Friday, February 09, 2007
Thursday, February 08, 2007
July 11-13, 2007: Ovarian Cancer National Alliance 10th Anniversary Conference
The Ovarian Cancer National Alliance 10th Anniversary Conference (Washington, DC)
| |||||||||||||
A personal or family history of breast, colon or ovarian cancer may increase your risk for ovarian cancer
Family history includes both your mother and your father’s sides of the family
Friday, January 26, 2007
2007 January: Sunnybrook cancels some cancer surgery
Sunnybrook cancels some cancer surgeryGlobe and Mail - Toronto,Ontario,Canada
TORONTO -- Sunnybrook Health Sciences Centre is cancelling dozens of operations, including those of cancer patients....
2007 January: Wait times for cancer patients decreasing: report - Ontario - reference surgical waits Sunnybrook Regional Cancer Centre
".....Sunnybrook Health Sciences Centre is cancelling dozens of surgeries as it tries to deal with a patient backlog, and those waiting for cancer treatment...."
2007 UK - 3rd annual conference: "Where's the Patient's Voice in Health Professional Education?"
An exceptional opportunity for patients/carers and healthcare professionals.
Sunday, December 31, 2006
Entrez PubMed
Entrez PubMed: "Adjuvant chemotherapy with irinotecan hydrochloride and cisplatin for clear cell carcinoma of the ovary."
Friday, December 29, 2006
Friday, December 22, 2006
Saturday, December 02, 2006
Friday, December 01, 2006
CancerWise - December 2006 - Trial Studies Ovarian Cancer Screening Test
CancerWise - December 2006 - Trial Studies Ovarian Cancer Screening Test
Trial Studies Ovarian Cancer Screening Test
Healthy Postmenopausal Women Being Recruited
Should women be screened for ovarian cancer? Researchers hope to answer that question through a new study in which blood and urine samples from healthy, postmenopausal women are collected and analyzed.
Goal of study
M. D. Anderson researchers conducting the Low-Risk Ovarian Cancer Study hope the clinical trial and others like it one day may lead to a more effective screening test to increase early detection of the disease.
“Unfortunately, there’s no effective screening test, like the mammogram or colonoscopy, to detect ovarian cancer at an early stage when the chance of cure is greatest,” says Karen Lu, M.D., associate professor in M. D. Anderson’s Department of Gynecologic Oncology. “As a result, more than two-thirds of all ovarian cancers are found at an advanced stage.”
The purpose of the study is to not only evaluate a blood marker called CA-125 over a period of time, but also to create new markers for ovarian cancer detection. Urine also will be collected so that its proteins can be used to help create new markers.
ScienceDirect - Gynecologic Oncology : Screening for ovarian cancer by transvaginal ultrasound and serum CA125 measurement in women with a familial pr
ScienceDirect - Gynecologic Oncology : Screening for ovarian cancer by transvaginal ultrasound and serum CA125 measurement in women with a familial predisposition: A prospective cohort study: "Screening for ovarian cancer by transvaginal ultrasound and serum CA125 measurement in women with a familial predisposition: A prospective cohort study"
Thursday, November 30, 2006
Thursday, November 23, 2006
How much will Herceptin really cost? -- Barrett et al. 333 (7578): 1118 -- BMJ
How much will Herceptin really cost? -- Barrett et al. 333 (7578): 1118 -- BMJ: "So we could fund Herceptin if we did not treat 355 patients receiving adjuvant treatment (16 of whom would be cured) or 208 patients receiving palliative chemotherapy, and if we found �0.5m from another source. These untreated patients will be people we know. We will be the ones to tell them they are not getting a treatment that has been proved to be effective, which costs relatively little, because it is not the 'treatment of the moment.'"
Entrez PubMed
Entrez PubMed: "Clinical characteristics of patients with sporadic colorectal cancer and primary cancers of other organs"
Tuesday, November 21, 2006
Monday, November 20, 2006
2006 November - Cancer - Our National Shame - The killing cost of drug treatment
globeandmail.com: The killing cost of drug treatment
http://tinyurl.com/ykrl7s
Cancer: Our national shame
The killing cost of drug treatment
For a health-care system based on the principle of equal access, the reality is tragically different
Sunday, November 19, 2006
BMJ: Breast Cancer News - Internet-Based Information Highly Accurate in Internet Breast Cancer Support Groups
* The information in the postings was highly accurate.
* Only 0.22% of postings had false or misleading information.
* 70% of the false or misleading postings were corrected by other participants in the support groups within a median time of four hours and 33 minutes.
Monday, November 13, 2006
Saturday, November 11, 2006
2006 Nov/Dec: Impact of an Educational Video on Patient Decision Making in Early Breast Cancer Treatment
589.pdf (application/pdf Object)
Journal of Medical Decision Making - November/December 2006 issue - full text
Tuesday, November 07, 2006
Monday, November 06, 2006
Sunday, November 05, 2006
Saturday, November 04, 2006
2006 Ovarian cancer: Patterns of surgical care across the United States
Gynecologic Oncology
Volume 103, Issue 2 , November 2006, Pages 383-390
Ovarian cancer: Patterns of surgical care across the United States
Barbara A. Goffa, Corresponding Author Contact Information, E-mail The Corresponding Author, Barbara J. Matthewsb, Michelle Wynnc, 1, Howard G. Muntzd, Denise M. Lishnerb and Laura-Mae Baldwinb
aDepartment of Obstetrics and Gynecology, Box 356460, University of Washington School of Medicine, Seattle, WA 98195, USA
bDepartment of Family Medicine, University of Washington School of Medicine, Seattle, WA 98195, USA
cDivision of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
dSection of Gynecology and Gynecologic Oncology, Virginia Mason Medical Center, Seattle, WA 98101, USA
Received 28 June 2006. Available online 26 September 2006.
Abstract
Objective.
To describe the primary surgical procedures and procedures for intraoperative and postoperative complications, and factors associated with these procedures, in women with ovarian cancer.
Methods.
Using hospital discharge data from nine states, obtained from the Heath Care Cost and Utilization Project from 1999 to 2002, we evaluated 10,432 women with a primary diagnosis of ovarian cancer who underwent at least an oophorectomy for additional procedural ICD-9 codes during their initial hospitalization.
Results.
Surgical procedures performed in addition to oophorectomy included: omentectomy/debulking 81.9%, hysterectomy 73.4%, lymph node dissection 41.4%, appendectomy 23.8%, bowel procedures 19.8%, laparoscopy 5.6%, diaphragmatic procedures 4.9%, colostomy 3.5%, and splenectomy 1.2%. Transfusions were given to 15.5% of patients. Intraoperative and postoperative procedures for complications were coded in 7.4% of patients, including repair of surgical injury 3.5%, procedures for cardiopulmonary complications 2.8%, reoperation 1.1%, and infection treatment 0.3%. In early stage disease 21.4% of women received no additional staging procedures and 46.8% did not have nodal sampling. In bivariate analysis of crude rates, factors associated with lymph node dissection were patient age, race, payer, teaching hospital status, hospital and surgeon volume, and surgeon specialty, p < .01. for all observations. Colostomies were performed by general surgeons in 23.1% of cases, by gynecologic oncologists in 2.7% of cases, and by obstetrician/gynecologists in no cases, p < .001. Complications were associated with age, payer, median household income, and stage, p < .001 for all observations. Complication rates were similar for low- and high-volume hospitals and surgeons. However, in higher volume settings, significantly more patients received debulking procedures, lymph node dissections, and additional surgical procedures, p < .001 for all observations.
Conclusions.
A significant percentage of women with ovarian cancer did not receive recommended surgical procedures. Almost 50% of women with early stage disease were not adequately staged and in women with advanced disease, the percentage who had additional surgical procedures such as bowel resections was much lower than in institutions that report high optimal cytoreduction rates.
Keywords: Ovarian cancer; Surgical care
2006: Waiting times for cancer surgery in Ontario/worse outcomes: 1984-2000
CONCLUSIONS: Waiting times for cancer surgery increased substantially between 1984 and 2000. Waiting times were influenced by disease, patient and health-system-related factors.
006 The Lancet Oncology: Cancer care: WHO's poor relation
OR pdf file:
http://download.thelancet.com/pdfs/journals/1470-2045/PIIS1470204506709123.pdf
Monday, October 30, 2006
New Warnings to Avastin - nasal septum perforation - RPLS
September 26, 2006 — The US Food and Drug Administration (FDA) and
> Genentech, Inc, have notified healthcare professionals regarding
> safety labeling revisions for bevacizumab injection (Avastin) that
> warn of potential risks for reversible posterior leukoencephalopathy
> syndrome (RPLS) and nasal septum perforation associated with its use.
Saturday, September 16, 2006
September 11, 2006: Annamarie DeCarlo - Washington, DC - Congressional Briefing Ovarian Cancer
Annamarie DeCarlo
Sept. 11, 2006:
Greetings -- After watching Dr. Wolf's presentation on mice and ovarian cancer, I want to make it clear to all of you:
I AM NOT A MOUSE!!!
