open access - 4 articles: Shared Decision Making — The Pinnacle of Patient-Centered Care NEJM

Perspective

Goal-Oriented Patient Care — An Alternative Health Outcomes Paradigm

D.B. Reuben and M.E. Tinetti

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Shared Decision Making — The Pinnacle of Patient-Centered Care

M.J. Barry and S. Edgman-Levitan

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• Audio Interview
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Defining “Patient-Centered Medicine”

C.L. Bardes

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What’s the Alternative? The Worldwide Web of Integrative Medicine

R. Srivastava

open access: Shared Decision Making — The Pinnacle of Patient-Centered Care — NEJM

Nothing about me without me.

— Valerie Billingham, Through the Patient's Eyes, Salzburg Seminar Session 356, 1998

"Caring and compassion were once often the only “treatment” available to clinicians. Over time, advances in medical science have provided new options that, although often improving outcomes, have inadvertently distanced physicians from their patients. The result is a health care environment in which patients and their families are often excluded from important discussions and left feeling in the dark about how their problems are being managed and how to navigate the overwhelming array of diagnostic and treatment options available to them..........If we can view the health care experience through the patient's eyes, we will become more responsive to patients' needs and, thereby, better clinicians. Recognition of shared decision making as the pinnacle of patient-centered care is overdue. We will have succeeded in building a truly patient-centered health care system when an informed woman can decide whether to have a screening mammogram and an informed man can consider whether to have a screening prostate-specific–antigen test without their clinicians labeling the decision “wrong” on the basis of different values and preferences.

open access: Goal-Oriented Patient Care — An Alternative Health Outcomes Paradigm — NEJM

"Ultimately, good medicine is about doing right for the patient. For patients with multiple chronic diseases, severe disability, or limited life expectancy, any accounting of how well we're succeeding in providing care must above all consider patients' preferred outcomes."

A phase II trial (AGO 2.11) in platinum-resistant ovarian cancer: a randomized multicenter trial with sunitinib (SU11248) to evaluate dosage, schedule, tolerability, toxicity and effectiveness of a multitargeted receptor tyrosine kinase inhibitor monotherapy

A phase II trial (AGO 2.11) in platinum-resistant ovarian cancer: a randomized multicenter trial with sunitinib (SU11248) to evaluate dosage, schedule, tolerability, toxicity and effectiveness of a multitargeted receptor tyrosine kinase inhibitor monotherapy:

Background:
.....This phase II study was conducted to evaluate sunitinib, an oral antiangiogenic multitargeted tyrosin kinase inhibitor, in this setting.

Material and methods:
The primary end point of this randomized phase II trial was the objective response rate according to RECIST criteria and/or Gynecologic Cancer InterGroup CA125 response criteria to sunitinib in patients with recurrent platinum-resistant ovarian cancer who were pretreated with up to three chemotherapies. A selection design was employed to compare two schedules of sunitinib (arm 1: 50 mg sunitinib daily orally for 28 days followed by 14 days off drug; and arm 2: 37.5 mg sunitinib administered daily continuously).

Results:
Of 73 patients enrolled, 36 patients were randomly allocated to the noncontinuous treatment arm (arm 1) and 37 patients were randomly allocated to the continuous treatment arm (arm 2). The mean age was 58.8 and 58.5 years, respectively. We observed six responders (complete response + partial response) in arm 1 (16.7%) and 2 responders in arm 2 (5.4%). The median progression-free survival (arm 1: 4.8 [2.9–8.1] months; arm 2: 2.9 [2.9–5.1] months) and the median overall survival (arm 1: 13.6 [7.0–23.2] months; arm 2: 13.7 [8.4–25.6] months) revealed no significant difference. Adverse events included fatigue as well as cardiovascular, gastrointestinal and abdominal symptoms, hematologic and hepatic laboratory abnormalities. Pattern and frequency of adverse events revealed no substantial differences between both treatment groups.

Conclusions:
Sunitinib treatment is feasible and moderately active in relapsed platinum-resistant ovarian cancer. The noncontinuous treatment schedule should be chosen for further studies in ovarian cancer.

Risk of serious toxicity in 1181 patients treated in phase I clinical trials of predominantly targeted anticancer drugs: the M. D. Anderson Cancer Center experience

Risk of serious toxicity in 1181 patients treated in phase I clinical trials of predominantly targeted anticancer drugs: the M. D. Anderson Cancer Center experience:

Background:

This study assessed toxicity in advanced cancer patients treated in a phase I clinic that focuses on targeted agents.

Patients and methods:

An analysis of database records of 1181 consecutive patients with advanced cancer who were treated in the phase I program starting 1 January 2006 was carried out.

Results:

All patients were treated on at least 1 of the 82 phase I clinical trials. Overall, 56 trials (68.3%) had only targeted agents, 13 (15.9%) only cytotoxics, and 13 (15.9%) targeted and cytotoxic agents. Rates of grade 3 and 4 toxicity that were at least possibly drug related were 7.1% and 3.2%, respectively, and 5 of the 1181 patients (0.4%) died from toxicity that was at least possibly drug related. The most common grade 3 or more toxic effects were neutropenia, thrombocytopenia, anemia, dehydration, infection, altered mental status, bleeding, vomiting, nausea, and diarrhea. Eastern Cooperative Oncology Group (ECOG) performance status greater than zero and use of a cytotoxic agent were selected as independent factors associated with serious toxicity.

Conclusion:

Phase I trials of primarily targeted agents showed low rates of toxicity, with 10.3% of patients experiencing grade 3 or 4 toxicity and a 0.4% rate of death, at least possibly drug related.

Grants.gov - Opportunity Synopsis - OCRP Ovarian Cancer Academy

The synopsis for this grant opportunity is detailed below, following this paragraph. This synopsis contains all of the updates to this document that have been posted as of 02/27/2012 . If updates have been made to the opportunity synopsis, update information is provided below the synopsis.
If you would like to receive notifications of changes to the grant opportunity click send me change notification emails . The only thing you need to provide for this service is your email address. No other information is requested.

Any inconsistency between the original printed document and the disk or electronic document shall be resolved by giving precedence to the printed document.

Document Type:	Grants Notice
Funding Opportunity Number:	W81XWH-12-OCRP-OCA
Opportunity Category:	Discretionary
Posted Date:	Feb 27, 2012
Creation Date:	Feb 27, 2012
Original Closing Date for Applications:	Jul 18, 2012
Current Closing Date for Applications:	Jul 18, 2012
Archive Date:	Aug 17, 2012
Funding Instrument Type:	Cooperative Agreement Grant
Category of Funding Activity:	Science and Technology and other Research and Development
Category Explanation:
Expected Number of Awards:	2
Estimated Total Program Funding:	$2,400,000
Award Ceiling:
Award Floor:
CFDA Number(s):	12.420 -- Military Medical Research and Development
Cost Sharing or Matching Requirement:	No

Eligible Applicants

Unrestricted (i.e., open to any type of entity above), subject to any clarification in text field entitled "Additional Information on Eligibility" Additional Information on Eligibility:

Agency Name

Dept. of the Army -- USAMRAA

Description

The OCRP Ovarian Cancer Academy, which was initially created in FY09, is intended to be a unique, interactive virtual academy providing intensive mentoring, national networking, and a peer group for junior faculty. The overarching goal of the Ovarian Cancer Academy is to develop successful, highly productive ovarian cancer researchers in a collaborative research training environment. The current Ovarian Cancer Academy is a virtual career development and research training platform consisting of seven Early-Career Investigator/Designated Mentor pairs from different institutions and one Academy Dean. The Academy Dean serves as a resource for the Early-Career Investigators and Mentors, assesses the progress of the Early-Career Investigators, and facilitates communication and collaboration among all of the Early-Career Investigators and Mentors.

