Mayo Clinic, Assured Diagnosis Inc. Announce Two New Private Health Insurance Products for Canadians

 Blogger's Note: the press release seems not quite ready for uploading (9:23 am); try later...

Mayo Clinic, Assured Diagnosis Inc. Announce Two New Private Health Insurance Products for Canadians:

ROCHESTER, MN, and CALGARY, April 16, 2012 /PRNewswire/ - Mayo Clinic and Assured Diagnosis Inc. (ADI) of Calgary, Alberta, announced today the launch of two new health insurance options that will provide more Canadians access to Mayo Clinic's expertise and care in the event of...

open access: G-I-N: Guidelines International Network: Toward International Standards for Clinical Practice Guidelines

 Blogger's Note: this is not specific to ovarian cancer but to guideline development in general (all on the same page, so to speak) hoping that patient care is reflected in a global environment for best care; would be helpful information for patient advocates

Guidelines International Network: Toward International Standards forClinical Practice Guidelines

Guideline development processes vary substantially, and many guidelines do not meet basic quality criteria. Standards for guideline development can help organizations ensure that recommendations are evidence-based and can help users identify high-quality guidelines. Such organizations as the U.S. Institute of Medicine and the United Kingdom's National Institute for Health and Clinical Excellence have developed recommendations to define trustworthy guidelines within their locales. Many groups charged with guideline development find the lengthy list of standards developed by such organizations to be aspirational but infeasible to follow in entirety.
Founded in 2002, the Guidelines International Network (G-I-N) is a network of guideline developers that includes 93 organizations and 89 individual members representing 46 countries. The G-I-N board of trustees recognized the importance of guideline development processes that are both rigorous and feasible even for modestly funded groups to implement and initiated an effort toward consensus about minimum standards for high-quality guidelines. In contrast to other existing standards for guideline development at national or local levels, the key components proposed by G-I-N will represent the consensus of an international, multidisciplinary group of active guideline developers.
This article presents G-I-N's proposed set of key components for guideline development. These key components address panel composition, decision-making process, conflicts of interest, guideline objective, development methods, evidence review, basis of recommendations, ratings of evidence and recommendations, guideline review, updating processes, and funding. It is hoped that this article promotes discussion and eventual agreement on a set of international standards for guideline development.

Obesity and cancer outcome : The Lancet

Obesity and cancer outcome : The Lancet

Obesity and cancer outcome

The Lancet

 

12 million Americans are cancer survivors and a staggering two-thirds of Americans are currently considered overweight or obese. On April 3, the National Cancer Policy Forum of the US Institute of Medicine released a welcome report entitled The Role of Obesity in Cancer Survival and Recurrence. Many epidemiological studies have identified obesity as a factor in cancer risk and prognosis. Obesity is associated with higher cancer incidence, recurrence, progression, and death. The report emphasises how little is still known about the precise cellular mechanisms that link obesity with cancer.

Adipose tissue can behave as an endocrine organ by generating hormones, growth factors, and cytokines that can disrupt regulation of cell growth and survival—the hallmark of malignancy. Knowing the precise cellular targets involved in this interplay could lead to targeted therapeutic approaches for controlling both cancer and obesity. For example, appropriate animal models could allow investigation of mechanisms of obesity and diabetes in precise genetic models of human cancers.

What is not yet known is whether weight management changes the prognosis and outcome in different cancers. The simple solution of tracking individuals' BMI and bodyweight during clinical trials to analyse effect on cancer outcomes needs to become standard practice. Another area of clinical controversy is related to proper chemotherapy dosing in obese cancer patients. Total body-surface area is used to calculate the chemotherapy dose, which does not take into account the body's composition (such as an individual's fat percentage). This approach often leads to suboptimum doses of chemotherapy.

But the most important lesson of this report comes from the basic science of obesity-associated cancer risk. Our population-level responses—which have largely failed—are based on a far too simplistic understanding of how obesity contributes to cancer. To address this challenge demands not more poorly thought out intervention trials. 

 Instead, we need greater understanding of the biological mechanisms underpinning cancer and obesity.

Genetic Variations in Stem Cell-Related Genes and Colorectal Cancer Prognosis

Genetic Variations in Stem Cell-Related Genes and Colorectal Cancer Prognosis:

Abstract

Background  

Many properties of cancer cells are reminiscent of those in normal stem cells. Genes important to stem cell development have been significantly implicated in the etiology and clinical outcome of colorectal cancer (CRC). However, the associations of genetic variations in these genes with CRC prognosis have not yet been elucidated.

Methods  

We analyzed the effects of eight potentially functional single nucleotide polymorphisms (SNPs) in six stem cell-related genes on the prognosis of a well-characterized population of 380 Chinese CRC patients diagnosed from February 2006 to January 2010.