My name is Annamarie DeCarlo, and I live in Annapolis, Maryland.
I want you to take a good, long look at my face.
I want you to remember me, this face: my green eyes, my Hair by Manuel, my newly straightened bottom teeth, my too short chin, my fair complexion, (the “beauty” of which I attribute to “better living through chemotherapy.")
It also is the face of my mother, Concetta Goetzinger, who died of advanced ovarian cancer at age 68 on Oct. 12, 2000, five months before I was diagnosed with advanced ovarian cancer during a hysterectomy for endometriosis.
I was monitored carefully during her illness -- multiple transvaginal ultrasounds, blood tests, CT scans, and bimanual pelvic examinations, yet still was diagnosed -- by accident -- during surgery for another condition.
BY ACCIDENT. That should shake every single person in this room to the bone.
This kind of "accidental" diagnosis must stop. We MUST help researchers and physicians develop an effective screening tool to detect this cancer in its early, most curable stages.
I really could stop right here, as I believe these are enough reasons for me to persuade you to continue to push for more research and more education for ovarian cancer and all gynecologic cancers.
But I want you to remember me because, like New York Yankee baseball great Lou Gehrig, I am one of the luckiest people on the face of the earth.
I am one of the 30 or so percent of late-stage ovarian cancer survivors who live 5 years past diagnosis. Come on! We can AND MUST do better than 30 percent!
My survivorship is less about me than I ever expected it would be. I slogged through my six treatments of chemotherapy -- taxol and cisplatin -- repeating as I dragged myself to work every day that "chemo is my friend, chemo is my friend."
The treatment is hard, and it is debilitating. It takes a long time -- years -- for your body to rebuild itself from the toxic cocktails. And that’s if you are among the lucky ones to respond well to front-line treatment, not have co-morbid conditions, and not recur!
I still anxiously await test results, even after more than 5 years. I know how this cancer behaves. It is insidious and it is relentless. It comes back more often than not.
I have been loved and cherished by my husband, my family, my friends, my medical team, and my extended family of ovarian cancer survivors and their caregivers.
I still wonder about the future, and how much of a future awaits me. As one of my ovarian survivor friends says, "You'll know you've beaten ovarian cancer when you die of something else."
I have survived more than 5 years and I have a future because of the diligent, tireless efforts of researchers and physicians who are working so hard to develop an effective screening test and working so hard to develop innovative treatments.
I have a future because of the women who have gone before me, some living and some dead, who are or were brave enough and desperate enough to try anything to stay alive.
Some of these women endured 12 to 18 treatments of what was the "gold standard" when I was treated 5 years ago. I have often wondered how I would have endured an additional 6 or 12 rounds. These women are my heroes.
My survivorship also is about the following women, my cherished friends, from whom I have learned more than I can properly tell you about courage, about faith, about “smarts.”
My survivorship is about Kelli Auletta who died Feb. 19 at age 38.
It is about Judi Watson, who died March 8 at age 56.
It is about Stephanie Whitaker, who died March 9 at age 38.
It is about Rita Lewis, who died Aug. 4 at age 52.
It is about Shirley, who has been on continuous treatment for 10 YEARS. Imagine that: 10 YEARS!
It is about Cindy, who has been exploring all combinations of drugs and treatments for 4 years.
It is about Helen, a 19-year late-stage survivor, who still is alive and healthy because of innovative treatments and clinical trials.
It is about Fran, who, after 5 years of various chemo combos, surgeries, infections, and all kinds of secondary problems, today lies in a hospice bed.
It is about Annie, who made that same difficult decision last week, after years of dealing with treatment that failed her.
These all are educated, intelligent, thoughtful women, broadsided by a cancer that has confusing symptoms, and jerked around by a medical system that continually misdiagnoses this cancer because there is no screening tool.
There also must be a national effort -- on par with the campaigns being waged against breast cancer (get your mammogram!) and colon cancer (get your colonoscopy!) and lung cancer (don‘t smoke!) -- to develop an early detection and awareness campaign for women and their health care providers.
Sheryl Silver, who lost her sister Johanna Silver Gordon to ovarian cancer, already has done the work regarding a national effort, writing Johanna’s Law (HR. 1245 and S. 1172). It is disgraceful and unacceptable that this proposed legislation has not been passed into law by the Congress of the United States of America. I wonder sometimes: do these decision makers have women in their lives?
We must give our health care providers the tools they need so no more women are diagnosed with a deadly cancer by accident, as I was.
We must give the women in this country -- and, by extension, women around the world -- a fighting chance to survive ovarian cancer.
If you believe this is “someone else’s problem,” or you don’t believe you personally have anything at stake, ask yourself these questions:
Are you a woman? Do you have a mother? Do you have a wife? Do you have a girlfriend? Do you have a daughter? Do you have any female friends?
If you answer “yes” to any of these questions, you have a stake in the development of a reliable screening test and a national outreach program.
Remember my face. I am a survivor. And one of the luckiest people on the face of the earth.
Thank you.
Annamarie, Annapolis
September 11, 2006: Annamarie DeCarlo - speech Washington, DC - Congressional Briefing
Sept. 11, 2006:
Greetings -- After watching Dr. Wolf's presentation on mice and ovarian cancer, I ant to make it clear to all of you:
I AM NOT A MOUSE!!!
My name is Annamarie DeCarlo, and I live in Annapolis, Maryland.
I want you to take a good, long look at my face.
I want you to remember me, this face: my green eyes, my Hair by Manuel, my newly straightened bottom teeth, my too short chin, my fair complexion, (the “beauty” of which I attribute to “better living through chemotherapy.")
It also is the face of my mother, Concetta Goetzinger, who died of advanced ovarian cancer at age 68 on Oct. 12, 2000, five months before I was diagnosed with advanced ovarian cancer during a hysterectomy for endometriosis.
I was monitored carefully during her illness -- multiple transvaginal ultrasounds, blood tests, CT scans, and bimanual pelvic examinations, yet still was diagnosed -- by accident -- during surgery for another condition.
BY ACCIDENT. That should shake every single person in this room to the bone.
This kind of "accidental" diagnosis must stop. We MUST help researchers and physicians develop an effective screening tool to detect this cancer in its early, most curable stages.
I really could stop right here, as I believe these are enough reasons for me to persuade you to continue to push for more research and more education for ovarian cancer and all gynecologic cancers.
But I want you to remember me because, like New York Yankee baseball great Lou Gehrig, I am one of the luckiest people on the face of the earth.
I am one of the 30 or so percent of late-stage ovarian cancer survivors who live 5 years past diagnosis. Come on! We can AND MUST do better than 30 percent!
My survivorship is less about me than I ever expected it would be. I slogged through my six treatments of chemotherapy -- taxol and cisplatin -- repeating as I dragged myself to work every day that "chemo is my friend, chemo is my friend."
The treatment is hard, and it is debilitating. It takes a long time -- years -- for your body to rebuild itself from the toxic cocktails. And that’s if you are among the lucky ones to respond well to front-line treatment, not have co-morbid conditions, and not recur!
I still anxiously await test results, even after more than 5 years. I know how this cancer behaves. It is insidious and it is relentless. It comes back more often than not.
I have been loved and cherished by my husband, my family, my friends, my medical team, and my extended family of ovarian cancer survivors and their caregivers.
I still wonder about the future, and how much of a future awaits me. As one of my ovarian survivor friends says, "You'll know you've beaten ovarian cancer when you die of something else."
I have survived more than 5 years and I have a future because of the diligent, tireless efforts of researchers and physicians who are working so hard to develop an effective screening test and working so hard to develop innovative treatments.
I have a future because of the women who have gone before me, some living and some dead, who are or were brave enough and desperate enough to try anything to stay alive.
Some of these women endured 12 to 18 treatments of what was the "gold standard" when I was treated 5 years ago. I have often wondered how I would have endured an additional 6 or 12 rounds. These women are my heroes.
My survivorship also is about the following women, my cherished friends, from whom I have learned more than I can properly tell you about courage, about faith, about “smarts.”
My survivorship is about Kelli Auletta who died Feb. 19 at age 38.
It is about Judi Watson, who died March 8 at age 56.
It is about Stephanie Whitaker, who died March 9 at age 38.
It is about Rita Lewis, who died Aug. 4 at age 52.
It is about Shirley, who has been on continuous treatment for 10 YEARS. Imagine that: 10 YEARS!
It is about Cindy, who has been exploring all combinations of drugs and treatments for 4 years.
It is about Helen, a 19-year late-stage survivor, who still is alive and healthy because of innovative treatments and clinical trials.
It is about Fran, who, after 5 years of various chemo combos, surgeries, infections, and all kinds of secondary problems, today lies in a hospice bed.
It is about Annie, who made that same difficult decision last week, after years of dealing with treatment that failed her.
