Correspondence/Aurthor's Response: Thromboprophylaxis in Patients Receiving Chemotherapy — NEJM

Thromboprophylaxis in Patients Receiving Chemotherapy — NEJM

Correspondence

Thromboprophylaxis in Patients Receiving Chemotherapy

N Engl J Med 2012; 366:1839-1840May 10, 2012

Article

To the Editor:

In their article on the results of the SAVE-ONCO study (ClinicalTrials.gov number, NCT00694382), which showed that semuloparin reduced the risks of deep-vein thrombosis in the lower or upper limbs and pulmonary embolism among patients receiving chemotherapy for cancer, Agnelli and colleagues (Feb. 16 issue)1 do not mention the development of central-venous-catheter thrombosis. Indeed, deep-vein thrombosis related to a central venous catheter is a frequent complication, reported in 4% of patients with symptomatic events and 20 to 30% of patients with asymptomatic events detected by means of venography or ultrasonography; this complication is associated with the risk of pulmonary embolism and loss of central venous access.2 A recent Cochrane review did not show any efficacy of heparins or vitamin K antagonists for the prevention of central-venous-catheter thrombosis.3 Accordingly, national guidelines mention no prophylactic treatment; specifically, they recommend no prophylactic doses of low-molecular-weight heparin or low-dose warfarin.2 Only the placement of the distal tip of the central venous catheter at the junction between the superior vena cava and the right atrium, and insertion on the right side are indicated.2,4 Therefore, was central-venous-catheter thrombosis observed in the study, and was semuloparin an effective prophylactic treatment?

Claude Bachmeyer, M.D.
Jean-Charles Pellen, M.D.
Tenon Hospital, Paris, France
claude.bachmeyer@tnn.aphp.fr

No potential conflict of interest relevant to this letter was reported.
4 References

Author/Editor Response

Bachmeyer and Pellen wonder whether central venous catheter–related thrombosis was observed in the study and whether semuloparin was an effective prophylactic treatment for this complication. In our study, a central venous catheter was present in 19.7% of patients in the semuloparin group and 18.8% of patients in the placebo group. Symptomatic deep-vein thrombosis of the upper limbs, including central-venous-catheter thrombosis, was part of the composite primary efficacy outcome. During the efficacy analysis period, symptomatic deep-vein thrombosis of the upper limbs occurred in 9 of 1604 patients in the placebo group (0.6%) and 3 of 1608 patients in the semuloparin group (0.2%) (hazard ratio, 0.33; 95% confidence interval, 0.07 to 1.18). All these patients had a central venous catheter. The risk reduction in deep-vein thrombosis of the upper limbs (including central-venous-catheter thrombosis) associated with semuloparin was consistent with the risk reduction in the other components of the composite primary efficacy outcome of the study, but the number of observed events is small.

Giancarlo Agnelli, M.D.
University of Perugia, Perugia, Italy
agnellig@unipg.it
Alexander G.G. Turpie, M.D.
McMaster University, Hamilton, ON, Canada

Continuing Bisphosphonate Treatment for Osteoporosis — For Whom and for How Long? — NEJM

Continuing Bisphosphonate Treatment for Osteoporosis — For Whom and for How Long? — NEJM

Bisphosphonates for Osteoporosis — Where Do We Go from Here? — NEJM

Bisphosphonates for Osteoporosis — Where Do We Go from Here? — NEJM

Seth's Blog: Why ask why? (including one important hint)

Why ask why?

"Why?" is the most important question, not asked nearly enough.

Hint: "Because I said so," is not a valid answer.

• Why does it work this way?
• Why is that our goal?
• Why did you say no?
• Why are we treating people differently?
• Why is this our policy?
• Why don't we enter this market?
• Why did you change your mind?
• Why are we having this meeting?
• Why not?

paywalled: (March 2012) Impact of FDG-PET and -PET/CT imaging in the clinical decision-making of ovarian carcinoma: an evidence-based approach.

Impact of FDG-PET and -PET/CT imaging in the clinical decision-making of ovarian carcinoma: an evidence-based approach

Abstract

The most definitive role of fluorodeoxyglucose (FDG)-PET/computed tomography (CT) at present is surveillance and detecting recurrence in patients who have completed primary therapy but demonstrate a rising serum tumor marker (e.g., CA-125 levels). In this scenario, PET/CT demonstrates high sensitivity and accuracy in detecting lesions that are otherwise challenging, and appears superior (with less interobserver variability) compared with CT alone. Despite the fact that peritoneal deposits may be missed by PET/CT, the overall performance is better than CT alone. FDG-PET does not play a significant additional role in the primary diagnosis of ovarian cancers; however, the role of combined PET/CT modality has recently begun to be re-explored for initial disease staging, particularly because PET/CT can pick up small unsuspected lesions and thereby provide a better disease assessment of the whole body in a single examination. The baseline PET/CT also subserves an important role for future monitoring of therapy response. Therapy monitoring by PET could help to optimize neoadjuvant therapy protocols and to avoid ineffective therapy in nonresponders early in its course, although PET/CT has cost-effectiveness issues that need further evaluation. The prognostic value of FDG-PET/CT has been investigated in the following areas: in the preoperative setting to predict optimal cytoreduction; to assess the value of a positive FDG-PET following primary surgery; and when employed as a replacement for second-look laparotomy following completion of primary surgery and chemotherapy. The data, although promising, are still sparse in all the three domains for a definite recommendation.

 

birthdays - Rocco and Patina

2012 Canadian Cancer Statistics - 5th ranking in women dying of cancer in Canada

2012 Report Canadian Cancer Statistics


new cases - 2,600 deaths - 1,750

8th ranking in # of new cases of cancers in women

5th ranking in # deaths of cancers in women

paywalled: Permanent scalp alopecia related to breast cancer chemotherapy by sequential fluorouracil/epirubicin/cyclophosphamide (FEC) and docetaxel

Permanent scalp alopecia related to breast cancer chemotherapy by sequential fluorouracil/epirubicin/cyclophosphamide (FEC) and docetaxel: a prospective study of 20 patients:

Background:
To analyze the clinical and histological features of permanent alopecia following a sequential fluorouracil/epirubicin/cyclophosphamide (FEC) and docetaxel regimen for adjuvant breast cancer treatment.