Link to Full Announcement

American Institute for Cancer Research (AICR): 2012 Research Conference on Food, Nutrition, Physical Activity and Cancer

2012 AICR Annual Research Conference
on Food, Nutrition, Physical Activity and Cancer

November 1-2 / Washington, DC

About the Conference:

This conference is a unique forum that brings together researchers and clinicians for a two-day program that is dedicated to increasing knowledge, stimulating research and promoting prevention and treatment of cancer through nutrition, physical activity and weight management.

Who Should Attend:

Basic scientists, clinical investigators, epidemiologists, dietitians, nutritionists, policy makers and other health professionals interested in food, nutrition, physical activity and weight management in relation to cancer.

Clinical Oncology News - Study Details Risks for Contralateral Cancer in BRCA1/2

"For years, researchers have known that the risk that a woman will develop CBC is higher than an average woman’s risk for developing a first cancer and that this risk is even greater if the woman carries the BRCA1/2 mutation."


Table. 10-year Risk for Contralateral Breast Cancer: Key Stats



"Dr. Van Poznak said the information in the study would help doctors counsel patients. “The analysis performed in this large database of European women under the age of 50 suggests that risks for contralateral breast cancer within 10 years may be estimated based on age and BRCA1/2 status,” she said.

Ms. van den Broek said that if the results are confirmed in other studies, age criteria and receptor status of the first breast cancers might be included in guidelines for prophylactic measures and screening in the follow-up of BRCA1/2 mutations carriers."

Clinical Oncology News - Applying Clinical Trial Results to ‘Real-World’ Care - Markman/Editorial

"A far less frequently discussed aspect of transitioning trial results into routine care is the realistic potential that when the strategy in question is undertaken by individuals without the same level of clinical expertise, the actual outcome may not be as favorable as the one demonstrated in the investigative setting."

 "Finally, it should be noted that the scenario presented is simply one of many that could have been provided as a word of caution in this important and complex discussion, that has relevance for both individual patients and society at large."

The POWER Study (Project for an Ontario Women's Health Evidence-based Report) Social Determinants of Health and Populations at Risk chapter

The POWER Study (Project for an Ontario Women's Health Evidence-based Report) Social Determinants of Health and Populations at Risk chapter is now available for download. 
 
 Using a community-engaged research model and integrated KT approach, the POWER Study has examined a comprehensive set of evidence-based indicators bridging population health and health system performance. The Women's Health Equity Report is serving as an evidence-based tool for policy makers, providers and consumers in their efforts to improve health and reduce health inequities in Ontario. POWER has examined gender differences in access to care, as well as quality and outcomes of care for the leading causes of morbidity and mortality in the province and how they differ by gender, socioeconomic status, ethnicity, and geography. 
 
The Social Determinants of Health and Populations at Risk chapter examines the social determinants of health among Ontario's women and men including: low income, low education, indicators of employment, lone-parent families, and food insecurity. We also summarize the POWER Study indicators across all chapters as they relate to low-income populations, providing a synthesis of health functional status, risk factors and prevention, access to health care services, clinical management, and health outcomes of lower-income adults. The final section re-examines and synthesizes the POWER Study findings in relation to immigrant and minority populations, as well as reporting three indicators of immigrant women's health that have not previously been reported in the POWER Study. Based on our analyses, identified opportunities to improve health and health care and reduce inequities, together with broad community consultation and dialogue, we developed the POWER Health Equity Road Map. The 
 aim of the Road Map is to help move us forward to the goal of achieving health equity in Ontario. The time to move forward is now. What is needed is the will and commitment.
 
 To download a copy of the full chapter or the highlights document (which outlines the chapter's key findings and messages): http://powerstudy.ca/the-power-report/the-power-report-volume-2/social-determinants-of-health-and-populations-at-risk
 
The French translation of the Social Determinants of Health and Populations at Risk Highlights document will be available on our website soon.
 
Also available for download from www.powerstudy.ca: Introduction to the POWER Study (Ch 1); The POWER Study Framework (Ch 2); Burden of Illness (Ch 3); Cancer (Ch 4); Depression (Ch 5), Cardiovascular Disease (Ch 6), Access to Health Care Services (Ch 7), Musculoskeletal Conditions (Ch 8), Diabetes (Ch 9), Reproductive and Gynaecological Health (Ch 10), HIV Infection (Ch 11), Older Women's Health Report.
 
The POWER Study's concluding chapter 'Achieving Health Equity in Ontario: Opportunities for Intervention and Improvement' is forthcoming and will be available on our website soon. 
 
Arlene S. Bierman, MD, MS
Echo's Ontario Women's Health Council Chair in Women's Health
Lawrence S. Bloomberg Faculty of Nursing, University of Toronto and
Keenan Research Centre in the Li Ka Shing Knowledge Institute, St. Michael's Hospital
30 Bond Street (209 Victoria Street, Room 219)
Toronto, ON  M5B 1W8
Phone:  (416) 864-3041
Fax:    (416) 864-5641
 
Web: www.powerstudy.ca 
 
The POWER Study is funded by Echo: Improving Women's Health in Ontario, an agency of the Ministry of Health and Long-Term Care. This report does not necessarily reflect the views of Echo or the Ministry. 
_______________________________________________

Canadian Scientists Develops World’s Most Advanced Drug to Protect the Brain After a Stroke (PSD95 inhibitor)

“There is hope that this new drug could be used in conjunction with other treatments, such as thrombolytic agents or other means to restore blood flow to the brain, in order to further reduce the impact of stroke on patients,” said Dr. Tymianski. “These findings are extremely exciting and our next step is to confirm these results in a clinical trial.”

abstract: Borderline ovarian tumour: pathological diagnostic dilemma and risk factors for invasive or lethal recurrence : The Lancet Oncology

The Lancet Oncology, Volume 13, Issue 3, Pages e103 - e115, March 2012

doi:10.1016/S1470-2045(11)70288-1

Borderline ovarian tumour: pathological diagnostic dilemma and risk factors for invasive or lethal recurrence

Summary

By comparison with ovarian carcinomas, borderline ovarian tumours are characterised clinically by superior overall survival, even in women with peritoneal spread.

In this Review, we aimed to clarify the histological and clinical factors potentially defining a high-risk group in whom disease is likely to evolve to invasive disease. Invasive peritoneal implants (in serous borderline ovarian tumours) and residual disease after surgery were the two factors clearly identified.

Other factors are controversial owing to increased risk of invasive recurrence: micropapillary patterns in serous borderline ovarian tumour, intraepithelial carcinoma in mucinous lesions, stromal microinvasion in serous lesions, and use of cystectomy in mucinous borderline ovarian tumours.

