Fifty-three patients were treated according to the risk of relapse: patients with stages IA or IB or with grade 1 (low risk) received 4 cycles of paclitaxel and carboplatin; patients with IC/IIA and grade 2 or 3 (high risk) received 6 cycles of chemotherapy. The outcome was compared with that of 95 patients who were all treated with 4 cycles.

Results: Median follow-up was 88, 113 and 42 months for the whole cohort, non-risk-adapted and risk-adapted treatment, respectively.

Five-year relapse-free and disease-specific survival was 86 and 93% for the whole population, 96 and 97% for low-risk and 81 and 91% for high-risk patients.

Risk classification was the only significant prognostic factor for relapse-free (p = 0.011) and disease-specific survival (p = 0.039). Among high-risk patients, the administration of 6 cycles was associated with a significantly lower relapse rate after censoring events, which occurred beyond 2 years (3 vs. 18%; p = 0.013), but this difference was diminished at 5 years (23 vs. 25%; p = 0.797).

Conclusions: Six cycles of chemotherapy reduced the risk of relapse within 2 years, but the benefit from two additional cycles beyond this time is questionable.

short abstract: Gynecological cancer: True progress in ovarian cancer or just the tip of the iceberg?

Blogger's Note: requires subscription to view full text ($$$)

Gynecological cancer: True progress in ovarian cancer or just the tip of the iceberg?

Lisa Hutchinson

Development of malignant ascites is common in patients with ovarian cancer, and few therapeutic options exist for women with ascites whose tumors become resistant to chemotherapy. Furthermore, in such patients symptom palliation options are limited, and the few available treatments are unpleasant and can result in the need for paracentesis."

Concurrent Endometrial Intraepithelial Carcinoma (EIC) and Serous Ovarian Cancer: Can EIC Be Seen as the Precursor Lesion?

OBJECTIVE:

The pathogenesis of serous ovarian carcinoma (SOC) is still unknown. Recently, endometrial intraepithelial carcinoma (EIC) was proposed to be the precursor lesion of SOC. This study examines the model of EIC as precursor for SOC.

CONCLUSION:

This study provides a first indication of EIC as possible precursor lesion for SOC. This finding could have major clinical implications for future ovarian cancer management and underscores EIC as a possible target for early SOC detection and prevention.

The Oncologist: commentary + link to original paper - Calcium and Magnesium Prophylaxis for Oxaliplatin-Related (taxanes) Neurotoxicity: Is It a Trade-off Between Drug Efficacy and Toxicity?

1) link to commentary:

Calcium and Magnesium Prophylaxis for Oxaliplatin-Related Neurotoxicity: Is It a Trade-off Between Drug Efficacy and Toxicity?

"In this context, a large international academic trial involving several U.S. and European oncological centers—the Chemotherapy-Induced Peripheral Neuropathy Outcome Measures Standardization (CI-PERINOMS) study[16]—recently completed the enrollment of >280 patients with CIPN who were examined with an extended series of scales and questionnaires to assess their reliability and validity, a critical step in the search for the optimal method to detect and describe its features in daily practice and in clinical trials. In fact, until reliable, valid, reproducible, and responsive methods are used to properly assess CIPN, any effort to establish an effective neuroprotection treatment will be unrealistic."

2) link to original paper:

Calcium and Magnesium Prophylaxis for Oxaliplatin-Related Neurotoxicity: Is It a Trade-off Between Drug Efficacy and Toxicity?

"......Furthermore, there is a lack of standardization in timing of assessment of neurotoxicity and inadequate assessment of long-term neurotoxicity related to oxaliplatin between studies investigating Ca/Mg prophylaxis. Also, because of the initial concerns raised by the IDMC examining the CONCePT trial, many of the major trials were terminated early and are thus underpowered. The NCCTG has initiated another prospective randomized, double-blinded trial aimed at addressing these issues." (safety)

Palliative Care in Advanced Cancer Patients: How and When? The Oncologist

Blogger's Note: requires subscription ($$$) to view full text

End Piracy, Not Liberty – Google (petition)

Millions of Americans oppose SOPA and PIPA because these bills would censor the Internet and slow economic growth in the U.S.

Two bills before Congress, known as the Protect IP Act (PIPA) in the Senate and the Stop Online Piracy Act (SOPA) in the House, would censor the Web and impose harmful regulations on American business. Millions of Internet users and entrepreneurs already oppose SOPA and PIPA.
The Senate will begin voting on January 24th. Please let them know how you feel. Sign this petition urging Congress to vote NO on PIPA and SOPA before it is too late.