Conclusion:
Permanent and severe alopecia is a newly reported complication of the FEC 100–docetaxel breast cancer regimen.

DARA BioSciences Announces New Analysis of Patient Self-Reported Diary Results in a Phase 2a Clinical Trial of KRN5500 in Patients With Cancer and Neuropathic Pain - Drugs.com

http://tinyurl.com/7tmt942

DARA BioSciences Announces New Analysis of Patient Self-Reported Diary Results in a Phase 2a Clinical Trial of KRN5500 in Patients With Cancer and Neuropathic Pain

"....Previous analyses of the study data were based predominantly on patient-reported Numeric Rating Scale (NRS) pain scores collected by healthcare professionals in a clinic setting during weekly visits, whereas this new analysis focused specifically on self-reported daily pain scores from patients' diaries. Responders in this analysis were defined as patients attaining a clinically-meaningful (at least 20%) improvement in mean NRS scores from baseline within any given week. Of the 12 patients who received KRN5500 in this 19-patient trial, 7 (58%) were classified as responders. Further, 5 of the 7 (71%) showed sustained pain relief over several weeks. Of the 7 patients who received placebo, none were responders. Therefore, the new analysis showed a temporal consistency of pain relief in a larger fraction of patients than had been noted in the earlier analysis of weekly clinic-reported pain. These findings are impressive since patients enrolled in this proof-of-concept trial had unrelenting pain at baseline despite the concomitant use of other approved analgesic agents........

 

Beware the creeping cracks of bias (in science research) : Nature News & Comment

Beware the creeping cracks of bias : Nature News & Comment

Long-Term Use of Osteoporosis Medication May Reduce Bone Fracture Risk for Some Patients - U California

Long-Term Use of Osteoporosis Medication May Reduce Bone Fracture Risk for Some Patients:

"Continuing a popular but controversial treatment for osteoporosis could reduce spine fracture risk for a particular group of patients, but others could see little to no change if they discontinue it. Based on available evidence, a UCSF researcher reevaluated his 2006 finding from a randomized 10-year study of alendronate, a type of bisphosphonate - a class of drugs that prevent loss of bone mass.....

New Cautions About Bisphosphonates - NYTimes.com

New Cautions About Bisphosphonates - NYTimes.com

paywalled: The Predictive Capacity of Personal Genome Sequencing - Science Translational Medicine

[Research Articles] The Predictive Capacity of Personal Genome Sequencing:

New DNA sequencing methods will soon make it possible to identify all germline variants in any individual at a reasonable cost. However, the ability of whole-genome sequencing to predict predisposition to common diseases in the general population is unknown. To estimate this predictive capacity, we use the concept of a "genometype." A specific genometype represents the genomes in the population conferring a specific level of genetic risk for a specified disease. Using this concept, we estimated the maximum capacity of whole-genome sequencing to identify individuals at clinically significant risk for 24 different diseases.

PLoS ONE: Citizen Participation in Patient Prioritization Policy Decisions: An Empirical and Experimental Study on Patients' Characteristics

PLoS ONE: Citizen Participation in Patient Prioritization Policy Decisions: An Empirical and Experimental Study on Patients' Characteristics

"The results of the survey questions showed that the vast majority of respondents agreed to prioritize patients with life threatening diseases and patients with acute diseases over all other patients. All criteria that described the patient's social engagement outside the family or socio-economic status (e.g., income, unemployment) were rejected as possible criteria for prioritization. A similar pattern could be observed in the discrete choice experiment: health status received the highest importance weight, whereas socio-economic status received a very low weight in terms of deciding which patient should be treated first. There is considerable agreement that those in need, i.e., the severely ill patient, should be treated first [1], [5]–[7]. Socio-economic status was not considered acceptable, but is a commonly practiced criterion in the daily routine of physicians [40], if not explicitly, at least implicitly so [41], [42]."


"In particular, medical criteria are highly accepted for prioritizing patients whereas socio-economic criteria and lifestyles are rejected. Especially the DCE showed that health status and quality of life were the only attributes that respondents would ultimately likely include in a decision-making process about which patients to prioritize for care. Policy makers in Germany have been very reluctant to even discuss the topic; indeed, all ministers of health over the last decade or so have refused to even talk about this issue. The present study shows that the “voice of the patient” – reliably captured through the methods used here – can be encapsulated in statistical models and thus introduced into policy-making settings [15]. The methods and findings illustrated in this research can be used to 1) increase citizen participation in the political discussion concerning this substantive policy topic, 2) define the scope of policy actions within the realm of the feasible, and 3) frame communications between policy-setting bodies and the population."

paywalled: Diathermy-Induced Injury May Affect Detection of Occult Tubal Lesions at Risk-Reducing Salpingo-Oophorectomy

Diathermy: In the natural sciences, the term diathermy means "electrically induced heat" and is commonly used for muscle relaxation. It is also a method of heating tissue electromagnetically or ultrasonically for therapeutic purposes in medicine.

Diathermy-Induced Injury May Affect Detection of Occult Tuba... : International Journal of Gynecological Cancer

Background: Electrosurgery-induced tubal thermal injury obscures cellular detail and hampers histomorphological assessment for occult pathology.

Objective: 

The objectives of this study were to report on diathermy-related thermal injuries to the fallopian tube observed at RRSO and explore its potential impact on the detection of occult tubal epithelial lesions.

Design: 

This study was composed of high-risk women from breast and/or ovarian cancer families attending a tertiary high-risk familial gynecologic cancer clinic. This was a retrospective case-control analysis of high-risk women who underwent RRSO. Cases were all women detected to have occult lesions (tubal atypia/carcinoma in situ/cancer) between January 2005 and December 2010. Control subjects were all women with normal tubal/ovarian histology between August 2006 and December 2007.

Conclusions: This report highlights the potential impact of electrosurgical thermal injury on detection of occult tubal pathology following RRSO. It is important for surgeons to avoid thermal injury to the distal end of the tube.