These all are educated, intelligent, thoughtful women, broadsided by a cancer that has confusing symptoms, and jerked around by a medical system that continually misdiagnoses this cancer because there is no screening tool.
There also must be a national effort -- on par with the campaigns being waged against breast cancer (get your mammogram!) and colon cancer (get your colonoscopy!) and lung cancer (don‘t smoke!) -- to develop an early detection and awareness campaign for women and their health care providers.
Sheryl Silver, who lost her sister Johanna Silver Gordon to ovarian cancer, already has done the work regarding a national effort, writing Johanna’s Law (HR. 1245 and S. 1172). It is disgraceful and unacceptable that this proposed legislation has not been passed into law by the Congress of the United States of America. I wonder sometimes: do these decision makers have women in their lives?
We must give our health care providers the tools they need so no more women are diagnosed with a deadly cancer by accident, as I was.
We must give the women in this country -- and, by extension, women around the world -- a fighting chance to survive ovarian cancer.
If you believe this is “someone else’s problem,” or you don’t believe you personally have anything at stake, ask yourself these questions:
Are you a woman? Do you have a mother? Do you have a wife? Do you have a girlfriend? Do you have a daughter? Do you have any female friends?
If you answer “yes” to any of these questions, you have a stake in the development of a reliable screening test and a national outreach program.
Remember my face. I am a survivor. And one of the luckiest people on the face of the earth.
Thank you.
Annamarie, Annapolis
2006 Ovary Removal Raises Young Women's Death Risk - surgical menopause and ERT recommendation
09.15.06, 12:00 AM ET
FRIDAY, Sept. 15 (HealthDay News) -- Younger women who have had their ovaries removed should consider estrogen therapy if they are under the age of 45, a new study suggests.
Monday, August 21, 2006
2006 Bevacizumab (Avastin) combination therapy in recurrent, platinum-refractory epithelial ovarian carcinoma: a retrospective analysis
Review:
Cancer. 2006 Jul 1;107(1):83-9.Click here to read Links
Bevacizumab combination therapy in recurrent, platinum-refractory epithelial ovarian carcinoma: A retrospective analysis.
* Wright JD,
* Hagemann A,
* Rader JS,
* Viviano D,
* Gibb RK,
* Norris L,
* Mutch DG,
* Powell MA.
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri 63110, USA. wrightj@msnotes.wustl.edu
BACKGROUND: The study was undertaken to determine the safety and efficacy of the monoclonal, antivascular endothelial growth factor antibody bevacizumab in combination with cytotoxic chemotherapy for women with platinum-refractory ovarian cancer.
METHODS: A retrospective analysis of women who received bevacizumab in combination with a cytotoxic agent was performed. Response was determined by measurable disease or assessment of serial cancer antigen (CA) 125 measurements.
RESULTS: Twenty-three patients were identified. The patients were heavily pretreated with a median of 7 prior regimens including a median of 3 prior platinum regimens. The combination regimen included cyclophosphamide in 15 (65%), 5-fluorouracil (5-FU) in 6 (26%), docetaxel in 1 (4%), and gemcitibine/liposomal doxorubicin in 1 (4%). Two (9%) women developed chylous ascites during treatment. CTC Grade 4-5 toxicities occurred in 4 (17%) subjects. Gastrointestinal perforation occurred in 2 (9%) patients. Measurable disease was present in 22. The overall best response rate was 35% and all 8 were partial responses (PRs). Stable disease was found in a further 10 (44%) women, whereas progressive disease was observed in 5 (22%). The median time to progression was 5.6 months in patients with a PR and 2.3 months in subjects with stable disease. Three (13%) women experienced a progression-free interval (PFI) of >6 months. At last follow-up, 8 (35%) subjects had died of disease, whereas 15 (65%) women were alive with disease.
CONCLUSIONS: Combination bevacizumab therapy demonstrated activity in heavily pretreated women with ovarian cancer. Gastrointestinal perforations were identified in 9%. Despite the toxicity of the regimen, prospective studies, particularly in less heavily pretreated patients, are warranted. Copyright 2006 American Cancer Society.
PMID: 16736514 [PubMed - indexed for MEDLINE]
Wednesday, July 26, 2006
Monday, July 24, 2006
2006 Whitby, Ontario - Ovarian Cancer Get Together
Letter of thanks to local business community on behalf of our ovarian cancer community:
Sandi Pniauskas
117 Glen Hill Drive
Whitby, Ontario, Canada L1N 6Z8
tel: 905 668-0767 fax: 905 666-0188
email: sandipn@sympatico.ca
Monday, July 24, 2006
Mr. Craig Gilpin
President
c/o Sobeys Canada
6355 Viscount Road
Mississauga, Ontario
L4V 1W2
Dear Mr. Gilpin:
Re: Ovarian Cancer Community, Whitby, Ont. July 22nd, 2006
On behalf of our ovarian cancer women/carers, may we express our thanks to Janet/Joe Glover (Oshawa); Nick Lucarelli/Tom Theodore (Whitby) and Alan Risk (Retail Stores, Ontario) for their generous donation(s). Your staff, as individuals and members of the community, recognized the significance of this unique event and the positive responses were sincerely appreciated.
Our unique ovarian cancer survivourship event was coordinated solely for and by survivours/carers. Participants included Canada, U.S., England and Australia. Given the success of our event, we have established a new ovarian cancer tradition. Both Chicago (2007) and Annapolis (2008) are now being organized and requests have been made for 2009. The profound sense of accomplishment in recognizing the power of the individual – the human connection was exceptional. Our positive experience with Sobeys staff confirms for us that you are well-represented in this area of human compassion and need.
Please accept and extend our thanks for recognizing and proactively supporting those in our ovarian cancer community(s).
Sincerely;
Sandi Pniauskas
Ovarian Cancer Survivour
cc: Alan Risk
Tuesday, June 13, 2006
Thursday, June 01, 2006
May 30th, 2006: Launch of Nation-wide study for early detection of ovarian cancer
CNW Group Portfolio E-Mail
MCGILL UNIVERSITY
MCGILL UNIVERSITY
UNIVERSITY OF CALGARY
UNIVERSITY OF CALGARY
Transmitted by CNW Group on : May 30, 2006 13:04
Launch of Nation-wide study for early detection of ovarian cancer
MONTREAL, May 30 /CNW Telbec/ - A multidisciplinary team of researchers
from the McGill University Health Centre (MUHC), and the universities of
Sherbrooke, Laval, Quebec, McGill and Calgary have launched a multi-centre
study designed for early identification of women at risk of ovarian cancer
(OC).
The study known as "DOVE - Detecting OVarian Cancer Earlier" is the
initiative of gynecological oncologist, Dr Lucy Gilbert of the McGill
University Health Centre (MUHC). Gilbert and a team of gynecological
oncologists, family practitioners, general gynecologists, mathematicians,
epidemiologists and scientists from centres across Canada have combined their
medical expertise to defeat this disease. Although ovarian cancer is
considered "the silent killer", there are numerous studies that show that
women with ovarian cancer are symptomatic but unfortunately because the signs
are vague and non-specific in nature, they are ignored by women and their
doctors.
"Ovarian cancer is the fourth leading cause of cancer death in women and
deadliest of the gynecological cancers" says Dr. Lucy Gilbert, the principal
investigator in the study. "The statistics are alarming and a reliable
assessment tool to detect this disease early and while it is treatable (in
stage 1 of the disease) must be developed without delay. We owe this to women
and the DOVE team is determined to work on achieving this goal," she explains.
Of the 2400 new women diagnosed each year more than 75% will die from the
disease. Four women die per day in Canada from ovarian cancer because most are
diagnosed in the advanced stages of the disease (stages 2 and 3). However, if
the cancer is detected early (at stage 1) more than 80% will survive.
"By the time women present to us with ovarian cancer over 60% are already
at stage three and four - very advanced stages of the cancer" says
gynecological oncologist, Dr. Prafull Ghatage of Calgary's Tom Baker Cancer
Centre. "Even with heroic efforts at surgery followed by the best available
chemotherapy combination we are able to achieve long term survival in only
about 20%".
"Screening women without clearly defined / recognized symptoms is not
recommended by the Canadian Task Force on the Periodic Health Examination and
the U.S. Preventive Services Task Force because it results in unnecessary
major surgery and has the potential to do more harm than good", says Dr Michel
Roy of University of Laval. "In the DOVE trial we are working with women who
have indications of OC to clearly profile a cluster of symptoms from the 70 or
so non-specific symptoms that would identify women with a high likelihood of
having the disease", adds Roy who is the president of the 'Regroupement des
Gynécologues-Oncologues du Québec'.
Dr Martin Dawes, Chair of Family Medicine at McGill, and director of
Family Medicine at the MUHC explains, "The challenge for doctors who first see
the patient is to identify those who do need urgent investigations from those
who do not." The Dove study is designed to further ensure that the predictive
tool we recommend to family doctors and general gynecologists profiles ovarian
cancer as precisely as possible, so the system is neither swamped by
over-investigating, nor is there undue delay in identifying women with cancer.