Tuesday, January 17, 2012

open access - PLoS ONE: Identification of a Potential Ovarian Cancer Stem Cell Gene Expression Profile from Advanced Stage Papillary Serous Ovarian Cancer

"...We propose the side population of ascites from women with high-grade advanced stage papillary serous ovarian adenocarcinoma would be enriched for cancer stem-like cells, and would express a gene signature trend for “stemness” in ovarian cancer stem-like cells...."

"Ethics Statement
Fresh ascites was obtained from 10 women with high-grade advanced stage ovarian adenocarcinoma at the time of primary cytoreductive surgery at Brigham and Women's Hospital, Boston, MA......

".....In summary, an expression profile for SP enriched for cancer stem-like cells from ascites of ovarian cancer patients is reported. The nature of the “stemness” of the SP gene signature was demonstrated by the identification of several stem cell-related genes including an activated Notch signaling pathway. The results were biologically validated using identified SP population from human ovarian cancer cell lines. The SP gene list generated from ovarian cancer patients was also found to be enriched in recurrent tumors from ovarian cancer patients. These results have important implications concerning the tumor recurrence and potential therapeutic approach. The SP cells showed a dose dependent sensitivity towards Notch pathway inhibitor, suggests the Notch signaling pathway may be an important therapeutic target in ovarian cancer."

Controversies in Oncologist-Patient Communication: A Nuanced Approach to Autonomy, Culture, and Paternalism - Cancer Network

"....Several aspects of communication between oncologists and their patients remain contentious:
• Autonomy: To what degree must physicians observe the principle of full disclosure in order to ensure true autonomy and informed decision making on the part of the patient?
• Culture: In caring for patients from different cultures, how should the physician respond to requests of family members who claim that in their culture decision making should be left to the family rather than to the patient?
• Paternalism: How does one balance the need for information with the concern that some patients may be harmed by physicians' honoring requests for either too much or too little information? When should the physician invoke the “therapeutic privilege” of paternalistically overriding a patient request or not seeking the patient's opinion?...."

open access: JNCI - Predicting the Value of Indexing Symptoms for Ovarian Cancer

Medscape: Questions About Data Linking Breast Cancer and HRT

24 hrs Wednesday Jan 18th - Wikipedia blackout: What is SOPA, and why are websites taking themselves down? | News | National Post

Rexall Recalls Calcium Vitamin Softgels Lot On Undeclared Shellfish

"The recalled product involves only one lot number 387651-04, and has product number 45211, UPC Code 3 01220 45211 3, and expiration date 08/15."

FDA fines Red Cross $9.6 million - Healthcare business news and research | Modern Healthcare (includes copies of letters FDA and Red Cross)

"....The Red Cross said in a written statement that the fine focuses on one inspection conducted at a donor and client support center in Philadelphia more than a year ago. The not-for-profit also said it is addressing other issues cited by the FDA in the letter.

“We are disappointed that the FDA believed it necessary to issue a fine for an inspection conducted so long ago and it is important to know we have already taken corrective steps to address those matters and that improvements in operations have been made,” the Red Cross said. “We are not aware of any adverse donor reactions or patient issues due to the problems in the FDA report.”

Ovarian cancer susceptibility alleles and risk of ovarian cancer in BRCA1 and BRCA2 mutation carriers - abstract

Abstract

"Germline mutations in BRCA1 and BRCA2 are associated with increased risks of breast and ovarian cancer. A genome-wide association study (GWAS) identified six alleles associated with risk of ovarian cancer for women in the general population. We evaluated four of these loci as potential modifiers of ovarian cancer risk for BRCA1 and BRCA2 mutation carriers."
"Four SNPs, rs10088218 (at 8q24), rs2665390 (at 3q25), rs717852 (at 2q31) and rs9303542 (at 17q21), were genotyped in 12,599 BRCA1 and 7,132 BRCA2 carriers, including 2,678 ovarian cancer cases."
" The identification of multiple loci modifying ovarian cancer risk may be useful for counselling women with BRCA1 and BRCA2 mutations regarding their risk of ovarian cancer."