Results 

The most significant finding was related to rs879882, a variant in the 5′ region of POU5F1 gene which encodes a protein essential for embryonic stem cell self-renewal and pluripotency, and induced pluripotent stem cell reprogramming. The variant-containing genotypes of rs879882 were associated with an increased risk of recurrence (hazard ratio [HR] = 2.10, 95 % confidence interval [CI] 1.17–3.76, P = 0.01). In chemotherapy-stratified analysis, the association remained borderline significant in patients receiving chemotherapy (HR = 1.97, 95 % CI 0.89–4.34, P = 0.09). In addition, a nonsynonymous SNP of APC gene was also significantly associated with recurrence risk in chemotherapy-treated patients (HR = 2.63, 95 % CI 1.14–6.06 P = 0.02). Further analyses showed a combined effect of the two SNPs in predicting CRC recurrence in patients receiving chemotherapy (P = 0.04) but not in those without chemotherapy (P = 0.43). Moreover, an exploratory multivariate assessment model indicated that these two variants enhanced the power to predict recurrence after chemotherapy.

Conclusion 

We presented one of the first epidemiologic studies showing that stem cell-related genetic variants may impact CRC clinical outcomes, especially in chemotherapy-treated patients.

• Journal Journal of Gastrointestinal Cancer

REPOST: Lilly Oncology On Canvas | 2012 Competition DEADLINE aPR 30TH

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Pharmaceutical drug shortages in Canada (website update to Apr 13th)

SDIS

abstract: Therapy-related myelodysplasia and acute myeloid leukemia following paclitaxel- and carboplatin-based chemotherapy in an ovarian cancer patient: a case report and literature review

 Blogger's Note: treatment-related secondary leukemia is a known adverse effect and previously reported in ovarian cancer; data shows risk ~1-5%; as in all treatment modalities,  it is a risk vs benefit decision; this abstract is dated 2008 but a timely reminder

                                          ~~~~~~~~~~~~~~~~
Therapy-related myelodysplasia and acute myeloid leukemia following paclitaxel- and carboplatin-based chemotherapy in an ovarian cancer patient: a case report and literature review:

Abstract

Alkylating agents have strong leukemogenic potential. There are a number of recent acute myeloid leukemia (t-AML) cases related to previous paclitaxel exposure. These leukemias tend to be of aggressive subtypes with long-latency periods. Unlike previously reported cases, the present case was of the secondary acute megakaryoblastic myeloid leukemia (AML M7) subtype. Additionally, it did not harbor a translocation in chromosome 19. A 73-year-old woman was diagnosed with t-AML M7 with antecedent myelodysplasia. Leukemia followed a second induction of paclitaxel- and carboplatin-based chemotherapy for recurrent ovarian cancer. Her second induction began 25 months after completion of her first course of chemotherapy. The increased incidence of postpaclitaxel leukemia suggests a probable role for paclitaxel as a leukemogenic agent. It highlights the importance of assessing for leukemia risk factors prior to beginning paclitaxel therapy.

Serous borderline ovarian tumors in long-term culture: phenotypic and genotypic distinction from invasive ovarian carcinomas

Serous borderline ovarian tumors in long-term culture: phenotypic and genotypic distinction from invasive ovarian carcinomas:

Abstract

Serous borderline ovarian tumors (SBOTs) are differentiated, slow growing, noninvasive, and have a better prognosis than their invasive counterparts, but recurrence and progression to invasive carcinomas are common, and unlike high-grade serous carcinomas, they tend to be nonresponsive to chemotherapy. However, due to a lack of culture systems and animal models, information about the properties of SBOT and their changes with neoplastic progression is extremely limited. Our objective was to establish a cell culture model for SBOTs and to characterize their phenotype and genotype..............In conclusion, we have established the first permanent SBOT cell line, which provides a new model to elucidate the undefined relationship of SBOTs to invasive ovarian carcinomas.

A snapshot of microarray-generated gene expression signatures associated with ovarian carcinoma

A snapshot of microarray-generated gene expression signatures associated with ovarian carcinoma:

Abstract

It was hypothesized that analysis of global gene expression in ovarian carcinoma can identify dysregulated genes that can serve as molecular markers and provide further insight into carcinogenesis and provide the basis for development of new diagnostic tools as well as new targeted therapy protocols................From these genes, merely three were identified in at least two different studies. This snapshot of available gene expression data not only provides independently described potential diagnostic and therapeutic targets for ovarian carcinoma but also emphasizes the drawbacks of the current state of global gene expression analyses in ovarian cancer.

abstract: Validation of an Algorithm for the Diagnosis of Serous Tubal Intraepithelial Carcinoma.

Validation of an Algorithm for the Diagnosis of Serous Tubal Intraepithelial Carcinoma

Abstract

It has been reported that the diagnosis of serous tubal intraepithelial carcinoma (STIC) is not optimally reproducible on the basis of only histologic assessment. Recently, we reported that the use of a diagnostic algorithm that combines histologic features and coordinate immunohistochemical expression of p53 and Ki-67 substantially improves reproducibility of the diagnosis. The goal of the current study was to validate this algorithm by testing a group of 6 gynecologic pathologists who had not participated in the development of the algorithm (3 faculty and 3 fellows) but who were trained in its use by referring to a website designed for the purpose. They then reviewed a set of microscopic slides, which contained 41 mucosal lesions of the fallopian tube. Overall consensus (≥4 of 6 pathologists) for the 4 categories of STIC, serous tubal intraepithelial lesion (our atypical intermediate category), p53 signature, and normal/reactive was achieved in 76% of the lesions, with no consensus in 24%. Combining diagnoses into 2 categories (STIC versus non-STIC) resulted in an overall consensus of 93% and no consensus in 7%. The κ value for STIC versus non-STIC among all 6 observers was also high at 0.67 and did not significantly differ, whether for faculty (κ=0.66) or fellows (κ=0.60). These findings confirm the reproducibility of this algorithm by a group of gynecologic pathologists who were trained on a website for that purpose. Accordingly, we recommend its use in research studies. Before applying it to routine clinical practice, the algorithm should be evaluated by general surgical pathologists in a community setting.

