Sunday, December 28, 2008
Patients with a history of epithelial ovarian cancer presenting with a breast and/or axillary mass
Patients with a history of epithelial ovarian canc...[Gynecol Oncol. 2008] - PubMed Result
CONCLUSION:
The interval between EOC diagnosis and the breast and/or axilla event, an elevated CA125 level, and a family history of breast and/or ovarian cancer may help differentiate patients with metastatic EOC to the breast and/or axilla from those patients with a second primary breast cancer. The presence of a metastatic EOC portends a poor prognosis.
(Note: EOC = Epithelial Ovarian Carcinoma)
Challenges in multidisciplinary cancer care among general surgeons in Canada
Abstract | Challenges in multidisciplinary cancer care among general surgeons in Canada:
"Conclusions
General surgeons appear to use a wide range of information resources but they may not address the complex needs of many cancer patients. Decision-making is challenged by informational and logistical issues related to the coordination of multidisciplinary care. This suggests that limitations in system capacity may, in part, contribute to variable guideline compliance. Further research is required to evaluate the appropriateness of information seeking, and both concurrent and consecutive mechanisms by which to achieve multidisciplinary care."
Clinical Patterns and Biological Correlates of Cognitive Dysfunction Associated with Cancer Therapy
Clinical Patterns and Biological Correlates of Cognitive Dysfunction Associated with Cancer Therapy -- Dietrich et al. 13 (12): 1285 -- The Oncologist
"Adult patients typically report cognitive symptoms, such as difficulties with memory and attention, soon after initiating treatment. Frequently, these symptoms persist after completion of therapy and are a cause of considerable distress for individuals who are unable to return to their previous academic, occupational, or social activities, or are able to do so only with significant additional mental effort. Long-term evaluation of cancer survivors has raised concerns that cancer and cancer therapy may result in persistent and late emerging cognitive dysfunction [25–27]. This observation has been supported by recent experimental studies. Both radiation and commonly used chemotherapy agents have been shown to cause acute and delayed injury to the CNS"
Saturday, December 27, 2008
Health 2.0 & The Widening Digital Divide: A Call to Action | e-Patients.net
Health 2.0 & The Widening Digital Divide: A Call to Action | e-Patients.net
"Too many years witnessing the same thing. First in the ACOR system. Then in many conferences about eHealth, e-Patients and now Health 2.0 and the Connected Health symposium at Harvard Medical School. Why is an entire segment of the US population almost completely absent from the fast evolving world of Health 2.0 and Participatory Medicine?............And if we do not force a change there is no reason this sad situation should change."
Friday, December 26, 2008
Influence of Intraoperative Capsule Rupture on Outcomes in Stage I Epithelial Ovarian Cancer.
- Obstet Gynecol. 2009 Jan;113(1):11-17.
-
Influence of Intraoperative Capsule Rupture on Outcomes in Stage I Epithelial Ovarian Cancer.
From the 1Division of Gynecologic Oncology, Mayo Clinic, Rochester, Minnesota; 2Division of Gynecologic Oncology, the Ohio State University College of Medicine, Columbus; and 3Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota.
OBJECTIVE:: To evaluate the effect of tumor capsule rupture on disease prognosis in stage I epithelial ovarian cancer.
METHODS:: All patients with International Federation of Gynecology and Obstetrics stage I epithelial ovarian cancer operated on at the Mayo Clinic and The Ohio State University between January 1991 and December 2007 were identified. Relevant tumor characteristics, procedures performed, adjuvant therapies, and follow-up were recorded and analyzed. Inclusion criteria included comprehensive staging. Cox proportional hazards, Kaplan-Meier estimation, log rank test, and chi test were used for statistical analyses.