Naturopathy: An Introduction [NCCAM Backgrounder]

Assessment Techniques in Naturopathy

Cochrane Summaries website wins plain language award | The Cochrane Collaboration

Cochrane Summaries website wins plain language award

Only recently launched, the Cochrane Summaries website (summaries.cochrane.org) has received global attention, which reached a pinnacle when The Cochrane Collaboration was awarded the runner-up trophy for the best public website by the Plain English Campaign, which has been “fighting for crystal-clear communication since 1979.” David Tovey, the Editor in Chief of the Cochrane Library, explains that "The Cochrane Summaries website aims to deliver the credible, accessible, and impartial information that patients and carers need to improve understanding and promote shared decision making."...

BMC Medical Research Methodology | Full text | Characteristics of meta-analyses and their component studies in the Cochrane Database of Systematic Reviews: a cross-sectional, descriptive analysis

Background

Cochrane systematic reviews collate and summarise studies of the effects of healthcare interventions. The characteristics of these reviews and the meta-analyses and individual studies they contain provide insights into the nature of healthcare research and important context for the development of relevant statistical and other methods.

"Some of the more widely studied medical specialty areas in the CDSR include meta-analyses that are able to draw upon a wealth of studies, the largest containing 294 [15], whilst 1% of meta-analyses contain 28 studies or more. Among the 11 specialty categories we used, cancer had a slightly higher median number of included studies (5) than any of the other categories."

"Study sizes show notable variation across medical specialties. The medians and quartiles are highest in cancer, and high also for meta-analyses in the areas of infectious diseases and gynaecology, pregnancy and birth. Study sizes tend to be lower in the areas of mental health and behavioural conditions and pathological conditions, symptoms and signs."

abstract: Combined treatment of L1CAM antibodies and cytostatic drugs improve the therapeutic response of pancreatic and ovarian carcinoma

Abstract: The adhesion molecule L1CAM (CD171) accounts for enhanced motility, invasiveness and chemoresistance of tumor cells and represents a novel marker for various tumor entities including pancreatic and ovarian carcinoma. Recently, we showed that L1CAM inhibition increases the apoptotic response of tumor cells towards cytostatic drugs pointing to the potential of L1CAM to serve as a chemosensitizer in anti-cancer therapy. Thus, the present study evaluated the therapeutic potential of combined treatment with L1CAM antibodies and chemotherapeutic drugs in pancreatic and ovarian carcinoma model systems in vivo.....

abstract: Uterine Serous Carcinoma: Increased Familial Risk for Lynch-Associated Malignancies.

Abstract

Purpose:
Serous uterine cancer is not a feature of any known hereditary cancer syndrome. This study evaluated familial risk of cancers for serous uterine carcinoma patients, focusing on Lynch syndrome malignancies.
CONCLUSIONS: We identified an excess of endometrial, ovarian, and pancreatic cancers in relatives of serous cancer patients in a single institution study. Follow-up studies suggest only pancreatic cancers are over-represented in relatives. DNA mismatch repair defects in familial clustering of pancreatic and other Lynch-associated malignancies are unlikely. The excess of pancreatic cancers in relatives may reflect an as yet unidentified hereditary syndrome that includes uterine serous cancers.

Avastin: New Ovarian Cancer Drug Approved By European Medicines Watchdog Gives New Hope To Sufferers | UK News + link to Cancer Drugs Fund in England/UK

"We are delighted that Avastin is now available to women across the country."
The National Institute for Health and Clinical Excellence has yet to consider the drugs for routine use by the NHS.
But it is available through the Cancer Drugs Fund in England. Doctors in other parts of the UK can make individual applications for funding.

abstract: Synchronous gynecologic malignancy and preliminary results of Lynch syndrome (Korean women)

METHODS:

Thirty six women with synchronous gynecologic tumors of endometrial and ovarian cancer were identified among patients being treated at our institution.

CONCLUSION:

In this study, the frequency of Lynch syndrome associated immunohistochemical staining (MLH1, MSH2, and MSH6) group was estimated as 9% (3/32) among Korean women with synchronous gynecologic tumors.

conference: Organisation for Oncology and Translational Research The Westin Miyako Hotel Kyoto, Japan Apr 20-21

Welcome Message

2012 Progress and Controversies in Gynecologic Oncology Conference Barcelona, Spain 13–14 April 2012

Monday, January 16, 2012

BMJ Group blogs: Liz Wager: Do we need to rethink our approaches to research misconduct and research integrity?