Myriad RBM Announces the Launch of OncologyMAP® v. 2.0

Myriad RBM Announces the Launch of OncologyMAP® v. 2.0

Myriad Genetics (NASDAQ: MYGN) announced today that Myriad RBM, a wholly owned subsidiary of Myriad Genetics, has launched OncologyMAP® v. 2.0, a powerful research tool developed with funding and direction from the National Cancer Institute and the Cancer Prevention Research Institute of Texas. OncologyMAP® v. 2.0 is a comprehensive, cost-effective testing service that builds on the success of the original OncologyMAP® service by increasing the scope and diversity of biomarker analysis for drug re-tasking, indication expansion, and patient stratification studies and provides researchers with the ability to accelerate the pace of discovery, validation, and translation of cancer biomarkers into clinically useful tests......................

No One is More Interested in Curing Your Cancer Than You « Dr. Robert A. Nagourney – Rational Therapeutics – Blog

No One is More Interested in Curing Your Cancer Than You « Dr. Robert A. Nagourney – Rational Therapeutics – Blog

No One is More Interested in Curing Your Cancer Than You

May 9, 2012 Leave a comment (Dr Robert A Nagourney blog)
 

A diagnosis of cancer thrusts a, heretofore, healthy individual into the strange and unfamiliar territory of medical oncology. Many of my patients describe this transition as “entering the cancer bubble.” Suddenly, you are on the inside and everyone on the outside is talking at you about what to do, where to go, whom to see, and what treatments to receive.
From the inside of the bubble however, all of this has a hollow ring as you ponder many options, few good and some, positively frightening. Unfortunately, few patients have the time to complete a MD, or PhD, between diagnosis and the initiation of treatment. Lacking the requisite expertise, they turn to the “authorities” for advice.

AHRQ Patient Safety Network - The Collection: Annotated links to patient safety literature, news, and other resources.

AHRQ Patient Safety Network - The Collection

The Collection

Annotated links to patient safety literature, news, and other resources.

Find items in The Collection by subject matter.

Approach to Improving Safety

Nurse Staffing Ratios

Culture of Safety

Quality Improvement Strategies

Human Factors Engineering

All Approaches to Improving Safety...

Clinical Area

Anesthesiology

Critical Care Nursing

Hospital Pharmacy

Pediatrics

All Clinical Areas...

Error Types

Cognitive Errors ("Mistakes")

Near Miss

Noncognitive Errors ("Slips & Lapses")

Epidemiology of Errors and Adverse Events

All Error Types...

Origin/Sponsor

Agency for Healthcare Research and Quality (AHRQ)

United States Federal Government

United Kingdom

State Governments and Agencies

All Origins/Sponsors...

Resource Type

Journal articles

Book/Report

Audiovisual

Legislation/Regulation

All Resource Types...

Safety Target

Look-Alike, Sound-Alike Drugs

Medication Errors/Preventable Adverse Drug Events

Nosocomial Infections

Wrong-Site Surgery

All Safety Targets...

Setting of Care

Hospitals

Operating Room

Ambulatory Care

Residential Facilities

All Settings of Care...

Target Audience

Nurses

Physicians

Health Care Executives and Administrators

Educators

All Target Audiences...

Produced for the Agency for Healthcare Research and Quality by a team of editors at the University of California, San Francisco with guidance from a prominent Editorial Board and Advisory Panel.

again! Pet food recalled after salmonella outbreak | Healthy Living - Yahoo! Shine

Pet food recalled after salmonella outbreak | Healthy Living - Yahoo! Shine

New roles for public health in cancer screening - CA: A Cancer Journal for Clinicians

New roles for public health in cancer screening - 2012 - CA: A Cancer Journal for Clinicians

paywalled: Why should I talk about emotion? Communication patterns associated with physician discussion of patient expressions of negative emotion in hospital admission encounters

Why should I talk about emotion? Communication patterns associated with physician discussion of patient expressions of negative emotion in hospital admission encounters

Objective 
To describe hospital-based physicians’ responses to patients’ verbal expressions of negative emotion and identify patterns of further communication associated with different responses.

Practice implications 
Providers should respond to expressions of negative emotion with statements that allow for or explicitly encourage further discussion of emotion.

paywalled: What Can We Learn About the Spiritual Needs of Palliative Care Patients From the Research Literature?

What Can We Learn About the Spiritual Needs of Palliative Care Patients From the Research Literature?

Context 
Spirituality is a distinctive subject within palliative care practice and literature, but research to date is relatively undeveloped in this field and studies often throw more light on conceptual and methodological issues than producing reliable data for clinical practice.

Objectives 
To determine what is known about the spiritual needs of palliative care patients from the evidence presented in published research.

Methods 
Specialist online databases were interrogated for primary empirical studies of patients with a chronic disease unresponsive to curative treatment. Studies that only used a proxy for the patient or reported expert opinion were excluded. Each study was critically appraised for quality and the strength of its evidence to determine if any data could be pooled.

Results 
Thirty-five studies were identified, equating to a total of 1374 patients.

VEGF induces ascites in ovarian cancer patients via increasing peritoneal permeability by downregulation of Claudin 5

VEGF induces ascites in ovarian cancer patients via increasing peritoneal permeability by downregulation of Claudin 5

Objective 
To evaluate the role of VEGF-dependent Claudin 5 production for the development of ascites via influencing endothelial permeability in peritoneal tissue of ovarian cancer patients.

Conclusion 
VEGF induces ascites in ovarian cancer patients. This instance happens due to increased peritoneal permeability, caused by downregulation of the tight junction protein Claudin 5 in the peritoneal endothelium.

paywalled - Outcomes of Primary Surgical Cytoreduction in Patients with BRCA-associated High-grade Serous Ovarian Carcinoma

 Outcomes of Primary Surgical Cytoreduction in Patients with BRCA-associated High-grade Serous Ovarian Carcinoma

Objective

BRCA-associated and sporadic ovarian cancers have different pathologic and clinical features. Our goal was to determine if BRCA mutation status is an independent predictor of residual tumor volume following primary surgical cytoreduction.