Teeny Tiny Kitten

video: Teeny Tiny Kitten

abstract: Endometriosis does not confer improved prognosis in ovarian carcinoma of uniform cell type.

Endometriosis does not confer improved prognosis in ovarian carcinoma of uniform cell type [Am J Surg Pathol. 2012]

Abstract

The role of endometriosis in ovarian cancer, disease progression, and survival is a subject of active investigation. A series of 144 ovarian cancers with clear cell or endometrioid histology or associated endometriosis, all classified on the basis of strict histologic criteria, was evaluated to further explore the relationship between endometriosis-associated ovarian cancer and age at presentation, FIGO stage, histology, presence of synchronous primary disease elsewhere in the mullerian tract, and survival.

Patients with endometrioid carcinomas were significantly younger (mean, 52 y) in comparison with patients with either clear cell carcinoma (mean, 55 y) or mixed tumors (mean, 59 y; P=0.002).

Clear cell carcinoma presented as low-stage disease (FIGO I) in 33% of cases compared with endometrioid carcinomas in 97% of cases and mixed carcinomas in 27% of cases. Endometriosis was associated with 53% of clear cell carcinomas, 33% of endometrioid carcinomas, and 45% of mixed tumors (P<0.001). Synchronous primary tumors, observed in 31% of endometrioid tumors, 5% of mixed tumors, and in 2% of clear cell tumors (P<0.001), were unlikely to be associated with endometriosis (P=0.04). Univariate analysis of the aggregate cohort demonstrated that the single best overall predictor of disease-free survival was FIGO stage at presentation (P<0.001), followed by histologic subtype (P=0.003).

Endometriosis did not have a significant relationship with disease-free survival (P=0.7). We conclude that the link between endometriosis and ovarian cancer is much stronger for clear cell carcinoma than for other histologic subtypes (P<0.001). Furthermore, when uniform histologic criteria are applied, true mixed endometrioid and clear cell carcinomas are uncommon; most endometriosis-associated mixed tumors are heterogenous mixtures of endometrioid, mucinous, and serous histology with areas of clear cell cytoplasm. Endometriosis per se does not appear to predict prognosis in clear cell and endometrioid tumors, with the possible exception of tumors with mixed histology. Until more data are collected, pathologists should classify ovarian tumors with mixed histology as a separate and potentially unique biological and prognostic group.

open access: Survivorship care plans in research and practice - Apr 2012 - CA: A Cancer Journal for Clinicians

 Blogger's Note: while the focus here is breast/colorectal cancers, research background included gyn cancer

Survivorship care plans in research and practice -  2012 - CA: A Cancer Journal for Clinicians 

 Abstract

The Institute of Medicine (IOM) recommends the use of survivorship care plans (SCPs) for all cancer survivors. Developing useful SCPs requires understanding what survivors and their providers need and how SCPs can be implemented in practice. Published studies investigating the perspectives of stakeholders (survivors, primary care providers, and oncology providers) were reviewed regarding the content and use of SCPs. All National Cancer Institute (NCI)-designated cancer centers were surveyed concerning the extent to which SCPs for survivors of breast and colorectal cancers are in use, their concordance with the IOM's recommendation, and details about SCP delivery. Survivors and primary care providers typically lack the information the IOM suggested should be included in SCPs. Oncology providers view SCPs favorably but express concerns about the feasibility of their implementation. Fewer than one-half (43%) of NCI-designated cancer centers deliver SCPs to their breast or colorectal cancer survivors. Of those that do, none deliver SCPs that include all components recommended by the IOM. Survivors' and providers' opinions about the use of SCPs are favorable, but there are barriers to implementation. SCPs are not widely used in NCI-designated cancer centers. Variation in practice is substantial, and many components recommended by the IOM framework are rarely included. 
                                          

abstract: Researchers find discordance between standard human epidermal growth factor receptor 2 (HER2) testing and HER2 status reported on Oncotype DX - CA: A Cancer Journal for Clinicians

Researchers find discordance between standard human epidermal growth factor receptor 2 (HER2) testing and HER2 status reported on Oncotype DX -  2012 - CA: A Cancer Journal for Clinicians

abstract: Religion, Spirituality, and Cancer: The Question of Individual Empowerment

Religion, Spirituality, and Cancer: The Question of Individual Empowerment:

It has often been noted that people with a severe illness endeavor to deepen their religious and spiritual practice and knowledge. It is generally accepted that spiritual and religious factors help sick people confront their suffering. The authors conducted a qualitative research on the role of religious and spiritual practices and knowledge among 10 cancer patients in Québec, Canada. Individual interviews focused on their illness experience confirmed that religion and spirituality can be present and contribute to coping when life is threatened. More precisely, the analyses of the place and use of these resources during the patient’s illness showed that these resources contributed to an individual empowerment process that was undertaken in response to a biographic and existential disruption induced by the illness diagnosis. The sick people took advantage of religious and spiritual content in their quest for meaning and a cure, progressing from a stage of despair and powerlessness to a stage of hope, a critical analysis of the disease, and a better management and control of it and its evolution. This article describes how people suffering from cancer use and participate in religious and spiritual content. It demonstrates the contribution of this content to an individual empowerment process. The use of religion and spirituality constitutes a quest for self-mastery, an acquiring of power and control. We understand that religious and spiritual phenomena do not always prevent people from fighting against their suffering, limit their freedom, or systematically reduce people’s viewpoints and worldviews.

abstract: Vitamins, minerals, essential fatty acids and colorectal cancer risk in the United Kingdom Dietary Cohort Consortium - 2012 - International Journal of Cancer

Vitamins, minerals, essential fatty acids and colorectal cancer risk in the United Kingdom Dietary Cohort Consortium - International Journal of Cancer 

Abstract

The risk for colorectal cancer may be influenced by the dietary intake of various vitamins, minerals and essential fatty acids. We conducted a pooled analysis of dietary data collected using food diaries in seven prospective studies in the United Kingdom Dietary Cohort Consortium. Five hundred sixty-five cases of colorectal cancer were matched with 1,951 controls on study centre, age, sex and recruitment date. Dietary intakes of retinol, vitamin A, thiamin, riboflavin, vitamin B6, folate, vitamin B12, vitamin D, calcium, iron, magnesium, potassium, n − 6 fatty acids, n − 3 fatty acids and the ratio of n − 6 to n − 3 fatty acids were estimated and their associations with colorectal cancer examined using conditional logistic regression models, adjusting for exact age, height, weight, energy intake, alcohol intake, fiber intake, smoking, education, social class and physical activity. There were no statistically significant associations between colorectal cancer risk and dietary intake of any of the vitamins, minerals or essential fatty acids examined.

open access: Cancer screening in the United States, 2012 - Smith - 2012 - CA: A Cancer Journal for Clinicians - Wiley Online Library

Cancer screening in the United States, 2012 CA: A Cancer Journal for Clinicians


section related to ovarian cancer:

Testing For Early Ovarian Cancer Detection

Although the annual incidence of ovarian cancer is low compared with breast cancer and precursor lesions of the cervix, it is the most lethal of the gynecologic cancers.21 Fewer than one-half of women diagnosed with ovarian cancer survive longer than 5 years, and although the 5-year survival rate for patients with localized ovarian cancer is greater than 90%, only 15% of all patients are diagnosed with localized disease.5

Screening and diagnostic methods for ovarian cancer include pelvic examination, CA 125 antigen as a tumor marker, transvaginal ultrasound (TVU), and, potentially, multimarker panels and bioinformatic analysis of proteomic patterns. The sensitivity and specificity of pelvic examination for the detection of symptomatic ovarian cancer are not well established, but are poor and do not support physical examination as a screening method. CA 125 has limited sensitivity and specificity (ie, while CA 125 levels are increased in many women with ovarian cancer, only approximately one-half of early ovarian cancers produce enough CA 125 to cause a positive test, and noncancerous diseases of the ovaries and other cancers, as well as other noncancerous influences, also can increase the blood levels of CA 125).45-47  TVU is capable of detecting small ovarian masses and may distinguish some benign masses from some malignant adnexal masses, although it still only poorly predicts which masses are cancers and which are due to benign diseases of the ovary. As an independent test, ultrasound has shown poor performance in the detection of ovarian cancer in women at average or high risk.48 There have been research and attempts to develop a blood test for ovarian cancer based on measuring genes, proteins, or multiple marker assays that may be present in higher or lower amounts in women with ovarian cancer compared with women who do not have ovarian cancer. This is a relatively new area of investigation that is accumulating promising results, but still requires prospective studies for validation.49 Thus, at this time, the lack of supporting evidence indicating that any one or a combination of these strategies is efficacious has prevented recommendations for ovarian cancer screening, although several prospective randomized trials have been underway.