"....Having failed to start a reasonable conversation about research integrity, based on major scandals, we see no point in trying to address so-called “minor” offences. But as Iain Chalmers said at the meeting, “lesser offences,” such as failing to publish research and publishing welcome results more often than disappointing results, harms many more patients than the high profile scandals (since it distorts the evidence on which guidelines and clinical practice are based). While plagiarism may be a nasty symptom of a sick system, it has probably never killed anybody while unreliable guidelines and misguided research undoubtedly have....."

abstract: Prevalence of BRCA1 and BRCA2 mutations in Ashkenazi Jewish families with breast and pancreatic cancer

BACKGROUND:

Germline mutations in the BRCA2 cancer susceptibility gene are associated with an increased risk of pancreatic cancer (PC). Breast-pancreas cancer families with BRCA1 mutations have also been observed. The influence of a family history (FH) of PC on BRCA mutation prevalence in patients with breast cancer (BC) is unknown.

CONCLUSIONS:

BRCA1 and BRCA2 mutations are observed with nearly equal distribution in AJ breast-pancreas cancer families, suggesting that both genes are associated with PC risk. In this population, a FH of PC was found to have a limited effect on mutation prevalence.

Major Cancer Societies to Support New Wiley Open Access Journal

January 16, 2012 – Wiley-Blackwell, the scientific, technical, medical and scholarly publishing business of John Wiley & Sons, Inc., today announced the launch of Cancer Medicine, a new Wiley Open Access journal. Cancer Medicine is a peer reviewed, open access, interdisciplinary journal providing rapid publication of cutting edge research from global biomedical and clinical researchers across all the oncologic specialties in cancer biology, clinical cancer research and cancer prevention. The journal’s promise of full global reach is reinforced by its editorial leadership and support from prestigious journals and societies. Cancer Medicine has unprecedented support from three major cancer societies......

Dr. Wei (Editor in Cheif) comments, “I am delighted to introduce Cancer Medicine, which will allow readers to have fast access to the most up to date global collaborations in cancer research and international approaches in practicing cancer medicine, as well as highlighting key achievements from the integration of basic, clinical and preventive research of cancer. In the years to come, I will work closely with the Wiley-Blackwell Cancer Medicine team to provide timely and impartial service to all contributors and readers, who will, without a doubt, make Cancer Medicine a success.”

The journal is open to submissions now and aims to publish its first content online in Spring 2012. Please visit the journal’s website www.cancermedicinejournal.com for further information and future updates.

Symptom indices 'should be reassessed' in ovarian cancer treatment | International Federation of Gynecology and Obstetrics (FIGO)

Complementary and alternative medicine — Mayo Clinic?

Resources for Health Care Providers [NCCAM] - Complimentary and Alternative Medicine

Evidence-Based Medicine

Results of NCCAM Research
Literature Reviews from PubMed^®
Evidence Reports from AHRQ
Cochrane Reviews (The Cochrane Collaboration)

Clinical Practice Guidelines

Full-text guidelines for oncologists, rheumatologists, general medicine practitioners, and more.

For Your Patients

Printable fact sheets and links to more resources.

National Center for Complementary and Alternative Medicine [NCCAM] - nccam.nih.gov Home Page

Resveratrol and Fraud - Forbes (note: long article)

Comment on "Training Surgeons and the Informed Consent Process: Routine Disclosure of Trainee Participation and Its Effect on Patient Willingness and Consent Rates"

Abstract: Training Surgeons and the Informed Consent Process: Routine Disclosure of Trainee Participation and Its Effect on Patient Willingness and Consent Rates

Patients
Three hundred sixteen individuals scheduled for elective surgery.

Conclusions
Most patients expressed approval of teaching facilities and resident education. However, consent rates were significantly altered when more detailed information was provided and they declined with increasing levels of resident participation. Providing detailed informed consent is preferred by patients but it could adversely affect resident participation and training.

Million Women Study Wrong, Group Says - in Endocrinology, Menopause from MedPage Today

"A study long used to establish causal links between hormone replacement therapy (HRT) and breast cancer is severely flawed, a group of epidemiologists have charged. The observational Million Women Study (MWS), conducted in the U.K., doesn't adequately satisfy several criteria for causality -- including information bias, detection bias, and biological plausibility -- and thus can't be used to conclude that HRT causes breast cancer, according to Samuel Shapiro, PhD, of the University of Cape Town in South Africa, and colleagues.
"HRT may or may not increase the risk of breast cancer, but the MWS did not establish that it does," they wrote in the Journal of Family Planning and Reproductive Healthcare.
Several experts not involved in the study, however, have emphasized that they're well aware of the limitations of observational studies such as the MWS, and that the totality of evidence thus far has shown a strong association between HRT and breast cancer....."