RESULTS:: There were 161 cases that met inclusion criteria. Seventy-four (46%) patients had intact capsules without positive cytology or surface involvement; 61 (38%) had capsule rupture; 33 (20%) had positive cytology; and 22 (14%) had surface involvement. Overall, 22 of 161 (14%) patients recurred and 12 of 161 (7%) patients died of their disease. In univariable analysis, both intraoperative capsule rupture and positive cytologic washings portended worse disease-free survival (hazard ratio [HR] 3.6, 95% confidence interval [CI] 1.5-8.9; P=.004 and HR 5.2, 95% CI 2.1-12.3; P<.001, respectively) and disease-specific survival (HR 4.1, 95% CI 1.3-15.4; P=.018 and HR 5.9, 95% CI 1.8-19.3; P=.005, respectively). In multivariable analysis, capsule rupture (HR 4.2, 95% CI 1.8-10.9; P=.001) and positive cytologic washings (HR 6.4, 95% CI 2.5-16.0; P<.001) remained independent predictors of worse disease-free survival. Disease-free survival and disease-specific survival were shortest for stage IC cases with positive cytology, surface involvement, or both, that also had intraoperative rupture.
CONCLUSION:: In stage I epithelial ovarian cancer, intraoperative capsule rupture portends a higher risk of disease recurrence and death from disease. Careful intraoperative removal of ovarian masses is important, and recognizing the higher-risk nature of such cases is imperative. LEVEL OF EVIDENCE:: III.
Monday, December 22, 2008
Research Summary: Australia - blood test for ovarian cancer OvPlex
Bloodtest-ovariancancer
"On 28 October 2008, OvPlex™ was released to the Australian market as a diagnostic test for women suspected of having ovarian cancer. The test is initially available through general practitioners in Melbourne at a cost of $200 to the patient. Healthlinx Limited plans to roll the availability of the test out across the country. OvPlex™ is not being marketed for use as a population screening test."
Sunday, December 21, 2008
Relapse and survival in early-stage ovarian cancer
Relapse and survival in early-stage ovarian cancer. [Arch Gynecol Obstet. 2008] - PubMed Result
CONCLUSION:
Patients with early ovarian cancer stage pT1c and pT2a or low grade tumor have to be
monitored closely in oncologic follow-up as they bare a significant risk for disease recurrence.
Ascites at primary diagnosis, pT1c or pT2a tumor stage or recurrent disease are associated
with a poor survival even in early ovarian cancer.
Patient satisfaction with quality of life as a prognostic indicator in ovarian cancer patients treated in an integrative treatment setting
Patient satisfaction with quality of life as a pro...[J Soc Integr Oncol. 2008] - PubMed Result
"Our study has demonstrated no statistically significant prognostic association of patient satisfaction with QoL, as measured by the QLI, with survival in ovarian cancer."
Canadian Doctors for Medicare-Position on Activity-based funding in Canadian Hospitals and other Surgical Facilities (references intl sources)
ABF-final-9.8.8.pdf (application/pdf Object)
What is activity-based funding?
Widespread confusion exists around the jargon used to describe different ways of funding
hospitals.
Activity-based funding (ABF) is also known in the UK as payment-by-results
(PbR), as patient-focused funding (PFF) by the Canadian Medical Association, as servicebased
funding or case-mix funding by the Kirby Commission, as prospective payment
system (PPS) in the US, and elsewhere as payment-for-volume, or volume-based funding.
We use the relatively neutral term of activity-based funding, because the focus is not
necessarily on the patient, but rather on the type and volume of service delivered.
Health and QOL Outcomes: How do medical students value health - evaluation of hypothetical health states compared to the general population
1477-7525-6-111.pdf (application/pdf Object)
In a recent European survey on the acceptance of quality of life measurement between 72-90% of
the physicians accepted quality of life (QoL) as an outcome measure, however with less than 50%
accepting the concept of quality adjusted life years (including utility measurement) [2]. In a similar
survey in the United States and Canada only about one third of the physicians had ever collected
data on quality of life or had taken it systematically into account in clinical decision making [3].
Medical students gain a different perspective on health problems during their medical education by developing the role of a medical doctor. The participation in a health state
valuation task potentially allows them to reflect on a patients’ perspective on decision making when
being confronted with hypothetical health states. Further it has been acknowledged that there is a
need for health related quality of life education in medical school [4]......Futures studies should investigate the change of health states valuations of health care professionals over the period of their medical training.
SABCS: Breast Cancer Risk No Higher for BRCA1/2-Negative Women from Mutation-Positive Families - Meeting Coverage
Medical News: SABCS: Breast Cancer Risk No Higher for BRCA1/2-Negative Women from Mutation-Positive Families - in Meeting Coverage, SABCS from MedPage Today
Action Points
* Explain to patients that women who are not carriers of BRCA1/2 mutations do not have an increased risk of breast cancer, even if they come from a mutation-positive family.