The pathologist has a pivotal role in assessment of the borderline nature of ovarian tumours and in identification of high-risk criteria, most of which are histological. But, reproducibility of the histological interpretation of some of these potential criteria—eg, classification of peritoneal implants (particularly in desmoplastic subtype), stromal microinvasion, micropapillary patterns, and intraepithelial carcinoma in mucinous borderline ovarian tumours—remains unclear, and should be investigated.

abstract: Inflammatory Pseudotumor: The Great Mimicker

Abstract:

OBJECTIVE. The purpose of this review is to describe the pathophysiologic findings, differential diagnosis, imaging features, and management of inflammatory pseudotumor in various locations throughout the body.

CONCLUSION. Inflammatory pseudotumor is a rare benign process mimicking malignant processes and has been found in almost every organ system. Radiologists should be familiar with this entity as a diagnostic consideration to avoid unnecessary surgery.

( Italy) Hyperthermic Intra-peritoneal Chemotherapy (HIPEC) in Ovarian Cancer Recurrence - Full Text View - ClinicalTrials.gov

Official Title:
Surgery Plus Hyperthermic Intra-peritoneal Chemotherapy (HIPEC) Versus Surgery Alone in Patients With Platinum-sensitive First
Recurrence of Ovarian Cancer: a Prospective Randomized Multicenter Trial

Hyperthermic Intra-peritoneal Chemotherapy (HIPEC) in Ovarian Cancer Recurrence (HORSE)

Purpose

The purpose of this study is to determine the role of surgery followed by hyperthermic intra-peritoneal chemotherapy (HIPEC) versus surgery

alone in patients with platinum-sensitive first recurrence of ovarian cancer. Moreover it is a prospective randomized multicenter trial, aimed

to investigate the prognostic role of surgery plus HIPEC versus surgery alone in terms of progression free interval, overall survival, morbidity

and mortality, second recurrence pattern, quality of life with EORTC QLQ-C30 and QLQ OV28 questionnaires.

This study is currently recruiting participants.

Verified February 2012 by Catholic University of the Sacred Heart

First Received on February 20, 2012. Last Updated on February 28, 2012 History of Changes

Sponsor:	Catholic University of the Sacred Heart
Information provided by (Responsible Party):	Prof. Giovanni Scambia, Catholic University of the Sacred Heart
ClinicalTrials.gov Identifier:	NCT01539785

not yet recruiting: phase 11/BRCA - Veliparib in Treating Patients With Persistent or Recurrent Epithelial Ovarian, Fallopian Tube, or Primary Peritoneal Cancer - Full Text View - ClinicalTrials.gov

Condition:
brca1 Mutation Carrier
brca2 Mutation Carrier
Fallopian Tube Cancer
Ovarian Cancer
Primary Peritoneal Cavity Cancer

Criteria

DISEASE CHARACTERISTICS:

• Patients must have recurrent or persistent epithelial ovarian, fallopian tube, or primary peritoneal carcinoma AND carry a germline mutation in BRCA1 or BRCA2 (confirmation required via Myriad test report); histologic documentation of the original primary tumor is required via the pathology report........

Veliparib in Treating Patients With Persistent or Recurrent Epithelial Ovarian, Fallopian Tube, or Primary Peritoneal Cancer

This study is not yet open for participant recruitment.

Verified February 2012 by National Cancer Institute (NCI)

First Received on February 22, 2012. No Changes Posted

Sponsor:	Gynecologic Oncology Group
Collaborator:	National Cancer Institute (NCI)
Information provided by:	National Cancer Institute (NCI)
ClinicalTrials.gov Identifier:	NCT01540565

Tutorials (2): Genetic Testing Registry (GTR) - YouTube

Tutorials: Genetic Testing Registry (GTR) - YouTube

Confused by genetic tests? NIH's new online tool may help, February 29, 2012 News Release - National Institutes of Health (NIH)

Confused by genetic tests? NIH’s new online tool may help

An online tool launched today by the National Institutes of Health will make it easier to navigate the rapidly changing landscape of genetic tests. The free resource, called the Genetic Testing Registry (GTR), is available at http://www.ncbi.nlm.nih.gov/gtr/

Stopping menopausal hormone therapy: If breast cancer really decreased, why did colorectal cancer not increase? Maturitas "Alternative explanations must be found."

Abstract

Objective

The Women's Health Initiative (WHI) study of postmenopausal hormone therapy (HT) found that estrogen plus progestogen therapy (EPT) decreased colorectal cancer risk. 

Thus, the decline in EPT use from 2002 to 2003 should have precipitated an increase in the incidence of colorectal cancer. We tested this prediction using the SEER 9 epidemiologic database.

Methods

We analyzed WHI data concerning the effects of EPT and estrogen therapy (ET) on colorectal cancer risks. We also examined HT prescription sales data, as well as SEER 9 colorectal cancer incidences from 2001 to 2004.

Results

In the WHI study, the incidence of colorectal cancer was comparable in EPT placebo-users, ET users, and ET placebo-users, but significantly lower in EPT users. Assuming that 30% of eligible women used HT in 2001, the decline in EPT sales from 2002 to 2003 of 63% should have increased the incidence of colorectal cancer by 2.8% in the overall population at risk. However, the SEER 9 colorectal cancer incidence fell by 5.9% in this population, which is comparable to the 6.7% decrease observed for invasive breast cancer from 2002 to 2003.

Conclusions

Declining EPT use from 2002 to 2003 should have precipitated an increase in the incidence of colorectal cancer, but the opposite trend was seen in the SEER 9 database during this time. The incidences of invasive breast cancer and colorectal cancer both declined by a similar amount from 2002 to 2003, despite the results of the WHI study predicting opposing trends for the two different types of cancer. Thus, the SEER 9 findings are fundamentally incompatible with expectations from the WHI findings. This implies that reductions in HT use from 2002 to 2003 cannot account for the contemporaneous changes in invasive breast cancer and colorectal cancer incidences. 

Alternative explanations must be found.

abstract : Hazard ratios in cancer clinical trials - a primer : Nature Reviews Clinical Oncology

Perspectives

Nature Reviews Clinical Oncology 9, 178-183 (March 2012) | doi:10.1038/nrclinonc.2011.217

Hazard ratios in cancer clinical trials—a primer

Abstract

The increase and diversity of clinical trial data has resulted in a greater reliance on statistical analyses to discern value. Assessing differences between two similar survival curves can pose a challenge for those without formal training in statistical interpretation; therefore, there has been an increased reliance on hazard ratios often to the exclusion of more-traditional survival measures. 

However, because a hazard ratio lacks dimensions it can only inform the reader about the reliability and uniformity of the data. It does not provide practitioners with quantitative values they can use, nor does it provide information they can discuss with patients. 

Motivated by a non-scientific poll of oncologists in training and those with board certification that suggested only a limited understanding of the derivation of hazard ratios we undertook this presentation of hazard ratios: a measure of treatment efficacy that is increasingly used and often misused.