"The analysis of the Million Women Study is the latest in a series of four papers by the Shapiro group exploring the credibility of three studies -- the MWS, the Women's Health Initiative (WHI), and the collaborative reanalysis (CR) -- that causally linking HRT, particularly estrogen plus progestogen therapy, with breast cancer.
The earlier papers similarly found that neither the CR nor the WHI could satisfy criteria for establishing causality...."

open access: Combination Drugs — Hype, Harm, and Hope — NEJM

‘Open Science’ Challenges Journal Tradition With Web Collaboration - NYTimes.com (open access)

Changes in tumor cells that lead to metastasis CTC's/circulating tumor cells)

ScienceDaily (Jan. 16, 2012) — Researchers at the Centro de Genómica e Investigación Oncológica (GENYO) -of which the University of Granada, Pfizer and the Andalusian Regional Government are members- have identified the genetic and phenotypic changes that cause tumor progression and metastasis. The process of metastasis -- which is the main cause of cancer death -- is caused by tumor cells invading distant organs with no direct anatomical relationship with the organ originally affected. For this to happen, it is necessary that these cells -which researchers call "circulating tumor cells" (CTCs) -, travel to these organs through blood....

"Biodynamics of Circulating Tumor Cell, Tumor Microenvironment and Metastasis," published in the journals Cancer Biology & Therapy, Clinical Translational Oncoly y Annals of Oncology.

abstract: Re-operation outcome in patients referred to a gynecologic oncology center with presumed ovarian cancer FIGO I-IIIA after sub-standard initial surgery

Blogger's Note:

1) this issue is not a new issue irrespective of country origin

2) it would be helpful if a timely comprehensive study be done (retrospective) on the fatality rates, stage and pathology, and according to surgeon/upstaging required via eg. national registries albeit the data bases most likely are lacking; until mandates are in place requiring specific surgical skills in surgical oncology these practices will continue (past and future decades)

Abstract

Background

Surgery is the mainstay of treatment for early ovarian cancer both as therapeutic and comprehensive staging. Only the latter allows appropriate tailoring of systemic treatment. However, the compliance with guidelines for comprehensive staging has been reported to be only moderate and, therefore, re-staging procedures are commonly indicated to avoid undertreatment. The purpose of our study was to evaluate re-operation (2nd surgery) in a tertiary gynecologic oncology unit after primary operation for presumably ovarian cancer FIGO I-IIIA in general gynecology departments. Only 5 patients (13%) were classified as having had a comprehensive staging by surgical records and pathology reports and 35 patients underwent comprehensive re-staging laparotomy after which 20 patients (50%) experienced an upstaging including 13 patients with final diagnosis of FIGO stage IIIC.

Results

40 patients were enrolled of whom 53% came by self-referral. Only 18% were referred by the primary surgeon and the remaining patients were referred by their home gynecologist..........

Conclusion

Comprehensive staging of presumed early ovarian cancer has been described as major problem especially outside gynecologic oncology units. Re-staging results in our department confirmed this deficiency by showing a considerable proportion of upstaging associated with alterations of recommendations for systemic treatment. However, series like this may even underestimate the problem, because incomplete staging is unfortunately accompanied by non-systematic referral practices not reflecting staging quality.

Access : Open-label feasibility study of pazopanib, carboplatin, and paclitaxel in women with newly diagnosed, untreated, gynaecologic tumours: a phase I|[sol]|II trial of the AGO study group : British Journal of Cancer

"Severe myelotoxicity was reported in 6 of 12 patients."

Conclusion:

Combining either 800 or 400 mg per day pazopanib with standard carboplatin/paclitaxel chemotherapy is not a feasible treatment option.

Seth's Blog: "Straight up"

Blogger's Note: a blog worth following

“On some positions, Cowardice asks the question, "Is it safe?" Expediency asks the question, "Is it politic?" And Vanity comes along and asks the question, "Is it popular?" But Conscience asks the question "Is it right?" And there comes a time when one must take a position that is neither safe, nor politic, nor popular, but he must do it because Conscience tells him it is right.”