Two large, prospective, randomized trials, one in the United States and the other in the United Kingdom, have been studying screening average-risk women with a combination of CA 125 and TVU. The US trial, the Prostate, Lung, Colorectal and Ovarian (PLCO) cancer screening trial,50 reported results in 2011.51 In the PLCO trial, 78,216 women ages 55 to 74 years were randomized to a group that was offered 6 annual rounds of screening with CA 125, and TVU for 4 years (n = 39,105) or a group that received usual care (n = 39,111). Participants were followed for a maximum of 13 years, with mortality from ovarian cancer as the main study outcome. At the conclusion of the study, the number of deaths from ovarian cancer was similar in each group (ie, there were 3.1 ovarian cancer deaths per 10,000 women-years in the group invited to screening vs 2.6 deaths per 10,000 women-years in the control group [relative risk, 1.18; 95% confidence interval, 0.82-1.71]). The authors concluded that simultaneous screening with CA 125 and TVU was not associated with a reduction in ovarian cancer mortality compared with usual care.51 However, the authors also noted that the absence of a stage shift in the group invited to screening compared with the control group suggests that the screening protocol in the PLCO study may not have been sensitive enough to diagnose ovarian cancer sufficiently early to alter its natural history. Nonetheless, for each of the 2 tests under evaluation, lower cutoff values would result in higher false-positive rates. An alternative approach, which is currently under evaluation in the UK Collaborative Trial of Ovarian Cancer Screening, is assessing the efficacy of multimodal screening including annual CA 125 screening with a risk of ovarian cancer algorithm and TVU as a second-line test versus annual screening with TVU only.52 The risk of ovarian cancer algorithm measures changes in CA 125 over time rather than with a single cutoff point, and is believed to improve sensitivity for smaller tumors without measurably increasing the false-positive rate.

While no organization recommends screening average-risk women for ovarian cancer, in 1994, a National Institutes of Health Consensus Panel concluded that women with 2 or more first-degree relatives diagnosed with ovarian cancer should be offered counseling about their ovarian cancer risk by a gynecologic oncologist (or another specialist qualified to evaluate family history and discuss hereditary cancer risks) since these women have a 3% chance of being positive for an ovarian cancer hereditary syndrome.53 The panel further advised that women with a known hereditary ovarian cancer syndrome, such as mutations on BRCA1 and BRCA2 (including breast-ovarian cancer syndrome, site-specific ovarian cancer syndrome, and (Lynch Syndrome) HNPCC), should receive annual rectovaginal pelvic examinations, CA 125 determinations, and TVU until childbearing is completed or at least until age 35 years, at which time prophylactic bilateral oophorectomy is recommended. Although women with these hereditary syndromes are estimated to represent only 0.05% of the female population, they have a 40% estimated lifetime risk of ovarian cancer." (Blogger's Note: the 40% would depend on which mutation)

open access: Cancer risks associated with external radiation from diagnostic imaging procedures - 2012 - CA: A Cancer Journal for Clinicians

Cancer risks associated with external radiation from diagnostic imaging procedures -  2012 - CA: A Cancer Journal for Clinicians

abstract: Laparoscopic and laparotomic staging in stage I epithelial ovarian cancer: a comparison of feasibility and safety - oncologic safety

Laparoscopic and laparotomic staging in stage I epithelial ovarian cancer: a comparison of feasibility and safety:

Abstract

The aim of this study was to compare laparoscopic and laparotomic surgical staging in patients with stage I epithelial ovarian cancer in terms of feasibility and safety. A retrospective chart review was undertaken of all patients with apparent stage I epithelial ovarian cancer who underwent laparoscopic (laparoscopy group) or laparotomic (laparotomy group) surgical staging at the Center for Uterine Cancer, National Cancer Center, Korea, between January 2001 and August 2006. During the study period, 19 patients underwent laparotomic surgical staging and 17 patients underwent laparoscopic surgical staging. No cases were converted from laparoscopy to laparotomy. The two groups were similar in terms of age, body mass index, procedures performed, number of lymph nodes retrieved, and operating time. The laparoscopy group had less estimated blood loss (P = 0.001), faster return of bowel movement (P < 0.001), and a shorter postoperative hospital stay (P = 0.002) compared to the laparotomy group. Transfusions were required only in two laparotomy patients, and postoperative complications occurred only in four laparotomy patients. However, two patients with stage IA grade 1 and 2 disease in laparoscopy group had recurrence with one patient dying of disease. The accuracy and adequacy of laparoscopic surgical staging were comparable to laparotomic approach, and the surgical outcomes were more favorable than laparotomic approach. However, the oncologic safety of laparoscopic staging was not certain. This is the first report on the possible hazards of laparoscopic staging in early-stage ovarian cancer. In the absence of a large prospective trial, this technique should be performed cautiously.

abstract: Prognostic factors associated with response in platinum retreatment of platinum-resistant ovarian cancer

Prognostic factors associated with response in platinum retreatment of platinum-resistant ovarian cancer:

Abstract

The goal of this study was to determine the factors associated with response to platinum retreatment in patients with platinum-resistant ovarian cancer. A review of patients with epithelial ovarian cancer retreated with cisplatin or carboplatin between 2002 and 2004 was performed. The platinum-free interval (PFI) and treatment-free interval (TFI) were determined for each patient. Response was based on serial CA125 levels using a modification of the Rustin criteria. Patients with clinical benefit ([CB] those who attained at least stable disease) were compared to patients with disease progression (PD). An analysis was performed to determine factors associated with CB in platinum-resistant patients retreated with platinum. Of 48 patients identified, 37 were evaluable included in this analysis. CB was observed in 27 (73%) while disease progression was noted in 10 (27%) women. The PFI was longer in those women who achieved CB (12.3 vs 6.9 months; P = 0.02). The TFI was 7.1 months for patients benefited from platinum retreatment vs 3.5 months for those with disease progression (P = 0.06). There was no statistically significant difference in the number of cytotoxic agents between the time of platinum retreatment and the prior platinum regimen (2 vs 1.5 months; P = 0.61). A prolonged PFI was associated with an improved chance of achieving CB with platinum retreatment. There was no association between the response to platinum retreatment and the number of intervening cytotoxic agents utilized. Further prospective study is warranted to define the optimal timing of platinum retreatment.