Highlights

► Differences in the biology of BRCA-associated and sporadic ovarian cancers do not result in differences in primary surgical outcomes.
► The improved survival of BRCA-associated ovarian cancers is not confounded by differences in primary surgical outcome.

(in research - genome) Integrated Analysis of Gene Expression and Tumor Nuclear Image Profiles Associated with Chemotherapy Response in Serous Ovarian Carcinoma

Integrated Analysis of Gene Expression and Tumor Nuclear Image Profiles Associated with Chemotherapy Response in Serous Ovarian Carcinoma
 

Background
Small sample sizes used in previous studies result in a lack of overlap between the reported gene signatures for prediction of chemotherapy response. Although morphologic features, especially tumor nuclear morphology, are important for cancer grading, little research has been reported on quantitatively correlating cellular morphology with chemotherapy response, especially in a large data set. In this study, we have used a large population of patients to identify molecular and morphologic signatures associated with chemotherapy response in serous ovarian carcinoma.

paywalled: Increased expression of OCIA domain containing 2 during stepwise progression of ovarian mucinous tumor - Pathology Intl

Increased expression of OCIA domain containing 2 during stepwise progression of ovarian mucinous tumor

Ovarian cancer immunoreactive antigen domain containing 2 (OCIAD2) has been reported to show cancer-specific expression in early invasive lung adenocarcinoma. OCIAD2 shows high homology with OCIAD1, which was originally immunoscreened from ascites of a patient with ovarian cancer and found to be a tumor-specific protein. Therefore, like OCIAD1, OCIAD2 is expected to show high immunoreactivity in ovarian tumors.

In this study, we examined the expression pattern of OCIAD2 in 117 ovarian mucinous tumors, and confirmed that it was more highly expressed in borderline tumor and carcinoma (51/74 cases, 69%) than in adenoma (6/43 cases, 14%). The immunoreactivity of OCIAD2 in borderline tumor and carcinoma was more specific than that of OCIAD1 (adenoma, 21/43 cases, 49%), and more sensitive than that of CEA (borderline tumor and carcinoma, 35/74 cases, 47%). Like OCIAD1, OCIAD2 is a cancer-related protein and its expression level increases during the course of malignant progression and is thought to be a very useful marker for evaluating the malignancy of ovarian mucinous tumors.

Fertility Q&A Ovarian Tissue Freezing

Fertility Q&A Ovarian Tissue Freezing:

An emerging method of fertility preservation offers hope for women with cancer.

By Karine Chung, MD, MSCE

If you are preparing to undergo cancer treatment, you may already be aware that cancer therapies—including chemotherapy and radiation—can cause infertility and premature menopause. If having children after completing your cancer treatment is important to you, you may have begun to consider options for fertility preservation. Because your chance of future successful pregnancies is best when fertility preservation procedures are performed before chemotherapy or radiation, the amount of time available to pursue these procedures is often limited and depends on when your cancer treatment is scheduled to start........

Complementary Therapies in Cancer Care

Complementary Therapies in Cancer Care:

An ongoing series highlighting complementary therapies
By Barrie R. Cassileth, MS, PhD

Complementary therapies are noninvasive, nonpharmacologic adjuncts to mainstream treatment.  They improve patients’ strength and control the physical and emotional symptoms associated with cancer and other serious illnesses. They provide self-help guidance to enhance body and soul at times when one feels vulnerable and life seems out of control.  Complementary therapies are used as adjuncts to mainstream care of cancer and other illnesses, not as substitutes. They improve physical and emotional function, and manage stress and symptoms of aging, regardless of health status.  Complementary therapies are rational, evidence-based practices delivered or taught by trained practitioners.  They include: mind-body practices such as meditation and self-hypnosis; massage therapies; nutritional counseling; physical fitness, including programs such as aerobic exercise, Chi Gong, tai chi, yoga and many other practices.
We begin this series with acupuncture, a two-to three-thousand-year-old practice known to relieve difficult, often otherwise untreatable symptoms and effect important improvements in physical function and well-being.......

FDA Approves New Silicone Gel-Filled Breast Implant

FDA Approves New Silicone Gel-Filled Breast Implant:

The U.S. Food and Drug Administration (FDA) has approved a silicone gel-filled breast implant manufactured by Sientra Inc for breast augmentation in women at least 22 years old and breast reconstruction in women of any age.

As a condition of approval, the company is required to conduct post-approval studies to assess long-term safety and effectiveness outcomes as well as the risks of rare disease outcomes.
Silicone gel-filled breast implants are implanted under breast tissue or chest muscle for breast augmentation or reconstruction. They have a silicone outer shell that is filled with silicone gel and come in different sizes.

Breast reconstruction may refer to a primary reconstruction to replace breast tissue that has been removed or revision surgery to correct the result of a primary reconstruction surgery.

The FDA based its approval of Sientra’s implant on 3 years of clinical data from 1,788 participants. Complications and outcomes reflected those found in previous studies of other breast implants and included tightening of the area around the implant (capsular contracture), reoperation, implant removal, an uneven appearance (asymmetry), and infection.
Sientra’s post-approval studies will include:

• An additional 7 years of follow-up of the 1,788 clinical trial participants in their pre-market study
• A 10-year study of 4,782 women receiving Sientra silicone gel-filled breast implants to collect information on long-term local complications such as capsular contracture, as well as less common disease outcomes, such as rheumatoid arthritis and breast and lung cancer
• Five case-control studies that will evaluate the association between Sientra’s silicone gel-filled breast implants and five rare diseases: rare connective tissue disease, neurological disease, brain cancer, cervical/vulvar cancer, and lymphoma.