Access : CA-125 can be part of the tumour evaluation criteria in ovarian cancer trials: experience of the GCIG CALYPSO trial : British Journal of Cancer

Background:

CA-125 as a tumour progression criterion in relapsing ovarian cancer (ROC) trials remains controversial. CALYPSO is a large randomised trial incorporating CA-125 (GCIG criteria) and symptomatic deterioration in addition to Response Evaluation Criteria in Solid Tumours (RECIST) criteria (radiological) to determine progression.

......In patients with CA-125 first progression who subsequently progressed radiologically, a delay of 2.3 months was observed between the two progression types......

Conclusion:

CA-125 and radiological tests performed similarly in determining progression with C-PLD (carboplatin-pegylated liposomal doxorubicin) or C-P (carboplatin–paclitaxel). Additional follow-up with CA-125 measurements was not associated with overtreatment.

open access: Swallowing dysfunction in cancer patients (International study)

"Swallowing of food and liquids including saliva is a complex biomechanical interaction of physiology and anatomy that occurs in four stages: oral preparatory, oral, pharyngeal, and esophageal [1, 2]."

"Dysphagia and odynophagia (painful swallowing) are common in cancer patients. Most studies on this complication are performed in patients with head and neck cancers (HNC), but swallowing disorders may also develop in patients with other malignancies."

"Non-head and neck cancers

Acute as well as chronic dysphagia may develop in any cancer patient with oropharyngeal mucositis as a result of treatment toxicity to the esophagus or secondary infection..... Dysphagia may also develop in patients with a wide variety of malignancies treated with targeted therapies."

Concluding remarks and future directions

"Most studies are performed in HNC patients, but the heterogeneous nature of studies with respect to design, inclusion criteria, and dysphagia assessment makes it difficult to obtain a clear insight in the prevalence and severity of dysphagia and aspiration after different treatment modalities. These conditions are likely underreported [52, 98]."

Supportive Care: Daytime sleepiness and sleep duration in long-term cancer survivors and non-cancer controls: results from a registry-based survey study

Conclusions

Disturbances in daytime sleepiness and sleep duration persist among long-term cancer survivors and should be monitored in routine survivorship care. More research is needed to identify cancer survivors who are at increased risk for daytime sleepiness and disturbed sleep duration, as well as to identify causal mechanisms for, and interventions to mitigate, persistent differences.

open access: Evidence of constitutional MLH1 epimutation associated to transgenerational inheritance of cancer susceptibility - Human Mutation

Blogger's Note: see references in paper to ovarian cancer; BRAF mutations

Epimutation , epimutation meaning , definition of epimutation , what is epimutation - A heritable change in gene expression that does not affect the actual base pair sequence of DNA . The first sign of cellular abnormality in some tumors is an epimutation—a change in heritable chromatin marks , such as an increase or decrease in the density of DNA methylation.
................................................................
"In addition, two patients were included in the study because of personal medical past history (endometrial cancer at the age of 24, and multiple sebaceous tumors associated with ovary cancer at the age of 44, respectively) strongly suggesting Lynch syndrome. The mean age of patients at diagnosis of the first Lynch syndrome-related cancer was 46 years (range, 24–74)."

"In conclusion, we have shown that constitutional epimutations in MMR genes constitute a rare cause of Lynch syndrome. However, they are associated to a real risk of transgenerational inheritance of cancer susceptibility. Moreover, tumors from patients with constitutional MLH1 epimutation can display BRAF mutations, mimicking MSI-H sporadic tumors. Altogether, these findings may have important implications for future diagnostic strategies and genetic counseling."

Sunday, January 15, 2012

abstract: (Lim et al.) JNCI Predictive Value of Symptoms for Ovarian Cancer: Comparison of Symptoms Reported by Questionnaire, Interview, and General Practitioner Notes

1) abstract:

Background

Because of the poor survival outcomes associated with advanced ovarian cancer, early detection strategies are needed. Although several symptom indices have been described, their relationship with the potential lead time has been poorly documented..........

Blogger's Note: see also prior post (Finding Ovarian Cancer) as well as re-post below - response to Lim et al:

2) Finding Ovarian Cancer

open access - JNCI: Finding Ovarian Cancer (correspondence in response to Lim et al.)