"The only way to defeat this deadly disease is if primary, secondary and
tertiary care services work as real partners', he emphasizes.
Epidemiologists, Dr.Marie-Elise Parent of Institut Armand-Frappier,
University of Quebec, and Dr. James Hanley of McGill University will be
instrumental in ensuring that the predictive tool is refined and tested in
three phases to ensure that it profiles early ovarian cancer as precisely as
possible. "In Phase I we will identify an accurate symptom profile and develop
a reliable diagnostic tool to detect ovarian cancer. In phase II we will
refine and validate this tool and by phase three, we will be able to take the
prediction tool and apply it to the community to fast-track women with
suspected OC", says Dr. Duarte-Franco, the trial coordinator.
In addition to identifying women with OC symptoms early, the Dove trial
will also allow scientists to compare large numbers of cancer patients with
controls, identifying not just the clinical or symptom profiles of women with
ovarian cancer, but also their molecular biology profile. Dr. Michel Tremblay,
Director of the McGill Cancer Centre, and his team will work on identifying
genetic and proteonomic markers that may allow detection of the disease even
before symptoms set in.
About the McGill University Health Centre (MUHC)
The McGill University Health Centre (MUHC) is a comprehensive academic
health institution with an international reputation for excellence in clinical
programs, research and teaching. The MUHC is a merger of five teaching
hospitals affiliated with the Faculty of Medicine at McGill University--the
Montreal Children's, Montreal General, Royal Victoria, and Montreal
Neurological Hospitals, as well as the Montreal Chest Institute. Building on
the tradition of medical leadership of the founding hospitals, the goal of the
MUHC is to provide patient care based on the most advanced knowledge in the
health care field, and to contribute to the development of new knowledge.
For more information on the DOVE study please contact: Dr. Eliane D.
Franco at (514) 398-2278.
-30-
/For further information: Seeta Ramdass, Public Relations &
Communications Coordinator, McGill University Health Centre Public Relations &
Communications Services, (514) 843-1560/
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Media Advisory - McGill/Calgary: Press Conference on Early Detection of Ovarian Cancer
CNW Group Portfolio E-Mail
MCGILL UNIVERSITY HEALTH CENTRE
Transmitted by CNW Group on : May 29, 2006 13:43
Media Advisory - Press conference on early detection of ovarian cancer
MONTREAL, May 29 /CNW Telbec/ - A multidisciplinary team of researchers
from the MUHC, and the universities of Sherbrooke, Laval, Quebec and Calgary
announce some important news about women at risk of ovarian cancer (OC).
"Ovarian cancer is the fourth leading cause of cancer death in women and
deadliest of the gynecological cancers," says Dr. Lucy Gilbert, Gynecological
Oncologist of the MUHC. "The statistics are alarming." Of the 2400 new women
diagnosed each year more than 75% will die from the disease. Scientists from
various regions of Canada are combining their expertise to defeat this deadly
disease.
<<
Date: Press Conference: Tuesday May 30, 2006
Time: 10 a.m.
Location: MUHC CUSM, Royal Victoria Hospital, 687, Pine Ave.
(Pine and Peel entrance) Room: Primrose Amphitheatre, F3.10
Who: - Dr. Lucy Gilbert, MUHC Gynecologist-Oncologist
- Dr. Michel Roy, Gynecologist-Oncologist, University of
Laval and President of 'Regroupement des Gynécologues-
Oncologues du Québec'
- Dr. Michel Tremblay, Director of the McGill Cancer Centre
- Dr. Marie-Elise Parent, Epidemiologist, Institut Armand-
Frappier, University of Quebec
>>
MEDIA: For Parking: Please take Pine Ave and Peel entrance, follow the
signs to Pavillon des Femmes / Women's Pavillion. You will be greeted by MUHC
PRC staff in the main lobby of this pavilion (F4) at 9:50 am.
-30-
/For further information: Seeta Ramdass, Public Relations &
Communications Coordinator, McGill University Health Centre Public Relations &
Communications Services, (514) 843-1560/
MCGILL UNIVERSITY HEALTH CENTRE - More on this organization
News Releases
News Releases
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Friday, May 19, 2006
2006 Clear cell carcinoma of the ovary: a retrospective multicentre experience of 254 patients with complete surgical staging
Clear cell carcinoma of the ovary: a retrospective multicentre experience of 254 patients with complete surgical staging
http://www.nature.com/bjc/journal/v94/n10/pdf/6603116a.pdf
Is Tumor Immunity the Same Thing As Autoimmunity? Implications for Cancer Immunotherapy
Is Tumor Immunity the Same Thing As Autoimmunity? Implications for Cancer Immunotherapy
Howard L. Kaufman, Jedd D. Wolchok
Columbia University and Memorial Sloan-Kettering Cancer Center, New York, NY
http://www.jco.org/cgi/content/full/24/15/2230?etoc
Importance of Surgical Aggressiveness in Advanced Ovarian Cancer
Giovanni D. Aletti, William A. Cliby
Department of Obstetrics and Gynecology, Mayo Clinic and Foundation, Rochester, MN
http://www.jco.org/cgi/reprint/24/15/2397.pdf
Aggressive Surgery and Ovarian Cancer
Journal of Clinical Oncology, Vol 24, No 15 (May 20), 2006: pp. 2395-2396
© 2006 American Society of Clinical Oncology
DOI: 10.1200/JCO.2005.05.4890
http://www.jco.org/cgi/reprint/24/15/2395.pdf
Saturday, May 06, 2006
May 31st FREE seminar - "Ovarian Cancer: What You Need to Know" - seminar
Ovarian Cancer - What You Need to Know
(please share and distribute this notice to others whom might benefit)
Presentations and Discussions by:
Sandi Pniauskas, ovarian cancer survivour/patient advocate
Cathy Chapman, caregiver
Pamela J. West, oncology nurse practiticoner
This presentation is an overview of the basics of Ovarian Cancer and the related risk factors.
sponsored by: Whitby Central Library, Whitby, Ont
Wednesday, May 31st, 2006
7:00 - 10:00 p.m. Meeting Room 1B
Please call 905 668-6531 ext. 2020 to register for this FREE program
Whitby Main Library website (events): http://www.whitbylibrary.on.ca/programs.php?cat=e
"Ovarian Cancer - Plant For Life"
For further information contact: Cathy Chapman: 1-905-579-2170 or cathy_f_chapman@yahoo.com
Ovarian Cancer-Plant for Life
It's a family affair!
Take a 2.5 km walk in Oshawa's Lakeview Park and plant a daffodil along the way to remember someone who touched your life. Bring a friend and the kids - plant for life!
When: Sunday, May 28th, 2006
Where: Lakeview Park, Oshawa, Ontario (starts at Southmead Park)
Time: 9 am - 3 pm
All proceeds go the Princess Margaret Hospital, Toronto, Ontario in support of ovarian cancer
Special thanks for support to: friends, family, Eastdale Collegiate Band and the Co-operators Insurance (Bowmanville, Ontario)
Sunday, April 23, 2006
Stage matters: choosing relevant model systems to address hypotheses in diet and cancer chemoprevention research -- Fenton and Hord 27 (5): 893 -- Car
Stage matters: choosing relevant model systems to address hypotheses in diet and cancer chemoprevention research -- Fenton and Hord 27 (5): 893 -- Carcinogenesis
Abstract:
http://carcin.oxfordjournals.org/cgi/content/abstract/27/5/893
* Carcinogenesis
* Volume 27, Number 5
* Pp. 893-902
Carcinogenesis Advance Access originally published online on February 10, 2006
Carcinogenesis 2006 27(5):893-902; doi:10.1093/carcin/bgi355
This Article
REVIEW
Stage matters: choosing relevant model systems to address hypotheses in diet and cancer chemoprevention research
Jenifer I. Fenton 1, 2, * and Norman G. Hord 2
1 Cancer Prevention Fellowship Program, Division of Cancer Prevention, National Cancer Institute, Bethesda, MD 20892, USA and 2 Department of Food Science and Department of Human Nutrition, Michigan State University, East Lansing, MI 48824, USA
Clinical evidence reveals that the efficacy of dietary factors to prevent cancer is probably stage-dependent.