abstract: Long-term adjustment of early-stage ovarian cancer survivors

Long-term adjustment of early-stage ovarian cancer survivors:

Abstract

The objectives of this study were to describe the quality of life (QOL), consequences of treatment, complementary therapy use, and factors correlating with psychologic state in 58 survivors of early-stage ovarian cancer since little is known about the QOL of early-stage ovarian cancer survivors. Survivors were interviewed using standardized measures to assess physical, psychologic, social, and sexual functioning; impact of cancer on socioeconomic status; and complementary therapy use. Survivors reported good physical QOL scores and few unmet needs. However, menopausal symptoms and negative impact on sexuality were reported. Less than 10% of survivors reported either an interest in sex or were sexually active. Psychologic assessment yielded a subset of 26% of patients with scores suggestive of posttraumatic stress disorder (PTSD) and 40% of survivors scored below the norm on the Mental Health Inventory-17 Survey. One third of patients required treatment for family/personal problems and took antianxiety medications. About 56% of survivors reported fear of cancer recurrence and 59% reported anxiety when their CA125 is tested. Better mental health was significantly related to less fatigue (Functional Assessment of Cancer Therapy [FACT]—fatigue, r = 0.61, P < 0.0001), less pain (European Organisation for Research and Treatment of Cancer [EORTC], r =−0.54, P < 0.0001), fewer stressful life events (Life Event Scale, r =−0.44, P > 0.001), and greater social support (MOS Social Support Survey, r = 0.41, P < 0.01). Early-stage ovarian cancer survivors had few physical complaints and unmet needs, but psychologic distress was evident in a subset of survivors; the majority of survivors reported sexual dysfunction. These results indicate the need for intervention and improved distress screening in the early-stage ovarian cancer population.

abstract: Common patterns in 558 diagnostic radiology errors

Common patterns in 558 diagnostic radiology errors:

Abstract

Introduction: As a Quality Improvement initiative our department has held regular discrepancy meetings since 2003. We performed a retrospective analysis of the cases presented and identified the most common pattern of error.

Methods: A total of 558 cases were referred for discussion over 92 months, and errors were classified as perceptual or interpretative. The most common patterns of error for each imaging modality were analysed, and the misses were scored by consensus as subtle or non-subtle.

Results: Of 558 diagnostic errors, 447 (80%) were perceptual and 111 (20%) were interpretative errors. Plain radiography and computed tomography (CT) scans were the most frequent imaging modalities accounting for 246 (44%) and 241 (43%) of the total number of errors, respectively. In the plain radiography group 120 (49%) of the errors occurred in chest X-ray reports with perceptual miss of a lung nodule occurring in 40% of this subgroup. In the axial and appendicular skeleton missed fractures occurred most frequently, and metastatic bone disease was overlooked in 12 of 50 plain X-rays of the pelvis or spine. The majority of errors within the CT group were in reports of body scans with the commonest perceptual errors identified including 16 missed significant bone lesions, 14 cases of thromboembolic disease and 14 gastrointestinal tumours. Of the 558 errors, 312 (56%) were considered subtle and 246 (44%) non-subtle.

Conclusion: Diagnostic errors are not uncommon and are most frequently perceptual in nature. Identification of the most common patterns of error has the potential to improve the quality of reporting by improving the search behaviour of radiologists.

Review of epidemiologic studies of dietary acrylamide intake and the risk of cancer.

Review of epidemiologic studies of dietary acrylamide intake and the risk of cancer.:

Eur J Cancer Prev. 2012 Apr 8;

Abstract
Hypothesized associations between dietary acrylamide intake and cancer have been evaluated in more than 15 epidemiologic studies examining almost every major cancer site. We have critically reviewed the epidemiologic studies of estimated dietary acrylamide exposure and cancer.....

In conclusion, epidemiologic studies of dietary acrylamide intake have failed to demonstrate an increased risk of cancer. In fact, the sporadically and slightly increased and decreased risk ratios reported in more than two dozen papers examined in this review strongly suggest the pattern one would expect to find for a true null association over the course of a series of trials. Therefore, continued epidemiologic investigation of acrylamide and cancer risk appears to be a misguided research priority.

Medpage: Medical News: DNA Repair Genes May Predict Ovarian Cancer Survival

Blogger's Note: the original paper and editorial were recently posted, however, the Medpage (Medscape) article is easier to read (eg. plain english)

DNA Repair Genes May Predict Ovarian Cancer Survival - in Oncology/Hematology, Ovarian Cancer from MedPage Today

"A high score based on the expression of 23 genes involved in repairing DNA damage after platinum-based chemotherapy for ovarian cancer was associated with a 5-year survival of 40% versus 17% for women who had a low score, investigators reported......"