Advanced Ovarian Cancer -- A Clinical Context Report - in Clinical Context, Ovarian Cancer from MedPage Today (overview: surgery, treatments, CA125...)

open access: PLoS ONE: Standard Colonic Lavage Alters the Natural State of Mucosal-Associated Microbiota in the Human Colon

Background & Aims

Past studies of the human intestinal microbiota are potentially confounded by the common practice of using bowel-cleansing preparations. We examined if colonic lavage changes the natural state of enteric mucosal-adherent microbes in healthy human subjects.

Conclusion

Standard bowel cleansing preparation altered the mucosal-adherent microbiota in all of our subjects, although the degree of change was variable. These findings underscore the importance of considering the confounding effects of bowel preparation when designing experiments exploring the gut microbiota.

"We recommend that future investigations of the human enteric microbiota include un-prepped subjects in whom the natural state of the colonic microbiota can be preserved and observed. Acquisition of left sided colon samples should not be a major problem, but obtaining right side colonic samples will be more technically demanding; potentially requiring conscious sedation and increasing risk and duration of colonoscopic procedures. Nonetheless, in the hands of an experienced endoscopist, full colonoscopy in un-prepped individuals is feasible. Our group has an 80% success rate reaching the cecum in un-prepped patients.

In summary, we report that the routine practice of colonic lavage may significantly alter the mucosa-associated microbiota of the distal human colon. While the effects are obvious in some individuals, the effects of colonic lavage can be unpredictable. Given that colonic lavage has the potential to distort the enteric microbiota, we recommend that future studies of the human enteric microbiota be performed on the un-prepped colon where the natural state of both luminal and mucosa-associated microbiota is most likely to be retained.

abstract: Priorities for cancer prevention: lifestyle choices versus unavoidable exposures

Priorities for cancer prevention: lifestyle choices versus unavoidable exposures:
Source: The Lancet Oncology

"Although cancer prevention in the USA and other developed countries focuses on disease attributable to lifestyle factors such as smoking, alcohol intake, sun exposure, and obesity, cancer caused by involuntary exposures is a concern. The term environmental is ambiguously used to distinguish between lifestyle and unavoidable exposures. The general community is said to be vulnerable to carcinogens encountered in pollution, contaminated food, and consumer products. In view of these concerns, assessments of the carcinogenicity of particular chemicals are of little assistance in prevention of cancer. Appraisal of cancer attributable to widespread and localised pollution, pesticides, endocrine disrupting chemicals, and consumer products yields diverse outcomes, from established causation to absence of harm. The precautionary principle is not a practicable approach for unknown carcinogenic risks. Procedures for individuals to reduce exposure to recognised or suspect carcinogens in consumer products are not effective measures for cancer prevention. Anxiety concerning insidious cancer causation could divert attention from proven means of cancer prevention."

abstract: Radiation Oncology Quality: Aggressiveness of Cancer Care Near the End of Life

Radiation Oncology Quality: Aggressiveness of Cancer Care Near the End of Life


Purpose
Quality in cancer care is an issue that has come to the forefront over the past decade. Although the American Society of Clinical Oncology has developed extensive quality metrics and goals, such as limiting chemotherapy being provided within the last 14 days of a patient's life, there are no similar quality metrics, and few data, in the field of radiation oncology.


Methods
In this study, morbidity and mortality records from 2008 to 2011 were reviewed for patients at Indiana University who received radiation therapy (RT) within 30 days of death; 63 patients met those criteria.


Results
Analysis showed that 22.2% of patients had Karnofsky Performance Status Scale scores >80, whereas 66.7% of patients had scores < 60. Just over half of patients (52%) were still on treatment at death, and more than half of patients (54%) had completed less than half of their original RT plans. Six patients had their final treatments on the days of their deaths, and another 43 patients had their last treatments within 10 days of death. Forty-eight percent of patients received RT for less than one-fifth of their final month of life and 21% for more than half of their last month alive.


Conclusions
These data are valuable in ongoing discussions of RT use at the end of life, especially as related to hospice underutilization.

abstManagement-changing errors in the recall of radiologic results — A pilot study Clinical Radiology

Management-changing errors in the recall of radiologic results — A pilot study

Aim

To evaluate the occurrence of alterations to diagnostic information from radiological studies, which are altered by person-to-person communication and/or faulty recall, and whether they affect patient management

Materials and methods

A structured telephone survey was conducted at a large tertiary care medical centre of house staff managing inpatients who had undergone chest, abdominal, or pelvic computed tomography (CT) or magnetic resonance imaging (MRI) and remained in the hospital at least 2 days later.  

Fifty-six physicians were surveyed regarding 98 patient cases. Each physician was asked how he or she first became aware of the results of the study. Each was then asked to recall the substance of radiological interpretation and to compare it with the radiology report. Each was then asked to assess the level of difference between the interpretations and whether management was affected. Results were correlated with the route by which interviewees became aware of the report, the report length, and whether the managing service was medical or surgical.

Results

In nearly 15% (14/98) of cases, differences between the recalled and official results were such that patient management could have been (11.2%) or had already been affected (3.1%). There was no significant correlation between errors and either the route of report communication or the report length.

Conclusion

There was a substantial rate of error in the recall and/or transmission of diagnostic radiological information, which was sufficiently severe to affect patient management.

Neoadjuvant chemotherapy, interval debulking surgery or primary surgery in ovarian carcinoma FIGO stage IV? 10.1016/j.ejca.2012.01.031 : European Journal of Cancer

Abstract

Objectives

The aim of this study was to investigate the impact of surgical approach, the extent of surgery and chemotherapy on overall survival in patients with ovarian carcinoma (OC) stage IV.

Methods

We retrospectively collected population-based data from the Norwegian Radium Hospital code registry on the diagnosis and surgery of 238 patients diagnosed with OC stage IV from 1996–2005. All patients received platinum-based chemotherapy. Surgical approach was registered as primary debulking surgery (PDS), interval debulking surgery (IDS) and delayed primary surgery (DPS). Surgery level was classified as radical surgery (RS), standard surgery (SS) or suboptimal surgery (SUBS). Univariate and multivariate analyses identified prognostic factors in PDS, IDS and DPS groups and subgroups.

Results

There were no differences in overall survival between the PDS, IDS and DPS groups. Surgery level was significantly associated with overall survival in the whole cohort (p < 0.001), the PDS and IDS groups, but not in the DPS group. More patients with RS achieved no residual tumour (RT), but overall survival was not superior compared to no RT in the SS group. In 66 patients with no RT there were no differences in overall survival between those who underwent PDS, IDS and DPS. Chemotherapy with platinum/paclitaxel tended to improve survival. RT, World Health Organisation (WHO) performance status and histology were prognostic factors for overall survival in the whole cohort.

Conclusion

No RT remains the objective, whether PDS, IDS or DPS is performed, and no differences in overall survival were found in the three treatment groups.

abstract: (negative trial) Phase II trial of imatinib mesylate in patients with recurrent platinum- and taxane-resistant low-grade serous carcinoma of the ovary, peritoneum, or fallopian tube

Phase II trial of imatinib mesylate in patients with recurrent platinum- and taxane-resistant low-grade serous carcinoma of the ovary, peritoneum, or fallopian tube:

Objective
To evaluate the efficacy and tolerability of imatinib mesylate in patients with recurrent low-grade serous carcinoma (LGSC) of the ovary, peritoneum, or fallopian tube.