The ability to demonstrate stage-specific effects of dietary compounds on normal, preneoplastic and malignant cell models may provide insights into puzzling clinical results from cancer chemoprevention trials. The relevance of these models to the field of cancer prevention is immense and will undoubtedly facilitate the ability to discover which dietary factors are most effective at preventing cancer and which, if any, specific steps in neoplastic transformation render cells refractory to the effects of dietary compounds. There are illustrative examples where exposure of high-risk individuals to dietary chemopreventive agents increases rather than decreases cancer risk. While geneticists and clinical oncologists acknowledge the morphological continuum along which tumors develop in specific tissues, tumor cells, rather than normal and preneoplastic cells, continue to be the primary in vitro reductionist tool employed to elucidate mechanisms underlying disease progression and to investigate the potential utility of dietary as well as other chemopreventive agents. Currently, there are few relevant model systems to study the progression of neoplastic transformation, especially in epithelial cells. We highlight examples of model systems isolated from prostate, breast, endometrial and intestinal tissue, with special emphasis on a specific set of non-tumorigenic, conditionally immortal cell lines derived from C57/BL6 mice [YAMC (Young Adult Mouse Colon cells; Apc+/+) cells and IMCE (Immorto-Min Colonic Epithelium cells; ApcMin/+) cells] that have yielded important information on early events in colorectal neoplasia development. These cell lines are an illustrative example of how researchers can examine stage-dependent effects of specific dietary components on carcinogenesis. The utilization of cell culture systems modeling early, middle and late stages of tumorigenesis will yield important insights into mechanisms by which dietary components impact cancer progression.
Online ISSN 1460-2180 - Print ISSN 0143-3334
Copyright © 2006 Oxford University Press
Oxford Journals Oxford University Press
Friday, April 21, 2006
Society of Gynecologic Oncologists :: New Study Establishes Criteria to Detect Ovarian Cancer Malignancy in Asymptomatic Postmenopausal Women
Society of Gynecologic Oncologists :: New Study Establishes Criteria to Detect Ovarian Cancer Malignancy in Asymptomatic Postmenopausal Women
New Study Establishes Criteria to Detect Ovarian Cancer Malignancy in Asymptomatic Postmenopausal Women
New Study Establishes Criteria to Detect Ovarian Cancer Malignancy in Asymptomatic Postmenopausal Women
PALM SPRINGS, Calif., March 24 /PRNewswire/ -- Reporting on the largest study of its kind today at the Society of Gynecologic Oncologists 37th Annual Meeting on Women's Cancer, researchers presented new criteria for detecting ovarian cancer malignancy in postmenopausal asymptomatic women, 55 to 74 years old. Utilizing the new criteria, researchers determined that they could accurately predict 93 percent of the advanced ovarian cancers and 87 percent of the early ovarian cancers in asymptomatic women enrolled in an annual screening program and found to have an abnormal screen..
The study, "Determining the Risk of Ovarian Malignancy in Postmenopausal Women with Abnormal Findings in the PLCO Screening Trial: A Guide for Physicians," was led by Edward E. Partridge, M.D., University of Alabama at Birmingham, Birmingham, AL.
"Until we have an accurate screening test to identify ovarian cancer in asymptomatic women, we must have guidelines to help doctors evaluate common test abnormalities and detect the malignancy with as much precision as possible," said, Dr. Partridge. "The results of this study are immediately useful for guiding interpretation of ultrasound and CA-125 abnormalities in asymptomatic postmenopausal women."
Early diagnosis of ovarian cancer is vital to reducing mortality. This is the largest prospective cancer screening study to evaluate the risk of malignancy in an exclusively postmenopausal population, ages 55-74, when there are no symptoms. This study is particularly noteworthy because the described screening tests (ultrasound and CA-125) are immediately available to women today.
"The dilemma we face with screening for a disease with low prevalence, like ovarian cancer, is false positive results," commented Dr. Andrew Berchuck, co-director of the Breast/Ovarian Cancer Program of the Duke University Comprehensive Cancer Center. "This study is important because it provides guidelines to better interpret the ultrasound and CA 125 testing we have available. Accurate interpretation of test results could ultimately help to save the lives of postmenopausal women who do not present with symptoms but have ovarian cancer, as well as save women who receive ambiguous results from invasive surgery when there is no real malignancy."
"These new guidelines are a significant step forward in the fight against women's cancers," explained Dr. Partridge. "We hope this will encourage further efforts to validate and refine these criteria in other populations so more women can be properly diagnosed and treated for ovarian cancer."
Ovarian cancer is the leading cause of death from gynecologic malignancies, according to the American Cancer Society. Annually, over 22,000 women in the U.S. will develop ovarian cancer and more than 16,000 will die from this disease.
Science Overview
Results from the first three years of The Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trials were reviewed to establish scoring criteria for distinguishing malignant from benign processes. Women enrolled in the study had annual screening for lung, colorectal and ovarian cancer. Although historically a CA-125 level over 35 has been considered abnormal, the authors found that a CA-125 of greater than 65 was the best predictor of ovarian cancer in a postmenopausal asymptomatic woman with an initial abnormal screen. In follow-up screening the following criteria, applied in a hierarchical manner, appear to be accurate at detecting malignancy:
-- CA-125 greater than or equal to 65;
-- Or a CA-125 increase of greater than or equal to 40 points;
-- Or a CA-125 change of greater than or equal to 10 with an ovary/cyst
greater than or equal to 3 cm:
-- Or an ovary/cyst change of > 6.5 cm.
Using the above criteria for a single screen, 15 of the 20 cancers in the initial or baseline screening group (T0) would have been detected. The study found that subsequent annual screenings provided the opportunity to compare current CA-125 levels and/or transvaginal ultrasounds (TVU) findings with the previous screen. Utilizing the above criteria for distinguishing benign from malignant masses in women with more than one screen, doctors would have been able to detect all 29, or 100 percent of the women with invasive cancer.
"Determining the Risk of Ovarian Malignancy in Postmenopausal Women with Abnormal Findings in the PLCO Screening Trial: A Guide for Physicians," was conducted by Edward E. Partridge, M.D., University of Alabama at Birmingham, Birmingham, AL; Robert T. Greenlee, Marshfield Clinic Research Foundation, Marshfield, WI; Thomas L. Riley, Information Management Services, Inc., Rockville, MD; Craig Williams, Information Management Services, Inc., Rockville, MD; Lawrence R. Ragard, Westat, Rockville, MD; Jian-Lun Xu, National Cancer Institute, Rockville, MD; Saundra S. Buys, Huntsman Cancer Institute, Salt Lake City, UT; and Philip C. Prorok, National Cancer Institute, Rockville, MD.
The 2006 Annual Meeting on Women's Cancer is the premier educational and scientific event for physicians and health care professionals involved in the field of gynecologic oncology and is being held March 22-26 at the Palm Springs Convention Center in Palm Springs, California. For more information visit, http://www.sgo.org/ .
About SGO
The SGO is a national medical specialty organization of physicians who are trained in the comprehensive management of women with malignancies of the reproductive tract. Its purpose is to improve the care of women with gynecologic cancer by encouraging research, disseminating knowledge which will raise the standards of practice in the prevention and treatment of gynecologic malignancies and cooperating with other organizations interested in women's health care, oncology and related fields. The Society's membership is primarily comprised of gynecologic oncologists, as well as other related medical specialists such as, medical oncologists, radiation oncologists and pathologists. SGO members provide multidisciplinary cancer care including chemotherapy, radiation therapy, supportive care and surgery. More information on the SGO can be found at http://www.sgo.org/ .
Contact: Jennifer Grunstad
Cell: (312) 282-0627
On-site SGO Annual Meeting Newsroom: (760) 322-8469
Website: http://www.sgo.org/
Wednesday, April 12, 2006
Sunday, March 19, 2006
Call for Participants - Toronto - March 31st, 2006: "Cancer: It IS about YOU"
Call for Participants (voluntary)
DATE: Friday, March 31st, 2006
TIME: 12:45 pm - 3:15 pm
LOCATION: Toronto (exact location to follow)
CONTACT: sandipn@sympatico.ca
BACKGROUND AND PROGRAM DETAILS:
I am writing to advise you that a filming of the prototype program "Cancer: It IS about YOU" will take place in Toronto on Friday, March 31st.
Your participation is the first step of the program proposal and approval process. It is an extensive undertaking and includes professional direction and support. The format of this proposal is similar to that as seen in 'town hall meeting' formats ie; highly interactive and engaging. This program is not specific to any one particular cancer but is intended as an inclusion of all, survivours, carers and the general public. The program concerns your perspectives, opinions and thoughts regarding cancer and includes; family, friends, general public, educators and carers (carers - def: all those who have or are caring for persons with cancer).
Your voice of significance = value+passion+knowledge=community benefit
I look forward to hearing from you and to the possibility of working with you as a participant in this new and exciting venture. At this time, no funds are available (sorry) to assist with any expenses which you may incur, so it is on a voluntary basis only. Please contact me to confirm your commitment to March 31st. See below for a few brief details which we require prior to the taping of the program.
If you have any questions feel free to contact me.
Thanks!
Sandi Pniauskas
P.S. subject to a successful conclusion of the community college strike
PARTICIPANT (please complete):
Full Name/Contact Number:
Cancer Connection (if any): ie myself, family member, friend, healthcare professional
Sunday, March 12, 2006
The Role of Radiotherapy in the Management of Ovarian Cancer
What is Radiation Therapy?