With the addition of Sientra’s approval, there are now three FDA-approved silicone gel-filled breast implants on the market in the U.S.
Silicone gel implants have generated a fair amount of controversy regarding their safety because of the question as to whether they can trigger certain connective tissue and autoimmune diseases. In 1992, the FDA restricted the use of silicone implants in order to evaluate whether they were indeed associated with autoimmune conditions. Clinical trials have continued and the data continues to indicate that the implants are safe.
It’s important to remember that breast implants are not lifetime devices and long-term monitoring is imperative.
Reference:
FDA approves new silicone gel-filled breast implant [FDA News Release]. U.S. Food and Drug Administration website. Available at: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm295437.htm”>http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm295437.htm

Rexahn Pharmaceuticals Submits Archexin Phase II Protocol for Ovarian Cancer to FDA - News

Rexahn Pharmaceuticals Submits Archexin Phase II Protocol for Ovarian Cancer to FDA

May 08, 2012 08:03 AM Eastern Daylight Time 

ROCKVILLE, Md.--(EON: Enhanced Online News)--Rexahn Pharmaceuticals, Inc. (NYSE Amex: RNN), a clinical stage pharmaceutical company developing and commercializing potential best in class oncology and CNS therapeutics, today announced that it has submitted a Phase II protocol for the clinical study of Archexin^® as a treatment of ovarian cancer to the U.S. Food and Drug Administration (FDA).

“Treatment options are limited for patients who are stricken with ovarian cancer, therefore we look forward to investigating Archexin as a potential combination treatment for this disease.”

The Phase II study will assess the safety and efficacy of Archexin when used in combination with both carboplatin and paclitaxel as a second-line therapy in subjects who are platinum-sensitive following their first relapse. The study will be conducted at multiple centers in the United States, and subjects will be randomized to receive either carboplatin/paclitaxel or carboplatin/paclitaxel/Archexin. Various measures of clinical benefit will be assessed

University of Arizona wins NIH Grant to on Diagnosis of Ovarian Cancer by Confocal Microendoscopy - Optical Coherence Tomography News

University of Arizona wins NIH Grant to on Diagnosis of Ovarian Cancer by Confocal Microendoscopy - Optical Coherence Tomography News

Optical Coherence Tomography News (18 hours ago) Gynecology 

The University of Arizona received a $276,708 2012 NIH grant to study diagnosis of Ovarian Cancer by Confocal Microendoscopy. The principal Investigator is Arthur Gmitro. This grant is part of a multi-year project that started in 2005 and ends in 2014. Below is a summary of the work.
The objective of this research is to further develop and clinically validate a real-time multispectral confocal microendoscope for in vivo diagnosis of ovarian cancer. The confocal microendoscope is a new type of instrument for visualizing tissue at the cellular level and has shown great promise for performing optical biopsy. Confocal microendoscopy has the potential to provide a physician with an immediate evaluation of tissue and to survey a much greater area of tissue, reducing the sampling error of traditional tissue extraction biopsy. A confocal microlaparoscope system was constructed and tested in vivo in humans during the prior funding period. A specific aim of this work is to now validate the system and show that it can be used to detect cancer of the ovary during a laparoscopic procedure. Additional objectives of the work are to expand the use of the instrument to the detection of peritoneal implants of ovarian cancer throughout the abdominal cavity and to develop and test a system capable of imaging inside the fallopian tubes. Further technical development is aimed at improving the confocal imaging performance and adding optical coherence tomography as a complimentary imaging modality. The new instrument will incorporate the two imaging modalities into a single compact probe with seamless and rapid switching between modes of operation. In addition to the technology development and clinical translation, another aim of the project is to develop and test targeted contrast agents that provide safer and more effective in vivo identification of ovarian cancer

paywalled: Is there any association between retroperitoneal lymphadenectomy and survival benefit in advanced stage epithelial ovarian carcinoma patients?

Is there any association between retroperitoneal lymphadenectomy and survival benefit in advanced stage epithelial ovarian carcinoma patients? 

Abstract

Aim:  The effect of systematic retroperitoneal lymphadenectomy (SRL) remains controversial in patients with advanced epithelial ovarian cancer (aEOC) who are optimally debulked.

Conclusion:  Our data suggest that aEOC patients with optimal cytoreduction who underwent SRL did not show a significant improvement in survival irrespective of each histological type.

paywalled: Physical Activity, Biomarkers, and Disease Outcomes in Cancer Survivors: A Systematic Review

Physical Activity, Biomarkers, and Disease Outcomes in Cancer Survivors: A Systematic Review:

Background
Cancer survivors often seek information about how lifestyle factors, such as physical activity, may influence their prognosis. We systematically reviewed studies that examined relationships between physical activity and mortality (cancer-specific and all-cause) and/or cancer biomarkers.

Methods
We identified 45 articles published from January 1950 to August 2011 through MEDLINE database searches that were related to physical activity, cancer survival, and biomarkers potentially relevant to cancer survival. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement to guide this review. Study characteristics, mortality outcomes, and biomarker-relevant and subgroup results were abstracted for each article that met the inclusion criteria (ie, research articles that included participants with a cancer diagnosis, mortality outcomes, and an assessment of physical activity).

Results
There was consistent evidence from 27 observational studies that physical activity is associated with reduced all-cause, breast cancer–specific, and colon cancer–specific mortality. There is currently insufficient evidence regarding the association between physical activity and mortality for survivors of other cancers. Randomized controlled trials of exercise that included biomarker endpoints suggest that exercise may result in beneficial changes in the circulating level of insulin, insulin-related pathways, inflammation, and, possibly, immunity; however, the evidence is still preliminary.

Conclusions
Future research directions identified include the need for more observational studies on additional types of cancer with larger sample sizes; the need to examine whether the association between physical activity and mortality varies by tumor, clinical, or risk factor characteristics; and the need for research on the biological mechanisms involved in the association between physical activity and survival after a cancer diagnosis. Future randomized controlled trials of exercise with biomarker and cancer-specific disease endpoints, such as recurrence, new primary cancers, and cancer-specific mortality in cancer survivors, are warranted.

May 7th: The connection between genes and colon cancer (Lynch Syndrome/FAP) - MD Anderson Cancer Center - audio/ iTunes

The connection between genes and colon cancer - MD Anderson Cancer Center

Cancer Newsline - 05/07/2012

About 20% of colon cancer cases are related to a strong family history of colon cancer. Eduardo Vilar-Sanchez, M.D., Ph.D., Assistant Professor in the Department of Clinical Cancer Prevention at The University of Texas MD Anderson Cancer Center, focuses his discussion on the main types of genetic colon cancers including hereditary nonpolyposis colorectal cancer syndrome or HNPCC (also called Lynch syndrome) and familial adenomatous polyposis (FAP).