Methods
This open-label, single-institution phase II trial enrolled patients with platinum-resistant LGSC who had measurable disease, had received up to 4 platinum- and/or taxane-containing chemotherapy regimens, and had been previously screened for at least one imatinib targeted biomarker (c-kit, platelet-derived growth factor receptor [PDGFR]-β, or bcr-abl). Imatinib (600 mg) was administered daily for one 6-week course and continued in the absence of toxicity and disease progression.

Results
Thirteen patients were enrolled; 12 were evaluable for toxicity, and 11 were evaluable for response. A total of 17 courses were administered (median, 1 course; range, 1–5 courses). Complete or partial responses were not observed. One patient had stable disease for 7.3 months.

c-Kit, bcr-abl, or PDGFR-β were present in 48%, 77%, and 100% of patients, respectively. No correlation between best response (stable disease) and the presence of imatinib-targeted biomarkers was observed.

Adverse events included grade 3 skin rash in one patient leading to discontinuation of the drug, and grade 3 febrile neutropenia and grade 2 weight gain in two patients leading to dose reductions. The most common grade 1 or 2 toxicities were fatigue (66%), nausea/ vomiting (66%), and diarrhea (41%); grade 3 toxicities included skin rash and granulocytopenia events. No grade 4 or 5 toxicities were observed. The median progression-free survival time was 1.3 months (95% CI, 1.27, 1.40 months), and the median overall survival time was 14.9 months (95% CI, 11.0, 18.9 months).

Conclusion
Imatinib is well-tolerated but has no activity in patients with platinum- and taxane-resistant LGSC or the ovary, peritoneum, or fallopian tube.

Highlights

► Low-grade serous carcinoma of the ovary or peritoneum is a unique entity.
► There is a need to develop new therapeutic agents for this rare subtype.
► Imatinib mesylate appears to have no activity in patients with recurrent low-grade serous carcinoma.

open access: BMC Cancer | Abstract | Monitoring physical and psychosocial symptom trajectories in ovarian cancer patients receiving chemotherapy (severe symptoms/loss of QOL/persist beyond treatments....)

Monitoring physical and psychosocial symptom trajectories in ovarian cancer patients receiving chemotherapy

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

BMC Cancer 2012, 12:77 doi:10.1186/1471-2407-12-77
Published: 28 February 2012

Abstract (provisional)

Background

Diagnosis and treatment of ovarian cancer (OC) entail severe symptom burden and a significant loss of quality of life (QOL). Somatic and psychological impairments may persist well beyond active therapy. Although essential for optimal symptom management as well as for the interpretation of treatment outcomes, knowledge on the course of QOL-related issues is scarce. This study aimed at assessing the course of depressive symptoms, anxiety, fatigue and QOL in patients with OC over the course of chemotherapy until early aftercare.

Methods

23 patients were assessed longitudinally (eight time points) with regard to symptom burden (depression, anxiety, fatigue, and QOL) by means of patient-reported outcome instruments (HADS, MFI-20, EORTC QLQ-C30/ -OV28) and clinician ratings (HAMA/D) at each chemotherapy cycle and at the first two aftercare visits.

Results

Statistically significant decrease over time was found for depressive symptoms and anxiety as well as for all fatigue scales. With regard to QOL, results indicated significant increase for 11 of 15 QOL scales, best for Social (effect size = 1.95; p<0.001), Emotional (e.s. = 1.62; p<0.001) and Physical Functioning (e.s. = 1.47; p<0.001). Abdominal Symptoms (e.s. = 1.01; p=0.009) decreased, Attitudes towards Disease and Treatment (e.s. = 1.80; p<0.001) improved significantly over time. Analysis of Sexual Functioning was not possible due to a high percentage of missing responses (61.9%).

Conclusions

The present study underlines the importance of longitudinal assessment of QOL in order to facilitate the identification of symptom burden in OC patients. We found that patients show high levels of fatigue, anxiety and depressive symptoms and severely impaired QOL post-surgery (i.e. at start of chemotherapy) but their condition improves considerably throughout chemotherapy reaching nearly general population symptom levels until aftercare.(Blogger's Note: small study which may or may not apply to our general ovarian cancer women's population)

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

open access (pdf) Familial Cancer: A prospective study of bowel preparation for colonoscopy with polyethylene glycol-electrolyte solution versus sodium phosphate in Ly

Familial Cancer

Original Article

A prospective study of bowel preparation for colonoscopy with polyethylene glycol-electrolyte solution versus sodium phosphate in Lynch syndrome: a randomized trial

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Abstract 

Lynch gene carriers undergo regular surveillance colonoscopies.

Polyethylene glycol-electrolyte solution (PEG) is routinely prescribed for bowel cleansing, but often poorly tolerated by patients. Sodium phosphate (NaP) may be an alternative. (note warnings published within the past several years on sodium phosphate) Prospective and random comparison of bowel preparation with PEG and NaP on colon cleansing and patients’ acceptance.
Patients, who previously underwent a colonoscopy, were invited to participate and randomly assigned to either PEG or NaP. They were asked to fill in a questionnaire about preparation tolerability and future preferences. The endoscopist filled out a report about the quality of colon cleansing. 125 Patients were included in the study. Nine (7%) were excluded because of missing data. The remaining 116 patients (53 PEG and 63 NaP) were included in the analysis. Baseline characteristics did not differ between groups. Before colonoscopy 20 (38%) patients using PEG experienced the preparation almost intolerable, in contrast to 7(11%) of those using NaP (P = 0.001). Eleven patients in the PEG group and 48 in the NaP group would prefer NaP in the future.
The colonoscopy was poorly tolerated in 17% of the individuals in both groups (P = 0.963). The endoscopist observed a more than 75% clean colon in 83% of patients on PEG and in 71% of patients on NaP (P = 0.076), however the coecum (P = 0.025) and ascending colon was cleaner after PEG.
Lynch patients tolerated NaP better and preferred this formula for future bowel preparation. Colon cleansing was suboptimal with both treatments with a tendency towards a cleaner proximal colon with PEG.

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Keywords Lynch syndrome – Colonoscopy – Polyethylene glycol – Sodium phosphate

abstract: Lynch syndrome: clinical, pathological, and genetic insights (prophylactic surgery - female)

Lynch syndrome: clinical, pathological, and genetic insights:

Conclusions
Therefore, taking the risk reduction into account, extended surgery at the time of the first colon primary should at least
be discussed, if not recommended. Also, prophylactic hysterectomy and bilateral oophorectomy at the time of a colorectal primary
should be recommended if family planning has been completed.

Safety Alerts Cite Cholesterol Drugs’ Side Effects - NYTimes.com

Safety Alerts Cite Cholesterol Drugs’ Side Effects - NYTimes.com

abstract: Extrapancreatic Malignancies in Patients With Pancreatic Cancer: Epidemiology and Clinical Consequences

Abstract

Objectives:

To investigate the incidence, characteristics, and prognostic impact of prior extrapancreatic malignancies on patients with pancreatic cancer (PDAC).