"For decades, investigators have sought a strategy for finding ovarian cancer early enough to reduce the risk of dying of ovarian cancer. In this issue of the Journal, Lim et al. (1) report on their study in which women answered a dozen simple questions such as whether they felt pelvic or abdominal pain in the recent past and, if so, when, how frequently, and how severely. Symptom indices like this are being promoted as easier or better ways to find ovarian cancer early, under the assumption that early therapy can achieve a better outcome than if the women wait until more or worse symptoms prompt them to see a physician. The study revealed that symptom indices as ovarian cancer screeners can be sensitive to the presence of cancer in the period between 3 and 14 months before clinical diagnosis......

abstract: Prevention and treatment of venous thromboembolism (blood clots) in patients with cancer

financial media: (cryoablation) Tumor-Freezing Treatment Gives Ovarian Cancer Patients Extra Time: Presented at ISET 2012 - MarketWatch

"MIAMI BEACH, Fla., Jan 15, 2012 (BUSINESS WIRE) --

Killing tumors by freezing them through cryoablation can extend the lives of women with ovarian cancer that has spread to other parts of the body and is cost-effective, according to research being presented at the 4th annual Symposium on Clinical Interventional Oncology (CIO), in collaboration with the International Symposium on Endovascular Therapy (ISET).

The study included 21 patients whose tumors in the abdomen, liver, lung and bone could not be removed surgically......."

press release (2): Rutgers, Massachusetts General investigators find novel way to prevent drug-induced liver injury

press release: Mass. General researchers find novel way to prevent drug-induced liver injury

FDA plans survey on direct-to-consumer drug ads -Modern Healthcare

By Melanie Evans

Posted: January 15, 2012 - 1:00 pm ET

The Food and Drug Administration announced plans to survey doctors, nurse practitioners and physician assistants on their awareness and perception of direct-to-consumer prescription drug advertising. The agency is seeking comment on a proposed survey of 2,000 healthcare professionals, according to a notice scheduled to appear in the Federal Register (PDF).

Jan 15th: New Symptom Indices Offer No Gain in Ovarian Ca - in Oncology/Hematology, Ovarian Cancer from MedPage Today

Action Points

Explain that two new ovarian cancer symptom indices offered little advantage over the current Goff Index.

Point out that for all three indices, sensitivity was lower for data obtained from the general practitioner's notes and highest for those interviewed over the telephone, ant that the specificity was largely unchanged

"The small differences between the three indices indicate that there is little to gain from deriving new symptom indices," the authors concluded.

"This sobering news follows hard on the heels of a large U.S. randomized trial finding no benefit, and indeed some harm, to women who were screened annually with a transvaginal ultrasound exam and a CA-125 blood test compared with a usual care control group," they wrote, referring to the NIH-sponsored Prostate, Lung, Colon, and Ovary (PLCO) screening program (JAMA 2011; 305:2295-2303).

They said one question the ovarian cancer community needs to answer is where it should focus its efforts: On the time between when a tumor is large enough to cause mild symptoms and when it is large enough to cause symptoms that prompt women to call a physician, or on a better understanding of disease etiology, leading to better prevention and therapy.

"These other research directions remain critical as the search continues for better ways to find ovarian cancer early," they said.

Primary source: Journal of the National Cancer Institute
Source reference:
Lim AWW, et al. "Predictive value of symptoms for ovarian cancer: Comparison of symptoms reported by questionnaire, interview, and general practitioner notes" J Natl Cancer Inst 2012; 104: 1-11.

Additional source: Journal of the National Cancer Institute
Source reference:
Hartge P, Speyer JL. "Finding Ovarian Cancer" J Natl Cancer Inst 2012; DOI: 10.1093/jnci/drj518.

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Medscape: Dermatologic Manifestations of Metastatic Carcinoma of the Skin

"Cutaneous metastasis is a rare occurrence but may be the presenting sign of a primary internal malignancy."

"The most common sources of cutaneous metastases in woman are the breasts (69%), the colon (9%), melanoma (5%), the ovaries (4%), and the lungs (4%). In men, they are the lungs (24%), the colon (19%), melanoma (13%), and the oral cavity (12%)."

The Nature and Timing of Family-Provider Communication in Late-Stage Cancer:abstract

New Articles -- EvidenceUpdates: A phase 3 trial of bevacizumab in ovarian cancer - abstract, reference + professional commentaries

also see linked reference:
Perren TJ, Swart AM, Pfisterer J, et al. A phase 3 trial of bevacizumab in ovarian cancer. N Engl J Med. 2011 Dec 29;365(26):2484-96. (Original) PMID: 22204725

Saturday, January 14, 2012