• Listen to The connection between genes and colon cancer
• Download The onnection between genes and colon cancer on iTunes

paywalled: Body size and breast cancer prognosis in relation to hormone receptor and menopausal status: a meta-analysis

Body size and breast cancer prognosis in relation to hormone receptor and menopausal status: a meta-analysis.

Abstract

Obesity is associated with poor survival after breast cancer diagnosis in individual studies and meta-analyses. Evidence regarding associations of obesity with breast cancer-specific survival (BCSS) and overall survival (OS) in relation to hormone receptor status, or BCSS in relation to menopausal status has not been evaluated in a previous meta-analysis. ............ These findings led us to conclude that there is no evidence showing that the association of obesity with breast cancer outcome differs by hormone receptor or menopausal status. This has implications for studies of weight loss interventions in the adjuvant BC setting.

Drug Data Shouldn’t Be Secret - NYTimes.com

Drug Data Shouldn’t Be Secret - NYTimes.com

"We should not have to wait for patients to be hurt by the medications they take, as recently happened with the diabetes drug Avandia, before reviewing this wealth of data."

Kodak Gallery/Shutterfly FAQ at KODAK Gallery

Kodak Gallery/Shutterfly FAQ at KODAK Gallery

paywalled: Dietary Supplements and Cancer Prevention: Balancing Potential Benefits Against Proven Harms

Dietary Supplements and Cancer Prevention: Balancing Potential Benefits Against Proven Harms

• Accepted March 12, 2012.

Abstract

Nutritional supplementation is now a multibillion-dollar industry, and about half of all US adults take supplements. Supplement use is fueled in part by the belief that nutritional supplements can ward off chronic disease, including cancer, although several expert committees and organizations have concluded that there is little to no scientific evidence that supplements reduce cancer risk. To the contrary, there is now evidence that high doses of some supplements increase cancer risk. Despite this evidence, marketing claims by the supplement industry continue to imply anticancer benefits. Insufficient government regulation of the marketing of dietary supplement products may continue to result in unsound advice to consumers. Both the scientific community and government regulators need to provide clear guidance to the public about the use of dietary supplements to lower cancer risk.

blog: Supplements: Not mystical anticancer magic [Respectful Insolence]

Supplements: Not mystical anticancer magic [Respectful Insolence]:

It's no secret that over the years I've been very critical of a law passed nearly 20 years ago, commonly referred to as the DSHEA of 1994. The abbreviation DSHEA stands for about as Orwellian a name for a law as I can imagine: the Dietary Supplement Health and Education Act. Of course, as we've pointed out time and time again, the DSHEA is not about health, and it's certainly not about education. Indeed, perhaps my favorite description of this law comes from blog bud and all around awesome internist Dr. Peter Lipson, who refers to it as a "travesty of a mockery of a sham." Rather, it's about allowing supplement manufacturers and promoters of so-called "complementary and alternative medicine" (CAM, with or without a preceding "s," depending on your taste) who do not want pesky things like government laws and regulations to interfere with their selling of pseudoscience to market various compounds as "dietary supplements" with near-impunity. As Harriet Hall once put it so accurately, the DSHEA is "a stealth weapon that allows the sale of unproven medicines just as long as you pretend they are not medicines."
The DSHEA accomplishes this by making a seemingly reasonable distinction between food and medicine and twisting it in such a way that allows manufacturers to label all sorts of botanicals and various other compounds, many of which have substances in them with pharmacological activity, and sell them as "supplements" without prior approval by the FDA before marketing.

medical news: Hypoxia Could Drive Cancer Growth

Hypoxia Could Drive Cancer Growth

"Low oxygen levels in cells may be a primary cause of uncontrollable tumor growth in some cancers, according to a new University of Georgia study. The authors' findings run counter to widely accepted beliefs that genetic mutations are responsible for cancer growth.......

paywalled: Science behind cisplatin-induced nephrotoxicity in humans: A clinical study

Science behind cisplatin-induced nephrotoxicity in humans: A clinical study: Publication year: 2012



Objective To investigate the relationship between serum electrolyte changes and cisplatin induced nephrotoxicity.


Conclusions The present study demonstrates that, acute nephrotoxicity was observed in patients with different types of cancers undergoing cisplatin based chemotherapy due to electrolyte disturbances, when no corrective measures were initiated.

Patients fear being seen as ‘difficult': study - Healthcare business news and research | Modern Healthcare

Patients fear being seen as ‘difficult': study - Healthcare business news and research | Modern Healthcare

Medication Errors Result from Current Medication Reconciliation Practices: It’s Time to Adopt Participatory Reconciliation | Journal of Participatory Medicine

Medication Errors Result from Current Medication Reconciliation Practices: It’s Time to Adopt Participatory Reconciliation | Journal of Participatory Medicine

JCO: A Way Forward on the Medically Appropriate Use of White Cell Growth Factors (hematopoietic colony-stimulating factors (CSFs))

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

Discussion points:

• Are Hematopoietic Colony-Stimulating Factors Over- or Underused?
• Table 1. Comparison of Major Guidelines
• How Can These Disparate Conclusions Be Reconciled?
• CSFs for Dose Maintenance in Routine Noncurative Cancer Care
• CSFs Used to Treat FN or Afebrile Neutropenia
• What Is the Harm in Using CSFs?
• Are CSFs a Prudent Use of Societal Resources?
• Why Do Oncologists Prescribe CSFs if There Is Minimal Evidence for Benefit?
• How Did We Arrive at Widespread Use Without Clinical Trial Justification?
• The Way Forward to Evidence-Based Use of CSFs
• Disclosures/REFERENCES

"There are concrete steps the US oncology community can take to foster more evidence-based care. The Quality Oncology Practice Initiative⁵¹ could add overuse as a quality criterion⁵² 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: Financial Hardship: A Consequence of Survivorship? editorial/link to original paper

editorial:
#1:  Financial Hardship: A Consequence of Survivorship?
Editorial: Financial Hardship: A Consequence of Survivorship?


referenced:
#2:  (paywalled) See accompanying article on page 1608 
 Risk Factors for Financial Hardship in Patients Receiving Adjuvant Chemotherapy for Colon Cancer: A Population-Based Exploratory Analysis

paywalled: How Radiation Oncologists Would Disclose Errors: Results of a Survey of Radiation Oncologists and Trainees (patient safety)

How Radiation Oncologists Would Disclose Errors: Results of a Survey of Radiation Oncologists and Trainees

Purpose

To analyze error disclosure attitudes of radiation oncologists and to correlate error disclosure beliefs with survey-assessed disclosure behavior.