Methods:

Records from 1733 patients who underwent surgery for PDAC were analyzed for the occurrence of prior extrapancreatic malignancies. Patients’ records showing extrapancreatic malignancies were then analyzed for tumor type, epidemiological data, risk factors, PDAC tumor stage, and long-term survival.

Results:

A total of 239 patients with PDAC (13.8%) had a history of 271 extrapancreatic tumors; 26 patients had a history of two pancreatic cancers, and 3 patients had 3 extrapancreatic cancers. The most common extrapancreatic tumors were breast cancer (56 patients) and prostate cancer (41 patients), followed by colorectal, reno/urothelial, and gynecologic tumors (39, 32, and 23 patients, respectively). No significant difference in overall survival was found between patients with PDAC with or without extrapancreatic malignancies.

Conclusions:

Pancreatic cancer is associated with extrapancreatic malignancies in a remarkable number of patients. A history of extrapancreatic malignancies does not influence prognosis and should not be an obstacle to a curative therapeutic approach. Surveillance of patients with extrapancreatic malignancies, especially breast, prostate, and colorectal cancer, could allow for earlier PDAC diagnosis and therefore improve prognosis of these patients.

Analysis: Is A New Federal Patient Safety Effort Doing Enough To Curb Medical Errors? - Kaiser Health News

Overdiagnosis as a Flaw in Health Care - NYTimes.com "If You Feel O.K., Maybe You Are O.K."

Physicians Mistakenly Believe That Poor People Sue More Often

"....Their work suggests that this myth may exist because of subconscious prejudices or stereotypes that affect thinking and decision making without doctors being aware of it - a phenomenon known as unconscious bias. Dr. Jimenez and his colleagues' work is published online in Springer's journal, Clinical Orthopaedics and Related Research."

abstract: Intraoperative Hypothermia During Cytoreductive Surgery for Ovarian Cancer and Perioperative Morbidity

hy·po·ther·mi·a

Noun:

The condition of having an abnormally low body temperature, typically one that is dangerously low.

Abstract

OBJECTIVE:

To evaluate intraoperative hypothermia as a predictor for morbidity after open abdominal surgery for ovarian cancer.

METHODS:

This cohort study included 146 women with stage IIIC and IV ovarian cancer who underwent debulking surgery at our institution from January 1, 2001, through December 31, 2003. Hypothermia was defined as end operative temperature lower than 36°C. Early complications (occurring within 30 days of surgery) included: mortality, infectious morbidities, cardiovascular events, venous thromboembolic (VTE) events, anastomotic leak, readmission, and reoperation. Survival was also evaluated. Logistic regression models were used to adjust for known confounders.

RESULTS:

The mean age was 63.9±11.7 years; 46 (32%) patients had a body mass index higher than 30; mean operative time was 239±85 minutes. There were five deaths perioperatively, all in the hypothermic group. Hypothermia was associated with an increased risk of any early complications (34 [42.0%] compared with 11 [16.9%]) with an adjusted odds ratio (OR) of 3.40 (95% confidence interval [CI] 1.48–8.33). For individual complications, hypothermic patients were at higher risk for VTE events with an adjusted OR of 3.53 (95% CI 1.02–16.44); infectious morbidity with an adjusted OR of 2.99 (95% CI 0.97–11.35); and reoperation with an adjusted OR of 4.96 (95% CI 0.80–95.7). The overall survival was shorter in hypothermic group with a median of 34 compared with 45 months (P=.045); this remained significant for an optimally resected subgroup with a median overall survival of 40 compared with 48 months (P=.049).

CONCLUSION:

Surgical hypothermia is an independent predictor of early perioperative complications and overall survival after cytoreductive surgery for ovarian cancer. This is a critically important finding, because maintaining normothermia is an inexpensive modifiable factor, which could result in reduced morbidity.

LEVEL OF EVIDENCE: II

abstract: A review of community engagement in cancer control studies among Indigenous people of Australia, New Zealand, Canada and the USA

A review of community engagement in cancer control studies among Indigenous people of Australia, New Zealand, Canada and the USA:

(2012) European Journal of Cancer Care

A review of community engagement in cancer control studies among Indigenous people of Australia, New Zealand, Canada and the USA

This review aimed to address studies of cancer control in Indigenous populations, with a focus on: (1) the nature and extent of community engagement; and (2) the extent to which community engagement has facilitated successful outcomes. Articles addressing Indigenous cancer control using some degree of community engagement were identified by a search of the following electronic databases: MEDLINE (via Ovid and Pubmed), psycINFO, CINAHL and Google Scholar. Relevant studies were scored and analysed according to Green et al.'s guidelines for participatory research. Studies often engaged the community only minimally. Where studies resulted in successful outcomes, they tended to have included Indigenous community members in genuine research roles, from planning, to implementation, to presentation of results at conferences. Studies with positive health outcomes were often initiated by a combination of academic researchers and community members or organisations. This narrative review highlighted significant scope for improvement in community-based studies addressing Indigenous cancer control. Increased attention to the philosophical underpinnings of community engagement is required to ensure that the benefits of this approach are translated to achieve improved cancer control outcomes. An increased awareness of the benefits of community engagement may prove effective in conducting cancer control research that leads to improved outcomes in Indigenous communities.

abstract: Accuracy of Frozen-Section Diagnosis of Ovarian Mucinous Tumors

Conclusions:
The sensitivity of frozen-section diagnosis of LMP and malignant mucinous tumors was low. The inaccuracy of a frozen-section diagnosis of ovarian mucinous tumors may be related to a tumor size of greater than 13 cm. Increasing the number of intraoperative samples over 3 sections per case may not effectively increase the accuracy of frozen-section diagnosis in mucinous tumors.

abstract: Antiangiogenic Agents in Combination With Chemotherapy for the Treatment of Epithelial Ovarian Cancer

Feb 27th: PET Report | TRIUMF : Canada's National Laboratory for Particle and Nuclear Physics (PET/CT scans)

"There is a human element to be considered in determining the value of a PET scan: The present report identifies numerous healthcare policies and provides considerable statistical information to describe the impact of PET imaging on cancer treatment. But it is also important to note that the impact of any healthcare policy goes beyond statistics to have a direct impact on individual patients and their families."

 
PET Report

The Use of Positron Emission Tomography (PET) for Cancer Across Canada: Time for a National Strategy

On Monday, February 27, 2012, TRIUMF/AAPS released a report surveying the utilization of PET imaging technolgoy for clincial care of cancer across Canada. The full report is available here in PDF format (about 3 MB). Susan Martinuk's briefing slides are available here. Helen Branswell's coverage on CTV.ca via the Canadian Press Pamela Fayerman's coverage in the Vancouver Sun

Cancer is a growing challenge to Canadians and an increasing burden on healthcare budgets. A ground-breaking report released today suggests that access to, and utilization of, leading-edge medical-imaging technology for the diagnosis, staging, and monitoring of cancer treatment varies widely from province to province, putting cancer patients in some areas at a distinct disadvantage.
The technology, called Positron Emission Tomography, is often coupled with Computerized Tomography (CT) and is known as PET/CT imaging. PET imaging is already widely used and integral to cancer care in most developed nations, and increased utilization of this technology could provide more clinically-effective and cost-effective treatment for cancer patients in Canada. A nationally coordinated strategy to take up this technology and standardize its use could bring Canada back to the forefront of global cancer care.