Radiation oncology is a branch of medicine that manipulates ionizing radiation to treat cancer and other benign diseases. The goal of radiation therapy is to eradicate cancer cells through the delivery of a measured dose of radiation to a precisely defined tissue volume, while attempting to minimize damage to any healthy surrounding tissue. In ovarian cancer radiation oncologists work closely with gynecologic oncologists, who are the primary surgical oncologists that treat ovarian cancer, and medical oncologists. Both medical and gynecologic oncologists deliver chemotherapy.
Radiation kills cancer cells by damaging the DNA. Tumor cells often have impaired repair mechanisms that are normally found in healthy cells. Thus, tumor cells can be inherently sensitive to radiation effects. Damage to DNA can occur by direct interaction of radiation with a cell’s DNA or indirectly by the creation of free radicals that are produced by the interaction of radiation and water within the cell.
2006 Jan-Feb Int J Gynecol Cancer: Active and passive smoking and risk of ovarian cancer
Int J Gynecol Cancer. 2006 Jan-Feb;16 Suppl 1:211-8
Active and passive smoking and risk of ovarian cancer.
Baker JA, Odunuga OO, Rodabaugh KJ, Reid ME, Menezes RJ, Moysich KB.
Department of Epidemiology, Roswell Park Cancer Institute, Buffalo, New York.
It is unclear whether smoking is a risk factor for epithelial ovarian cancer, although some studies have suggested that it may be associated with an increased risk of mucinous tumors.
This study investigated the effect of smoking and environmental tobacco smoke (ETS) on ovarian cancer risk among 434 women with primary epithelial ovarian, peritoneal, or fallopian cancers and 868 age- and region-matched hospital controls with nonneoplastic conditions.
All participants completed a comprehensive epidemiologic questionnaire. Results indicate that decreased risk of ovarian cancer was associated with being a nonsmoker exposed to ETS (adjusted odds ratio [aOR] 0.68, 95% confidence interval [CI] 0.46-0.99), a former smoker (aOR 0.76, 95% CI 0.53-1.10), or a current smoker (aOR 0.53, 95% CI 0.32-0.88).
A similar protective effect was noted for smokers with moderate or high exposure based on smoking intensity, duration, and cumulative exposure, as well as for never smokers exposed to ETS. Results did not differ substantially by histologic subtype. Although prevailing theories of ovarian cancer etiology implicate incessant ovulation, characteristics of the study population suggest that anovulation was not the protective mechanism in this study. Immunosuppression by nicotine or upregulation of enzymes that metabolize carcinogens may be responsible for the effects observed.
2006 Update Guidelines of Practice (U.S.)
Welcome to the NCCN Clinical Practice Guidelines in Oncology™
The NCCN Clinical Practice Guidelines in Oncology™ are the recognized standard for clinical policy in the oncology community. These guidelines are updated at least annually in a consensus-driven process with explicit review of the evidence by multidisciplinary panels of expert physicians from NCCN member institutions. The breadth and scope of this collaborative effort, which now covers more than 95% of all cancers, represents a significant advance beyond any previously developed guidelines. The NCCN guidelines have become the most widely used in oncology practice. Treatment recommendations are specific and are being implemented through performance measurement. In addition, the NCCN guideline panels address cancer detection; risk assessment and reduction; and supportive care areas such as nausea and vomiting, distress management, cancer-related fatigue, and cancer pain management.
Development of the guidelines is supported by NCCN Member Institution dues. No industry support is accepted for any costs associated with the development of the guidelines. NCCN does receive support from industry for distribution of the Complete Library of NCCN Clinical Practice Guidelines in Oncology™ on CD-ROM.
Then and Now - 2002 Sandi Pniauskas presentation to the Romanow Health Care Commission of Canada
Submission to the Health Care Commission of Canada
Sandi Pniauskas*
Ovarian Cancer
Patient and Advocate
Public Submission and Presentation: May 30th, 2002 Toronto, Ontario, Canada
May 30th, 2002
Introduction
Thank you for allowing me this opportunity to present my views regarding the ongoing debates concerning our Health Care system in Canada. The issues are overwhelming. There are many needs and enormous disparities. I will tell you that I have reviewed all the Submissions on your website that directly and indirectly affect Ovarian Cancer women. I have also communicated with Ovarian Cancer women across the Nation – from coast to coast. I consider it a privilege and an honour to be the voice of many of these women and to be able to express their views.
I will tell you about dignity and care and respect and the human side of this woman’s cancer.
But, I also want to highlight about other realities as well. This is not for the faint of heart.
I need to preface my remarks by saying that Ovarian Cancer women in this province, and in this country, value and appreciate the dedication and commitment of medical professionals who go above and beyond their duties in practicing quality patient care: not only quality care, but outstanding support of ovarian cancer women and their families as they face and endure daily obstacles. I witnessed this only this past Tuesday when visiting the Kingston Cancer Centre.
Pam West, who is with me here today, exemplifies a real life example of true progression between patient and nursing. The support, which Pam has provided to me and in turn, our Ovarian Cancer community is not to be found elsewhere in the whole of this country. She recognized the need to educate and communicate. She allowed me the opportunity to teach nurses about ovarian cancer. We just decided – okay – let’s do it and we did and we continue to do so. It has progressed from there. It does not have to be complicated. No budget, no meetings, no bureaucracy
Please keep this in mind as you hear what I am about to say, as I do have some criticisms.
Let me present a patient’s perspective on what is not working and propose some solutions that can be put in place today, without draining our existing limited resources.
Background
In order to understand what I am about to discuss, it is important that you appreciate the significance of a cancer women fear the most – Ovarian Cancer. Being diagnosed with ovarian cancer gives the connotation that this is a disease which comes with an automatic death sentence. This misconception permeates the minds of both only the public and health professionals. It does not have to be that way.
In Canada in 2002, ovarian cancer has the highest mortality rate of all gynecologic cancers with an estimated annual mortality rate of 62% of all diagnosed cases. (1) To contrast this and to use
the same criteria, the annual mortality rate of women’s breast cancer is 26%. Colorectal cancer (a disease of both men and women) has a 37% annual death rate among its diagnosed.
There are no screening tests, such as a PSA test in prostate cancer, colonoscopy in colorectal cancer or mammography in breast cancer. Seventy-five per cent of ovarian cancers are diagnosed in advanced stages resulting in a 5-year survival rate of approximately 25%. Approximately 78% of ovarian cancer women live at least one (1) year post diagnosis and the majority will die within two and a half (2½) years.(3) There have been no significant improved survival rates in years and decades.(14) The fact remains that ovarian cancer has a high rate of recurrence after surgery and other treatment modalities.
There is no known cause of 90% of ovarian cancers. Five to ten per cent of women are pre-disposed due to genetic/familial links between ovarian/breast and ovarian/colorectal cancers. Ovarian cancer does not necessarily exist in isolation. As an example, if a woman is predisposed by carrying the HNPCC gene, her lifetime risk of colorectal cancer is 80%. A secondary cancer is also of grave concern in that it relates to the treatment of a first cancer (ie: leukemia as a direct result of chemotherapy and/or radiation therapy).
There is also no established relationship between diet and smoking and ovarian cancers. (2) Often considered an “older” woman’s disease, sadly (and fortunately uncommon), this disease may strike your young daughters. We, ovarian cancer patients, do not fit the mold of today’s mantra of Healthy Lifestyle and Prevention. Sadly, these lifestyle and health issues have no relationship with Ovarian Cancer issues.
In Canada, there is simply not enough attention paid to Ovarian Cancer.
Barriers
1) Access to Specialized Care
Ovarian Cancer women in this country deserve equal and fair access to services. Many women across this country use the term “luck” when speaking about their care. This “luck” refers to waiting times for surgery, waiting times in emergency care, waiting times for treatments and waiting times for doctors’ appointments.
All Canadian women must have access to gynecologic oncologists. International clinical evidence supports specialist care right from the onset of a suspicion of ovarian cancer. (4, 5, 6) Specific guidelines regarding the proper surgical procedures exist and need to be followed. In this country these guidelines are not being met (7, 8, 9) Surgery is one of the most important keys to ovarian cancer survival. In Canada, we are ignoring this evidenced-based research. The practical implementation is not happening. In fact, gynecologist/obstetricians still practice ovarian cancer surgery, when it should be left to gynecologic oncologists only. In doing this, I am reminded of the medical profession’s code of ethics of “Do the least harm”.
Inadequate resources (10), including human resources, outdated diagnostic equipment, lack of knowledge and education: these key issues have been ignored.