Health News - Targeting ovarian cancer - Dr. Robert Bristow finds disparities in access to the top-quality care that boosts survival

Health News - Targeting ovarian cancer

 Dr. Robert Bristow finds disparities in access to the top-quality care that boosts survival

Not all tumor cells are equal: Huge genetic diversity found in cells shed by tumors

Not all tumor cells are equal: Huge genetic diversity found in cells shed by tumors

Nutrition and physical activity guidelines for cancer survivors - 2012 - CA: A Cancer Journal for Clinicians

Nutrition and physical activity guidelines for cancer survivors - 2012 - CA: A Cancer Journal for Clinicians

Medical News: Breast Imaging (thermography) Study Flunks Clinical Test - in Meeting Coverage

Medical News: Breast Imaging Study Flunks Clinical Test - in Meeting Coverage

Patients Share Of Expensive Specialty Drugs Is Rising - Kaiser Health News (choices: eating vs insurance costs...)

Patients Share Of Expensive Specialty Drugs Is Rising - Kaiser Health News

"....The coinsurance was killing them. "It was a choice between that and eating," says Gary Ryness.
Working with an insurance consultant, they switched from a preferred provider organization to a health maintenance organization that didn't have coinsurance charges for self-injectable drugs such as Avonex. Now, they pay nothing for the drug...."



".....many patients who rely on specialty drugs are coping with very serious, long-term medical conditions. "Consumerism" - encouraging patients to shop wisely for health care - doesn't really apply when such patients need drugs for which there are few or no alternatives, says Stone.
"With people as sick as the patients we're talking about, I don't think they're going to say, 'Is there a less expensive injectable drug I can take?' " she says. "It's a whole different dynamic."
Next week: Some states seek to require parity on oral cancer drug coverage.

April 2011 (latest revision) - Alberta, Canada health services recommendations: RISK REDUCTION AND SURVEILLANCE STRATEGIES FOR INDIVIDUALS AT HIGH GENETIC RISK FOR BREAST AND OVARIAN CANCER

RISK REDUCTION AND SURVEILLANCE STRATEGIES FOR INDIVIDUALS AT HIGH GENETIC RISK FOR BREAST AND OVARIAN CANCER Date Developed: December, 2007 Last Revised: April, 2011

National Guideline Clearinghouse | Epithelial ovarian, fallopian tube, and primary peritoneal cancer - Alberta, Canada

Blogger's Note: note the differences in early stage recommendations per cell type

National Guideline Clearinghouse | Epithelial ovarian, fallopian tube, and primary peritoneal cancer.

Guideline Title

Epithelial ovarian, fallopian tube, and primary peritoneal cancer.

Bibliographic Source(s)

 

Alberta Provincial Gynecologic Oncology Tumour Team. Epithelial ovarian, fallopian tube, and primary peritoneal cancer. Edmonton (Alberta): Alberta Health Services, Cancer Care; 2010 Jul. 19 p. (Clinical practice guideline; no. GYNE-005).  [104 references]

Guideline Status

This is the current release of the guideline.

- Scope Methodology Recommendations Evidence Supporting the Recommendations Benefits/Harms of Implementing the Guideline Recommendations

- Qualifying Statements Implementation of the Guideline Institute of Medicine (IOM) National Healthcare Quality Report Categories Identifying Information and Availability Disclaimer

Back to top

Scope

Disease/Condition(s)

• Epithelial ovarian cancer
• Fallopian tube cancer
• Primary peritoneal cancer

Guideline Category

Evaluation Management Treatment

Clinical Specialty

Obstetrics and Gynecology Oncology Radiation Oncology Surgery

Intended Users

Physician Assistants Physicians

 

Guideline Objective(s)

To outline management decisions for women with epithelial ovarian, fallopian tube, or primary peritoneal cancer



Key Points

1. Completely staged, early epithelial ovarian, fallopian tube, and primary peritoneal cancers are highly curable. As such, patients should be referred to a gynecologic oncologist for adequate staging, including sampling of para-aortic and pelvic lymph nodes, infracolic omentectomy, possible appendectomy and biopsy of suspicious peritoneal lesions, in addition to a thorough inspection and palpation of all peritoneal surfaces, and peritoneal washings.
2. Advanced epithelial ovarian, fallopian tube, and primary peritoneal cancers are best treated with optimal debulking surgery in conjunction with adjuvant therapy. As such, patients should be referred to a gynecologic oncologist  

National Guideline Clearinghouse | Palliative radiotherapy.

Blogger's Note: the document reveals only one indication for ovarian cancer and it has been categorized under urogenital bleeding

National Guideline Clearinghouse | Palliative radiotherapy.