"Canada conducted 42,620 scans in 2009; 22,400 (51%) of those were carried out in the province of Quebec."

(PDF) Table of Contents

1.0 Summary of Key Findings....................................................................................................3
2.0 Preface ................................................................................................................................7
3.0 Executive Summary............................................................................................................11
4.0 Introduction to Positron Emission Tomography (PET)........................................................23
5.0 Clinical Effectiveness of PET Imaging in Oncology............................................................33
6.0 Cost Effectiveness..............................................................................................................43
7.0 Status of PET Imaging in Canada.......................................................................................47
8.0 Status of PET Imaging in British Columbia.......................................................................61
9.0 Status of PET Imaging in Alberta.......................................................................................69
10.0 Status of PET Imaging in Saskatchewan...........................................................................77
11.0 Status of PET Imaging in Manitoba....................................................................................83
12.0 Status of PET Imaging in Ontario.......................................................................................89
13.0 Status of PET Imaging in Quebec..................................................................................... 103
14.0 Status of PET Imaging in Nova Scotia ............................................................................. 113
15.0 Status of PET Imaging in New Brunswick....................................................................... 119
16.0 Status of PET Imaging in Prince Edward Island.............................................................. 125
17.0 Status of PET Imaging in Newfoundland......................................................................... 131

18.0 Findings: An Opportunity to Improve the Cancer Care of Canadians............................. 137

19.0 Conclusions: Time for a National Strategy...................................................................... 149

(HIPEC) Targeted treatment for ovarian cancer to be studied at University Hospitals (this spring) | cleveland.com

"The studies, which physicians hope to begin this spring, have been designed for a very specific patient population -- no more than a couple dozen women with ovarian or endometrial cancer will be enrolled in each one....."

"Here are the Phase 1 trials:

• A study involving the use of heated chemotherapy for ovarian cancer that has spread to the chest. What the surgical team has dubbed HITEC (the "T" coming from the word intrathoracic) is performed after minimally invasive lung surgery. "To my knowledge, no one has treated ovarian cancer [that has spread to] the chest like this," DeBernardo said.

• A study for advanced ovarian-cancer patients whose cancer is in remission following surgery and chemotherapy. The patients will undergo HIPEC to prevent recurrence.

• A study for patients whose cancer recurs; HIPEC will be performed following surgery.

• A study for patients who undergo chemotherapy prior to (neoadjuvant) surgery and HIPEC during the surgery.

index: Current Issue : International Journal of Gynecological Cancer

index - Current Issue : International Journal of Gynecological Cancer

abstract: Treatment of Ovarian Cancer in Young Women : Clinical Obstetrics and Gynecology

Clinical Obstetrics & Gynecology:

March 2012 - Volume 55 - Issue 1 - p 65–74

doi: 10.1097/GRF.0b013e318248045b

Ovarian Cancer

Treatment of Ovarian Cancer in Young Women

GERSHENSON, DAVID M. MD

Abstract

Ovarian cancer accounts for approximately 22,000 cases annually in the United States. 

Although the vast majority of ovarian cancers occur in postmenopausal women and are of advanced stage, a significant subset occurs in young women. 

Among those subtypes having a predisposition for young women are malignant ovarian germ cell tumors, sex cord-stromal ovarian tumors, and tumors of low malignant potential. 

However, invasive epithelial ovarian cancers may also occur in young women, particularly the subtypes of low-grade serous carcinoma and mucinous carcinoma. This article details the diagnosis and optimal treatment of ovarian cancers subtypes in young women.

Canada - OxyContin delisting not the answer to opioid addiction, experts say - media

OxyContin delisting is not the answer - media

"The decision by some provinces to remove public funding for OxyContin and its newer harder-to-abuse formulation, OxyNEO, is being cast by many politicians and health professionals as a significant victory in the battle against the scourge of painkiller addictions.
If it were only that simple....."

"OxyNEO will be available for those who had existing prescriptions for the old drug and for cancer and palliative-care patients.
Yet, even if provincial plans won’t cover Purdue’s notorious product, individuals whose private insurance covers the drugs will still be able to get them...."

Press Release -grant award "SQUID Imaging for Detection of Early Stage Ovarian Cancer"

ALBUQUERQUE, N.M.--(BUSINESS WIRE)--

"The National Foundation for Cancer Research has awarded a grant to Dr. Robert C. Bast, Jr. of The University of Texas MD Anderson Cancer Center to work with Senior Scientific LLC, a company owned by Manhattan Scientifics (OTCBB: MHTX), to apply Senior Scientifics’ technology to the early detection of ovarian cancer.

Senior Scientific has pioneered a novel technology using special magnetic sensors and magnetic nanoparticles for a highly sensitive and very specific approach to cancer detection.

The new grant, entitled “SQUID Imaging for Detection of Early Stage Ovarian Cancer,” will augment Dr. Bast’s ongoing program at The University of Texas MD Anderson Cancer Center with this emerging technology. Dr. Bast is a world leader in the early detection of ovarian cancer and was responsible for the discovery of the most accurate marker for this disease, CA-125......."

U.S. News & Events - National Institutes of Health (NIH)

NIH Highlights & Headlines

Weekly media tip sheet of health research, discoveries, and science

Dateline: Monday, February 27, 2012

Information below is designed for credentialed journalists and under embargo per the date on each item. Item dates are as accurate as possible as of today.

Coming this week:

Monday, 2/27 – Information about an NIH collaboration to examine the repurposing of known medications

Wednesday, 2/29 – A statement from the National Eye Institute on Rare Disease Day

Wednesday, 2/29 – NIH introduces database of genetic tests

Thursday, 3/1 – An update on the GuLF STUDY: over 10,000 participants enrolled

More news and events: www.nih.gov/news/

Colon cancer screening news coverage all over the map & readers are probably lost - Health News Review (includes professional commentaries)

Observational study miscommunication of the week: citrus & 'women's) stroke (risk) - HealthnewsReview.org

A spin around the Web today will give you many stories about citrus fruits and women’s stroke risk.

HealthNewsReview.org analyzes HealthDay story on mammography study

Canadian Doctors for Medicare: Neat, Plausible and Wrong: The Myth of Health Care Unsustainability

Neat, Plausible and Wrong: The Myth of Health Care Unsustainability

The “Sustainability” Myth The assertion that Medicare is “unsustainable” has been repeated so many times[1] that in some circles it has become accepted as indisputable fact. Critics[2] of...
[+] Read full story

JCO: Are Hematopoietic Colony-Stimulating Factors Over- or Underused?

Are Hematopoietic Colony-Stimulating Factors
Over- or Underused?

"Since their introduction, there has been debate about the benefits,
risks, and costs of hematopoietic colony-stimulating factors
(CSFs). We suggest that the use of CSFs to allow dose maintenance of
chemotherapy for common metastatic solid tumors is unsupported
by evidence, and we should reconsider using a $3,500-per-cycle injection
for a supportive care drug without major benefit......."

Comments and Controversies -

  A Way Forward on the Medically Appropriate Use of White Cell Growth Factors

 JCO published online on February 27, 2012; DOI:10.1200/JCO.2011.39.9980.