Action Points

• A high score based on the expression of 23 genes involved in repairing DNA damage after platinum-based chemotherapy for ovarian cancer was associated with improved survival.
• Note that the gene score outperformed clinical factors associated with ovarian cancer outcome and was the only baseline factor that had a significant association with overall survival.

Climb4Life Documentary Coming to Denver | HERA Women's Cancer Foundation - honoring (the late) Sean Patrick founder HERA

Climb4Life Documentary Coming to Denver | HERA Women's Cancer Foundation

Climb4Life Documentary Coming to Denver

April 12, 2012

The new KUED PBS documentary on HERA’s founder, Sean Patrick, recently premiered in Salt Lake City to a very enthusiastic audience.

Now, “Climb for Life:  A Legacy” is coming to Denver!  Please join us for this special showing as we celebrate Sean’s life and work.  In establishing the HERA Women’s Cancer Foundation, she gathered a community, became a catalyst for change, and continues, even after her death, to inspire the critical quest for ovarian cancer research and awareness.

Saturday, May 5, 2012, 7:00-9:00 pm

at The Garden, 3435 Albion Street, Denver, CO 80207; 303-321-5231

Higher US expenditures on cancer patients do not result in improved mortality. : denialism blog

Higher US expenditures on cancer patients do not result in improved mortality. : denialism blog

                                    ~~~~~~~~~~~~~~~~

Blogger: Hoofnagle has a MD and PhD in physiology from the University of Virginia, and is now a general surgery resident. His interest in denialism concerns the use of denialist tactics to confuse public understanding of scientific knowledge.

                               ~~~~~~~~~~~~~~~~~~~~~
Higher US expenditures on cancer patients do not result in improved mortality.

" But you'd never know that reading AEI's highly dubious contribution to the literature in this week's Health Affairs (lay Reuters article here). Consistent with their free-market solves everything and can do no wrong (cover ears and yell "nananananananana") attitude towards the broken US healthcare system, they have managed to contaminate the literature with a paper that suggests our higher expenditures on cancer are generating significant returns in patient survival. Except that it doesn't show this, and to her great credit, Reuter's Sharon Begley nails it:........

"Experts shown an advance copy of the paper by Reuters argued that the tricky statistics of cancer outcomes tripped up the authors.
"This study is pure folly," said biostatistician Dr. Don Berry of MD Anderson Cancer Center in Houston. "It's completely misguided and it's dangerous. Not only are the authors' analyses flawed but their conclusions are also wrong."

".... It's been a topic of debate among medical professions and discussed extensively by other medical bloggers like Ora.....(Blogger's Note: see prior postings)

abstract: (FOBT) Fecal occult blood testing instructions and impact on patient adherence

Fecal occult blood testing instructions and impact on patient adherence: Publication year: 2012

Source: Cancer Epidemiology

Introduction
Although the physician's role with patients is crucial in encouraging FOBT screening, the nature and content of physician-patient discussions about FOBT screening is unclear. As part of a larger study, this paper reports on our analyses of physician beliefs about fecal occult blood testing (FOBT) and strategies they employed to enhance patient adherence. The second aim of this paper is to report on the perceptions of individuals at average risk for colorectal cancer (CRC) in regard to their awareness of the FOBT and their responses to physician recommendations about FOBT screening.

Clinical value of 18F-FDG PET-CT in detecting primary tumor for patients with carcinoma of unknown primary

Clinical value of 18F-FDG PET-CT in detecting primary tumor for patients with carcinoma of unknown primary: Publication year: 2012


Objective: 
To investigate the clinical value in detecting occult primary tumors with ¹⁸F-FDG PET-CT whole body imaging.

Methods: 
120 patients with unknown primary origin were referred for ¹⁸F-FDG PET-CT whole body imaging. All patients were performed ¹⁸F-FDG PET-CT whole body scan. PET-CT images were interpreted by visual inspection and semi-quantitative analysis (standardized uptake value, SUV). Histopathological and formal clinical follow-up findings were used to assess the value of FDG PET-CT.

Results: 
FDG PET-CT was able to detect the primary tumor in 54/120 patients (42.5%). The primary tumors were confirmed by histopathologic and formal clinical follow-up findings, and located in the head and neck (n =17), the lung (n =19), the breast (n =2), the esophagus (n =1), the stomach (n =2), the bile ducts (n =1), the pancreas (n =3), the co1on (n =3), the ovary (n =2), the prostate (n =l), others (n =3). FDG PET results were proved false positive in 9 patients (7.5%), which were located in the head and neck (n =3), the lung (n =1), the gastric (n =1), the colon (n =2), the ovary (n =1), the prostate (n =l).

During the clinical follow-up of median 32months (range, 2–45months), primary tumor was found in only 5 patients of 60 cases unidentified by PET-CT (breast cancer, gastric cancer, co1on cancer, prostate cancer and urinary tumors, respectively). The sensitivity, specificity, and accuracy of ¹⁸F-FDG PET-CT in the detection of the primary tumor site were 91.5%, 85.2%, and 88.3%, respectively.