Guideline Objective(s)

To provide recommended palliative radiotherapy strategies for adult patients with advanced cancer

Scope  

Disease/Condition(s)

Advanced cancer with:

• Brain metastases
• Malignant epidural spinal cord compression
• Malignant superior vena cava obstruction
• Bone metastases
• Upper aero-digestive tract obstruction, compression, or invasion
• Malignancy-associated urogenital or gastrointestinal bleeding, or hemoptysis

Guideline Category

Management Treatment

Clinical Specialty

Gastroenterology Neurological Surgery Obstetrics and Gynecology Oncology Pulmonary Medicine Radiation Oncology Urology

Bleeding
Recommendations for Urogenital Bleeding

1. External beam radiotherapy has been shown to control hematuria in up to 60 percent of patients with advanced bladder cancer; and control rates of 80 percent at six weeks have recently been reported in patients with advanced prostate cancer. In patients with a life expectancy less than six months, external beam radiotherapy treatment with 8 Gy/1 fraction could be considered. Otherwise, a short course multi-fraction schedule could be considered.
2. In patients with vaginal bleeding who are unsuitable for radical treatment, radiotherapy is effective in resolving bleeding secondary to endometrial or cervical cancer. There is insufficient evidence to recommend an ideal dose and fractionation schedule. Radiotherapy may also be used to control bleeding and palliate pain and mass effect in advanced ovarian cancer.  

paywalled: Clinical implications of pleural effusions in ovarian cancer - Porcel - Respirology - Wiley Online Library

 Blogger's Note: note the use of neoadjuvant therapy in this particular subset of ovarian cancer patients

Clinical implications of pleural effusions in ovarian cancer - Porcel - Respirology

Keywords:

• malignant pleural effusion;
• ovarian cancer;
• thoracoscopy;
• pleurodesis

ABSTRACT

The pleural cavity constitutes the most frequent extra-abdominal metastatic site in ovarian carcinoma (OC). In patients with OC and pleural effusions, a positive fluid cytology is required for a stage IV diagnosis. Unfortunately, about 30% of malignant pleural effusions exhibit false negative cytological pleural fluid results. In those circumstances, exploratory video-assisted thoracoscopic surgery (VATS) serves as a diagnostic, staging and even therapeutic modality. Maximal (no visible disease) or, at least, optimal (no residual implant greater than 1 cm) cytoreduction should be the primary surgical goal in stage IV OC patients. This is due to residual tumor after cytoreductive surgery being one of the most important factors impacting on survival. Although malignant pleural effusions do not preclude abdominal surgical debulking, excision of gross pleural nodules may be necessary to achieve optimal cytoreduction. VATS quantifies pleural tumor burden and allows for intrathoracic cytoreduction or, if the latter is not feasible, ensures that abdominal surgery is not unnecessarily performed on women in whom gross tumor would still remain in the pleural space afterwards. Taxane-platinum neoadjuvant chemotherapy should be offered to this group. Patients with tumor extension into the pleural space have a median overall survival of 2 years.

Insight: Training immune system to fight cancer comes of age | Reuters

 Blogger's Note: not specific to ovarian cancer

Insight: Training immune system to fight cancer comes of age | Reuters


".....While extending life is the gold standard, most cancer drug trials have been deemed successful if tumors shrink or if a treatment can demonstrate a delay in tumor growth or in worsening of the disease, known as progression-free survival (PFS).
But Provenge and Yervoy have extended survival without necessarily impacting PFS or tumor shrinkage in many cases.
"Overall survival is the accurate indicator. Tumors may look bigger because they are filled with immune cells, so they appear worse," said Wolchok. "We've proposed a new set of response criteria to try to incorporate some of this biology.".......

PLoS ONE: Empty Reviews: A Description and Consideration of Cochrane Systematic Reviews with No Included Studies - your opinions?

Blogger's Note/Opinion: gyn cancers - this topic of discussion should be of interest: Cochrane total gyn cancers reviews = #85; empty reviews = #7; because Cochrane synthesizes and analyses systematic reviews,  often the results are inadequate (for patients/providers) in that studies included are: poor quality; lacking in data or are not randomized clinical trials; we often see this as 'further research is required'; many 'argue' that the value of systematic reviews in gyn cancers are dated (as discussed in this article) but part of this issue is the nature of, in particular, ovarian cancer research itself; the other 'issue' for this blogger is the number of systematic reviews which  continually review reviews; (re: reviews that include Cochrane systematic reviews); there needs to be a streamlining of systematic reviews (randomized clinical trial reviews) nominating or permitting one entity/conglomerate - eg. the philosophy of meaningful use, however, therein lies system wide issues within cancer; observational studies are often not included in the reviews and Cochrane is attempting to address this issue within the parameters of the purpose and philosophy of Cochrane itself, still for quality evidence Cochrane remains the leader; note also that Cochrane has always been one of, if not the leader, in including patients/consumers - your thoughts?

PLoS ONE: Empty Reviews: A Description and Consideration of Cochrane Systematic Reviews with No Included Studies

Introduction  

The Cochrane Library is the largest and perhaps best recognized global collection of health care evidence, currently hosting more than 4,500 systematic reviews in its Cochrane Database of Systematic Reviews (CDSR). However, it has been reported that clinicians find Cochrane reviews of limited relevance to practice decisions. For example, one study found that while Cochrane reviews are highly regarded for their quality, they are used less than other sources for clinical decision-making because of their emphasis on methodology and rigor rather than on clinical relevance [1].

It is not Cochrane's policy to provide guidelines for practice or policy decisions [2]. Instead, it sees itself as the provider of best quality evidence and specifically states that guidelines go “beyond a systematic review and require additional information and informed judgments that are typically the domain of clinical practice guideline developers.”
Systematic reviews that find no studies eligible for inclusion, commonly known as “empty reviews,” may be especially problematic for clinicians and other decision-makers. Little is known about the incidence, prevalence or variation in reporting of such reviews [3]. The little that has been written about them suggests that the reporting of implications for practice may sustain a risk for bias. With no studies meeting criteria for inclusion, these empty reviews may appear to: (1) offer no conclusions, (2) offer conclusions based on referenced excluded studies, (3) offer conclusions based on other evidence, or (4) offer conclusions not based on evidence. Thus, empty reviews may contribute to what appears to be generalized disappointment with The CDSR among some clinicians and policymakers [1], [4]........

Conclusions

The stated purpose of Cochrane reviews is to help healthcare providers, consumers, researchers, and policy makers “make well-informed decisions about health care… by providing a reliable synthesis of the available evidence on a given topic… considering all the evidence on the effect of an intervention” [2]......

www.ccocr.org - Guest Speakers - 6th Canadian Conference on Ovarian Cancer Research (patients/ advocates need not apply)

Blogger's Note: unlike the annual SGO programme ovarian cancer patient advocates need not apply (not welcome); survivor's course available for a fee

www.ccocr.org - Guest Speakers