[PDF]

Table 1. Comparison of Major Guidelines 

 

How Did We Arrive at Widespread Use Without
Clinical Trial Justification?

 

The Way Forward to Evidence-Based Use of CSFs

"Increased concern about escalating costs 46-48 should cause us to
examine each component of current care. Oncology professional societies have demanded some demonstrable improvement in an important outcome before adoption of a new technology.49 The lack of
proven benefit from CSFs in support of therapy in common advanced
solid tumors, the high cost, the disparate US and world use patterns
with no difference in mortality, 50 and the potential for or appearance
of economic self-interest should give the oncology community pause.
There are concrete steps the US oncology community can take to
foster more evidence-based care. The Quality Oncology Practice Initiative 51 could add overuse as a quality criterion 52 and report CSF use in palliative-intent regimens when there is less than a 20% risk of FN. The major guideline groups (European Organisation for Research and Treatment of Cancer,6 National Comprehensive Cancer Network,5
and ASCO4) should endorse dose modification as an equally appropriate and preferred strategy in the absence of proven benefit."

 

 

JCO: Neuropsychological Performance in Survivors of Breast Cancer More Than 20 Years After Adjuvant Chemotherapy (chemobrain)

Breast Cancer Neuropsychological Performance in Survivors of Breast Cancer More Than 20 Years After Adjuvant Chemotherapy
JCO published online on February 27, 2012; DOI:10.1200/JCO.2011.37.0189.

• [Abstract]
• [PDF]

open access: Correspondence Breast Cancer Risk for Noncarriers of Family-Specific BRCA1 and BRCA2 Mutations: More Trouble With Phenocopies

Correspondence:  Breast Cancer Risk for Noncarriers of Family-Specific BRCA1 and BRCA2 Mutations: More Trouble With Phenocopies

• D. Gareth Evans and
• Anthony Howell

JCO published online on February 27, 2012; DOI:10.1200/JCO.2011.40.8021.

• [PDF]

A giant 'little step' in cancer treatment opening up new therapeutic horizons - (rechallenging with drugs which in the past did not work)

“The novelty factor does not lie in the combination itself, but in the combination of two drugs that had already been administered in the past and had each failed,” explained Dr Javier Cortés, the Head of the Breast Cancer Programme at the VHIO and main author of this work. This not only offers new alternatives for patients with advanced tumours –the most important aspect – but also opens up a parallel dimension of new therapeutic options to the existing treatments, given that it offers numerous combinations between existing pharmacological treatments that not only boost each other but also counteract patients’ resistance to them. “The study focused on HER2 positive breast cancer, although the concept could be applied to the treatment of other tumours”, continued Dr Cortés."

a FYI - Ovarian Cancer and Us blog - other stats

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a FYI: top 5 most read articles this month Ovarian Cancer and Us blog

Cancer Drug Monographs - Gynecologic Cancer Resource

Results of post-operative abdomino-pelvic radiotherapy

open access: Participatory Medicine: Must You Be Rich

Rexall Recalls Calcium Vitamin Softgels Lot On Undclared shellfish

open access: Peripheral Neuropathy In Ovarian Cancer (Dr Yi Pan)

Commentary: Primary care and diagnosis of cancer : The Lancet Oncology

Commentary: Primary care and diagnosis of cancer : The Lancet Oncology

open access: JTM - Absolute lymphocyte count is associated with survival in ovarian (SEROUS) cancer independent of tumor-infiltrating lymphocytes

  lymphocytesplural of lym·pho·cyte

Noun:

A form of small leukocyte (white blood cell) with a single round nucleus, occurring esp. in the lymphatic system.

 Abstract (provisional)

Background

The immune system strongly influences outcome in patients with ovarian cancer. In particular, the absolute lymphocyte count in peripheral blood (ALC) and the presence of tumor-infiltrating lymphocytes (TIL) have each been associated with favourable prognosis. However, the mechanistic relationships between ALC, TIL and prognosis are poorly understood. We hypothesized that high ALC values might be associated with stronger tumor immunity as manifested by increased TIL, decreased tumor burden and longer survival.

Conclusions

Patients with high intrinsic ALC values show no clinical or survival advantage upon subsequent development of HGSC. ALC values at diagnosis are prognostic due to an association with disease burden rather than TIL. Therapeutic enhancement of ALC may be necessary but not sufficient to improve survival in HGSC. 

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

Consumer Updates - Helping Rare Disease Patients Find Their Voice

New study reveals increasing nurse-to-patient ratios do not extend patient safety

http://tinyurl.com/7os7xze

On not reinventing the wheel : Nature Genetics : Nature Publishing Group

On not reinventing the wheel : Nature Genetics : Nature Publishing Group

abstract: Surveillance for hereditary cancer: Does the benefit outweigh the psychological burden?—A systematic review

Surveillance for hereditary cancer: Does the benefit outweigh the psychological burden?—A systematic review


Individuals at risk for developing hereditary cancer are offered surveillance in order to improve the prognosis. An important question is whether the benefit of surveillance outweighs the psychological burden. In this review, we evaluated all studies that investigated psychological distress and the quality of life in individuals under surveillance for hereditary cancer of the breast, ovarian, prostate, pancreas, colorectum, melanoma, and various rare syndromes such as familial adenomatous polyposis, Li–Fraumeni and Peutz–Jeghers syndrome.Thirty-two studies were identified. Surveillance for most hereditary cancers was associated with good psychological outcomes. However, surveillance of individuals at high risk for developing multiple tumors appeared to be associated with increased distress and a lower quality of life. Common factors associated with worse psychological outcomes included a personal history of cancer, female gender, having a first degree relative with cancer, negative illness perceptions and coping style. The use of a simple screening tool to identify distressed individuals is recommended.

abstract: Patients and staff perceptions of cancer patients' quality of life

Patients and staff perceptions of cancer patients' quality of life


Background
Discrepancies exist in estimation of quality of life (QL) by patients and caregivers but underlying factors are incompletely characterised.

Methods
QL of 153 patients was estimated by themselves, by 70 nurses and by 53 physicians in a cross-sectional study. Variables which could influence inter-rater agreement were evaluated.

Results
Inter-rater agreement of QL was fair (r = .292) between patients and nurses and between patients and physicians (r = .154). Inter-rater agreement with nurses was significantly lower concerning fatigue and pain for patients with a Karnofsky Index <50 when compared to patients with a KI >50. Their inter-rater agreement with physicians was significantly lower for fatigue, pain and physical functioning. Agreement on the degree of anxiety was significantly (p = .009) better for female patients. Agreement on the need for social assistance (p = .01) and physical functioning (p = .03) was significantly better for male patients. Agreement with patients on their physical functioning was significantly (p = .03) better for male nurses and male physicians (r = .944) than for female nurses and female physicians (r = .674).

Conclusions
Our study showed that estimation of overall QL of patients by professional caregivers is inaccurate. Inter-rater agreement was influenced by KI of patients, by gender of patients and caregivers and by professional experience of nurses.

Endodermal sinus tumor (yolk sac/germ cell tumor) of the ovary in an 86 year old woman - Gynecologic Oncology Case Reports | ScienceDirect.com