Conclusion:
¹⁸F-FDG PET-CT whole body imaging is both a noninvasive and a very sensitive tomographic whole-body imaging modality, allowing for the detection of a primary tumor and complete tumor staging in single examination, which can contribute substantially to selecting appropriate therapeutic methods and evaluating prognosis. Perhaps ¹⁸F-FDG PET-CT whole body imaging should be used as a first-line imaging modality for patients with carcinoma of unknown primary rather than using it after other diagnostic procedures have failed to identify a primary tumor.

abstract - Patient Education and Counseling - Teaching patients how to talk with biomedical providers about their complementary and alternative medicine use

Patient Education and Counseling - Teaching patients how to talk with biomedical providers about their complementary and alternative medicine use

open access: Gynecologic Oncology Case Reports - A case of endometrial cancer in the context of a BRCA2 mutation and double heterozygosity for Lynch syndrome

ScienceDirect.com - Gynecologic Oncology Case Reports - A case of endometrial cancer in the context of a BRCA2 mutation and double heterozygosity for Lynch syndrome

 "....While endometrial cancer diagnosed under the age of 50 is not included in the Revised Bethesda Guideline, evidence suggests that these individuals should be evaluated for Lynch syndrome (Resnick et al., 2009). The patient presented was diagnosed with endometrial cancer at the age of 41 and genetic testing revealed triple heterozygosity for BRCA2, MLH1 and MSH6 mutations."

 Introduction

Lynch syndrome, also called hereditary non-polyposis colorectal cancer (HNPCC), is an autosomal dominant cancer susceptibility syndrome caused by germline mutations in DNA mismatch repair (MMR) genes, MLH1, MSH2, and less frequently MSH6 and PMS2. MMR mutation carriers are predisposed primarily to colorectal cancer and endometrial cancer, with an increased frequency of stomach, ovary, pancreas, upper urinary tract, brain, small bowel, and skin consistently reported. This hereditary syndrome accounts for approximately 2–3% of colorectal cancers and 1–4% of endometrial cancers in the United States (Lynch and de la Chapelle, 2003). Depending on the MMR gene involved, women with Lynch syndrome can have up to an 80% lifetime risk of developing colorectal cancer, and a 20–60% risk of endometrial cancer.

Germline mutations in BRCA1 or BRCA2 (BRCA1/2) cause hereditary breast ovarian cancer syndrome. Female carriers of BRCA1/2 mutations have excessive risks for both breast and ovarian cancer, with lifetime breast cancer estimates ranging from 45% to 84%, and lifetime ovarian cancer estimates ranging from 11% to 62%, depending upon the population studied. BRCA1/2 kindreds are also noted to have an increased frequency of prostate cancer, and in BRCA2 kindreds, increased frequencies of pancreatic cancer and melanoma are observed. The frequency of BRCA1 or BRCA2 mutations in the general population is estimated to be 1 in 300 to 1 in 800, respectively (King et al., 2003).

While there are kindreds with more than one cancer susceptibility syndrome and/or mutation reported in the literature ( [Thiffault et al., 2004] and [Smith et al., 2008]), they are not often encountered in routine clinical settings........

Highlights

► Endometrial cancer with BRCA2 mutation and double heterozygosity for Lynch syndrome.
► Loss of MLH1 and PMS2 by immunohistochemical stain.
► MSH1 and MSH6 gene mutations by genomic sequencing.

abstract: Comparative cost efficiency across the European G5 countries of originators and a biosimilar erythropoiesis-stimulating agent to manage chemotherapy-induced anemia in patients with cancer

Comparative cost efficiency across the European G5 countries of originators and a biosimilar erythropoiesis-stimulating agent to manage chemotherapy-induced anemia in patients with cancer

Conclusion: Managing chemotherapy-induced anemia with biosimilar epoetin α is consistently cost efficient over treatment with originator epoetin α, epoetin β, and darbepoetin α under both fixed and weight-based dosing scenarios.

Epigenetics does not mean that thinking makes it so : Respectful Insolence

Epigenetics does not mean that thinking makes it so : Respectful Insolence

".....The not-so-subtle implication is that the reason one gets sick is because of one's habits. Of course, there are a lot of lifestyle diseases, but the implications goes beyond the sensible, science-based observation that obesity and lack of exercise increase the risk of certain diseases, into the realm of stating that if you just eat the right foods and do the right exercises you'll never get sick.

Utter nonsense, of course.

There's also a dark side to this sort of thinking, and that's the flip side of the argument. If you can nearly completely control the state of your health by what you eat and do, the not-so-subtle implication is that if you get sick it must be your fault. After all, if we have complete control over our health through our lifestyle, then it follows that if you're sick, you must be doing something wrong....."

"The latest way that quacks are trying to push the idea that you have near total control over your health is by abusing new findings in epigenetics. Epigenetics is the study of heritable changes in gene expression or phenotype that are not caused by changes in the underlying gene sequence........ It's a fascinating area of research, because it suggests that gene expression can be altered longer than transiently by environmental influences. Of course, given that organisms and biology are affected by environmental influences, this is almost a trivial observation; the power of epigenetics is that it can explain how such changes in gene expression can come about.....