Allow me to share several experiences of ovarian cancer women, told to me over the past week. One woman stated that it would always be a thought in her mind that if she had proper surgical staging, maybe her tumour would not have ruptured. In another incident, a gynecologist’s secretary told a woman that a specific doctor would “take very good care of her,” meaning she did not need to see a gynecologic oncologist. It seemed like they were “selling/advertising” their services, which is impossible to understand. In addition, in both of these cases, gynecologic oncologists were available nearby, and waiting times were not an issue. In a third case, a woman recently went out of the country for a second opinion because in her province, there is no one to provide a second opinion. More disturbing than all of this is this incident. Last year, an ovarian cancer patient saw a general oncologist (not a gynecologic oncologist) because she was having significant symptoms of recurrence. This doctor performed an inappropriate exam and told the patient, who was in emotional and physical distress, to come back in 6 months time for a CT scan. She died before the proposed appointment. I wish I could tell you that these are isolated incidents, but I cannot.
So, here we stand. Ignorance of the disease and ignorance of adequate health care interventions.
2) Treatment
Ovarian Cancer does not care where you live, and yet, from province to province there are gross disparities in the delivery of care and in the availability of chemotherapy drugs. Drug formularies or drug coverage (or lack of) prescription medication varies from province to province. A case in point relates to Gleevec (STI 571). While Gleevec clinical trials are accruing patients in Ontario, British Columbia has lifted Gleevec (STI 571) from it drug formulary. Another example would be Taxol in the recent past. Should patients diagnosed with ovarian cancer move to a province that will care for them in the fairest way?
Community-based cancer centres are popping up all over Ontario without the foresight and/or ability to include/hire the appropriate staffing. Canadians have expressed their desire to receive access to care closer to home but at what expense? If the ovarian cancer patient fully understood that traveling to see a specialist could impact on her survival, there would be no decision. This should be obvious from recent examples of patients willing to travel outside of the country for treatment. In remote communities, this may be understandable. However, are we at the point in our Health Care system where any care is deemed better than no care?
Women are sent home from hospital to die without the proper support mechanisms. Ovarian cancer women suffer excruciating pain because health care workers are not available. Women experience nausea because they have no private health care plan and cannot afford the costly anti-nausea medications. There is financial distress but families are too proud to talk about it; preferring to suffer in silence. I could tell you of a ‘middle-class’ family who could not afford the bus fare to send their children to the hospital to visit their dying Mom. Have we considered single Moms and elderly women who live on their own?
Cancer pain at the close of life should not be a medical issue in 2002, but it exists because of an ineffective system that does not recognize the wider problem.
We have choices and we need to make them right.
3) Quality of Care
Quality of care not only surrounds the previously alluded to ‘specialist’ care but also includes diagnosis, treatment, counseling and follow-up care for a cancer which never goes away. Palliative care is a reality in ovarian cancer. We have leapt into a home care system with little resources and poor planning. We need to pay more attention to these realities.
4) Respect of Patient – Education – Awareness – Patients’ Bill of Rights/Dispute Mechanism
It is time for a new patient bill of rights, but not in the prevailing or traditional manner. I have had personal experience with a “Patient Advocate” and realized later that in fact this ‘Patient Advocate’ was more of a Hospital or Doctor Advocate. A Patients’ Bill of Rights means one thing to an institution but something entirely different to a patient. There needs to be a forum or individual ombudsman for support when things go wrong and a protective mechanism in place without having to revert to legal counsel. Communication is key and, in fact, solves most issues. Who speaks for the patient? Patients are afraid to contact doctors because of physicians’ time limitations and a fear that this may jeopardize future care. Sometimes, this is too late. It is incumbent upon Canadians, as a compassionate Nation, to stand by those who are in need and who are unable to advocate for themselves. Although this may represent a minority of cases, one case is one too many.
Specifically ovarian cancer patients need education and resources from diagnosis to death, including not only the physical but the emotional support. Today when patients are diagnosed with ovarian cancer, many leave their doctor’s office without any resources. They go home stunned, shocked and in fact totally emotionally isolated.
We need to provide both the public and medical personnel with accurate information about ovarian cancer. Awareness will achieve many things. Most importantly, it will result in the detection of ovarian cancer in earlier stages when survival is much improved and women can return to their place in society as healthy and fully contributing members. No one wants this more than the patient herself. Ovarian Cancer patients are not abusers of our health care system: they just want their fair share of resources and supports.
Overall, I am advocating that:
1) All women suspected of ovarian cancer will be referred to a gynecologic oncologist at onset of a suspicion of malignancy (exception noted - see #4)
2) All women will have initial surgery performed by a gynecologic oncologist (exception noted – see #4)
3) All women will be educated in an unbiased manner as to the survival advantages of specialized care;
4) In remote communities where a gynecologic oncologist is not available (and the patient does not wish to commute outside her community), a consultation between all affected parties will take place
5) All women at the time of initial will be given appropriate and timely educational material covering the basic facts of ovarian cancer;
6) A nationwide Ovarian Cancer education programme will be established in all communities – for both the public and health care professionals
7) A nationwide Ovarian Cancer Survivor panel will be established to ensure that a patient’s opinion/participation is sought in any discussion or proposal (research or community/hospital based program)(12)
Implementation
We acknowledge with evidenced-based medicine that ovarian cancer surgery and specialized care is required. The allocation of resources stretches far beyond me. However, if you educate family doctors regarding ovarian cancer then the mechanism for direct referral is already in place. You can circumvent the “middle man” in this case, gynecologic obstetricians, thereby relieving their workload. Time is money. Time is savings. There need not be more studies. There needs to be action.
Education can start today. It can be done across this country with little cost. Seminars, community activities, communication through nursing associations and designated awareness campaigns: all are easy ways to share the message.
Conclusions
Our universal health care philosophy is sound but needs to be updated to reflect the diversity of current needs and today’s environment. We have to stop thinking about why things can’t be done but rather what can be done. We need to honour the intellectual capabilities of patients and we need to operate in a manner of mutual respect and in a time frame conducive to doing so. We have internationally recognized researchers whose talents are wasted. (11, 13) We need to find solutions to ovarian cancer mortality rates and we have people with a great desire and ability to do so.
We need to scrap the politics because this truly is THE very one thing that stands in the way of progress.
Lastly, we need to put a human face to our health care system. We need to find the will to do this. I truly believe the will exists on an individual basis but, collectively, we are in a mess.
Communication + Will = Success + Benefits
Thank you on behalf of Ovarian Cancer women in Canada
Sandi Pniauskas
117 Glen Hill Drive
Whitby, Ontario, Canada
L1N 6Z8
(1) NCI Canadian Cancer Statistics 2002 Current Incidence and Mortality Estimated New Cases and Deaths for Cancer Sites by Gender, Canada, 2002
(2) American Cancer Society 2001 e.5 Cancer Medicine
(3) Excerpts: Management of Advanced-Stage Ovarian Cancer; Prescrire Int Feb 2002, Survival in familial, BRCA 1-associated, and BRCA-2-associated epithelial ovarian cancer; United Kingdom Coordinating Committee for Cancer Research, Familial Ovarian Cancer Study Group Cancer Res Feb 1999, Prognostic factors of stage IV epithelial ovarian cancer: a multicenter retrospective study; Gynecol Oncol 2001, Department of Obstetrics and Gynecology, Tohoku University School of Medicine, Sendai, Japan, Long-term follow-up of the Stockholm screening study on ovarian cancer; Gynecology Oncol Dec 2000; Gynecological Department, Radiumhemmet, Stockholm, Sweden
(4) The Benefits of comprehensive surgical staging in the management of early-stage epithelial ovarian carcinoma, Gynecol Oncol May 2002 Le T, Adolph A; Krepart GV; Lotocki R; Heywood MS, Division of Gynecologic Oncology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
(5) Why American Women are not receiving state-of-the-art gynecologic cancer care Gershenson DM, Department of Gynecologic Oncology, The University of Texas, M.D. Anderson Cancer Center, Houston, Texas, USA Nov-Dec 2001
(6) Surgical Management of Ovarian Cancer, Mutch DG, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Washington University School of Medicine, St Louis, MO, USA Feb 2002 (excerpt)
(7) Surgical standards in the management of ovarian cancer, Robert E. Bristow, MD Johns Hopkins Hospital and Medical Institutions, Baltimore, Maryland, USA
(8) Surgical Management of Ovarian Cancer David G. Mutch Seminars in Oncology Feb 2002
(9) Implementation of Ovarian Cancer Surgery Guidelines Elit,L, Rosen,B, Anderson G, Thircuchelvan D, Department of Obstetrics and Gynaecology, McMaster University, Department of Obstetrics and gyneaecology, University of Toronto, Health Administration, Faculty of medicine, University of Toronto, Toronto, Research Services Unit, Public Health Science, University of Toronto, Toronto
(10) A Shortage of Medical Oncologists at the McGill University Health Centre Prompts an Aggressive Recruitment Campaign March 2002 McGill University health Centre, Montreal, Quebec
(11) First line chemotherapy in advanced ovarian cancer, Dan Grisaru Oncology Rounds from Princess Margaret Hospital, Toronto, Ontario February 2002
(12) Cancer Survivor Involvement: California Cancer Research Program, Sacramento California, USA 2002
13) Canadian Institute for Health Research, Ottawa, Ontario – database search Funding years 1999-2003 – All Provinces/All Institutions – All Themes/All Classes/All Areas – Ovarian Cancer – total dollar amount for specified search criteria - $1,956,205
14) Distinguished Professor Series: Is There any Progress in the Outcome of Patients Suffering from Ovarian Cancer? Treatment Strategies Since 1957 Albrecht Pfleiderer, Professor Emeritus, Freiburg, Germany Sept 2001
*To whom correspondence and reprint requests should be addressed:
Sandi Pniauskas 117 Glen Hill Drive, Whitby, Ontario, Canada L1N 6Z8
E-mail: sandipn@sympatico.ca
Thursday, March 09, 2006
Wednesday, March 08, 2006
Sunday, March 05, 2006
CBC News: Marketplace - Chasing the Cancer Answer: Wendy Mesley
CBC News: Marketplace
Chasing the Cancer Answer: After fighting the disease herself, Marketplace's Wendy Mesley is asking questions about our rising cancer rates.
She's getting some disturbing answers.
Wednesday, March 01, 2006
Tuesday, February 28, 2006
Sunday, February 26, 2006
Saturday, February 25, 2006
Prophylactic Surgery to Reduce the Risk of Gynecologic Cancers in the Lynch Syndrome - January 19, 2006 NEJM
Prophylactic Surgery to Reduce the Risk of Gynecologic Cancers in the Lynch Syndrome
Kathleen M. Schmeler, M.D., Henry T. Lynch, M.D., Lee-may Chen, M.D., Mark F. Munsell, M.S., Pamela T. Soliman, M.D., Mary Beth Clark, M.S.W., Molly S. Daniels, M.S., Kristin G. White, B.S., Stephanie G. Boyd-Rogers, R.N., Peggy G. Conrad, M.S., Kathleen Y. Yang, M.D., Mary M. Rubin, Ph.D., Charlotte C. Sun, Dr.P.H., Brian M. Slomovitz, M.D., David M. Gershenson, M.D., and Karen H. Lu, M.D.
ABSTRACT
Background Women with the Lynch syndrome (hereditary nonpolyposis colorectal cancer) have a 40 to 60 percent lifetime risk of endometrial cancer and a 10 to 12 percent lifetime risk of ovarian cancer. The benefit of prophylactic gynecologic surgery for women with this syndrome has been uncertain. We designed this study to determine the reduction in the risk of gynecologic cancers associated with prophylactic hysterectomy and bilateral salpingo-oophorectomy in women with the Lynch syndrome......
Monday, February 20, 2006
2005 Survey of HNPCC Management Analysis of Responses from 18 International Cancer Centres
Survey of HNPCC Management Analysis of Responses from 18 International Cancer Centres
Hereditary Cancer in Clinical Practice 4/2005
Survey of HNPCC Management Analysis of Responses from 18 International Cancer Centres
Hereditary Cancer in Clinical Practice 2005; 3(4) pp. 137-146
authors: Elizabeth Chow, Finlay Macrae, John Burn,
Introduction
HNPCC is an autosomal dominant condition with high penetrance for colorectal and certain other cancers. A mutation in one of the several mismatch repair genes is responsible. Mutational analysis is widely available to guide risk assessment and screening strategies in families with HNPCC. However, there are many management decisions that need to be made where the level of evidence supporting those decisions is low. In September 2003, participants at the International Collaborative Group for Hereditary Non-Polyposis Colorectal Cancer were invited to complete a questionnaire relating to their clinic practices, so as to inform the cancer genetics community about variations and levels of consensus.
Methods
Eighteen centres (three from Australia, nine from the UK, two from the USA, two from Denmark, one from Canada, one from Israel) responded to the questionnaire. The questionnaire covered clinical definitions of HNPCC and high and moderate risk, thresholds for referral to clinics, positioning and funding of pre-genetic testing in clinical management, indications and funding for mutational analysis, consent protocols, counselling relating to variants of uncertain significance, disclosure of genetic testing information across families, surveillance planning for colorectal, gynaecological and other malignancies, and surgical decision making. Responses were generally in the multiple choice format, and where appropriate one or more “correct” answers were allowed. Free text provision (“other”) was liberally provided throughout. The questionnaire was not anonymous. However, as there was no universal agreement from the contributors to identify their own familial clinic's response, the results are presented anonymously.
Results
Results are displayed with reference to the question and the multiple choice response alternatives.
A. Definition
1. In your familial bowel cancer practice, for the purposes of initiating direct mutational analysis (without necessarily requiring evidence of MSI/IHC MMR protein loss), which definition of HNPCC do you accept? (tick any)
a) Amsterdam I
b) Amsterdam II
c) Amsterdam II plus ovarian cancer
d) Amsterdam II plus stomach cancer
e) Amsterdam II plus biliary tract cancer
f) Amsterdam II plus brain cancer
g) Amsterdam II plus breast cancer in hMLH1
h) Amsterdam II plus clear cell cancer of kidney
i) Other---please specify any variation
Saturday, February 18, 2006
2006 Review: Cochrane Collaboration - Intraperitoneal chemotherapy for the initial management of primary epithelial ovarian cancer
Review]
Intraperitoneal chemotherapy for the initial management of primary epithelial ovarian cancer
K Jaaback and N Johnson
The Cochrane Database of Systematic Reviews 2006 Issue 1 (Status: New)
Copyright © 2006 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
DOI: 10.1002/14651858.CD005340.pub2 This version first published online: 25 January 2006 in Issue 1, 2006
Date of Most Recent Substantive Amendment: 15 November 2005
This record should be cited as: Jaaback K, Johnson N. Intraperitoneal chemotherapy for the initial management of primary epithelial ovarian cancer. The Cochrane Database of Systematic Reviews 2006, Issue 1. Art. No.: CD005340. DOI: 10.1002/14651858.CD005340.pub2.
Abstract
Background
Ovarian cancer tends to be chemosensitive and confine itself to the surface of the peritoneal cavity for much of its natural history. These features have made it an obvious target for intraperitoneal chemotherapy. Chemotherapy for ovarian cancer is usually given as an intravenous infusion repeatedly over 5 to 8 cycles. Intraperitoneal chemotherapy (IP) is given by infusion of the chemotherapeutic agent directly into the peritoneal cavity. This may increase the anticancer effect with fewer systemic adverse effects in comparison to intravenous therapy.
Objectives
To determine if adding a component of the chemotherapy regime into the peritoneal cavity affects overall survival, progression free survival, quality of life (QOL) and toxicity for women receiving primary treatment of epithelial ovarian cancer.
Search strategy
The reviewers searched the UK Cochrane trials register, Gynaecological Cancer Group Specialised Register, computer databases and handsearched and cascade searched the major gynaecological oncology journals.
Selection criteria
The analysis was restricted to randomised controlled trials assessing women with a new diagnosis of primary epithelial ovarian cancer, of any FIGO stage, following primary cytoreductive surgery. Standard intravenous chemotherapy was compared with chemotherapy that included a component of intraperitoneal administration.
Data collection and analysis
Two reviewers conducted data extraction independently. The reviewers retrieved data on overall and disease free survival as well as adverse events and QOL and then performed a meta-analysis of outcomes, using hazard ratios for time-to-event variables and relative risks for dichotomous outcomes.
Main results
Eight randomised trials studied 1819 women receiving primary treatment for ovarian cancer. Women were less likely to die if they received an intraperitoneal (IP) component to the chemotherapy (hazard ratio (HR) =0.79; 95% confidence interval (CI): 0.70 to 0.90)and the disease free interval (HR =0.79; 95%CI: 0.69 to 0.90) was also significantly prolonged. There may be greater serious toxicity with regard to gastrointestinal effects, pain and fever but less ototoxicity with the intraperitoneal than the intravenous route.
Authors' conclusions
This analysis establishes the benefit of IP chemotherapy. It increases overall survival and progression free survival from advanced ovarian cancer. The results of this meta-analysis provide the most reliable estimates of the relative survival benefits of IP over IV therapy and should be used as part of this decision making process. However, the potential for catheter related complications and toxicity needs to be considered when deciding on the most appropriate treatment for each individual woman. The optimal dose, timing and mechanism of administration cannot be addressed from this meta-analysis. This needs to be addressed in the next phase of clinical trials.
Plain language summary
Intraperitoneal (IP) chemotherapy for advanced ovarian cancer improves both overall and disease free survival.
Ovarian cancer commonly spreads through the peritoneal cavity and usually responds to intravenous chemotherapy. This review compared the effectiveness of this intravenous chemotherapy to chemotherapy administered directly into the peritoneal cavity. The evidence suggests an improvement in survival if some of the chemotherapy is administered via the intraperitoneal route. The disadvantage is an increase in adverse effects principally relating to the presence of a peritoneal catheter, including pain, catheter blockage, gastrointestinal effects and infection.
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