* Note that this study was published as an abstract and presented orally at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.
Saturday, December 20, 2008
Associations between p53 overexpression and multiple measures of clinical outcome in high-risk, early stage or suboptimally-resected, advanced stage..
Associations between p53 overexpression and multip...[Gynecol Oncol. 2008] - PubMed Result
"Associations between p53 overexpression and multiple measures of clinical outcome in high-risk, early stage or suboptimally-resected, advanced stage epithelial ovarian cancers A Gynecologic Oncology Group study."
Treatment of the peritoneal carcinomatosis by cytoreductive surgery and intraperitoneal hyperthermic chemotherapy (IHPC): postoperative morbidity.....
[Treatment of the peritoneal carcinomatosis by cyt...[Ann Ital Chir. 2008 Jul-Aug] - PubMed Result
"Treatment of the peritoneal carcinomatosis by cytoreductive surgery and intraperitoneal hyperthermic chemotherapy (IHPC): postoperative morbidity and mortality and short-term follow-up"
September 2008: Tips for consultants - "Here's How to Fool Most of the People Most of the Time"
Canadian Centre For Policy Alternatives - Septmeber 2008: Tips for consultants
"If you are planning a consultation, you must first ensure that control of the process stays in corporate and government hands. Minimal public notice, short time frames, distant or expensive venues, and hired guns (process consultants) are all techniques that have been used successfully. It is also important to restrict citizen participation to the smallest number you can get away with. This may or may not include whatever segment of the public poses the greatest threat to the policy or development being proposed."
The Cancer Epidemic as a Social Event
cancer.pdf (application/pdf Object)
"Critics of the war on cancer argue that it has largely been a failure. The widespread belief that
we are making progress against cancer is an illusion. The vaunted increases in five year survival
rates are misleading according to the critics because they now count things that are not
cancer and because they are able to diagnose real cancer at an earlier stage, people appear to
survive longer."
"We can win the war against cancer. The best available research is necessary, but not sufficient,
for our victory. Cancer research is designed and undertaken, and the results published and acted
upon, in a deeply political context. The social, political and economic changes necessary to win
the war against cancer will require more than research alone. It will also require collective action,
the uniting of movements that have operated for the most part independently."
Social Watch Canada2008 - Centre for Policy Alternatives: "Rights, budgets and building alternatives"
Social_Watch_Canada2008.pdf (application/pdf Object)
"The Government of Canada, as a signatory to several key UN treaties, including the Covenant on Economic
Social and Cultural Rights and the Convention on the Elimination of All Forms of Discrimination against
Women (CEDAW), has committed to ensure that Canada respects its human rights commitments
to all its citizens. These rights include but are not exclusive to access to justice, affordable housing,
access to education and employment as well as the appropriate provisions to ensure women’s equality
and implement “appropriate measures” to fulfill Canada’s obligations under CEDAW.
Canadian federal budgets from the last decade have ignored these obligations and have, indeed,
made things worse for women and vulnerable populations. While Canada does hold limited open
pre-budget consultations with non-governmental organizations and claims to do a high level of gender
budgeting, the focus of federal governments have moved away from sustained social and strategic
investments towards an aggressive tax cut agenda."
Financing the Health Care System: Is Long-term Sustainability Possible?
Financing_Health_Care_Dec_11.pdf (application/pdf Object)
"This analysis focuses on expenditures for health care as a determinate of sustainability. The first
part looks at historical trends in spending, followed by estimated cost drivers and the
expected influence these will have on total health care spending. Finally, financing options
will be reviewed for their impact on public spending."
Canada’s aging population will not create a crisis in health
care costs, but will remain a variable to be managed into the future.
Thursday, December 18, 2008
Surprised by Hope -- JCO When the Tumor is Not the Target series
Surprised by Hope -- Francis 26 (36): 6001 -- Journal of Clinical Oncology
"I never lied to my patient at any point about the potential benefits of therapy, but appropriately tempered my approach to avoid beating her over the head with poor prognosis talk at every juncture along the way. I believe that my patient had her eyes wide open, but preferred to wear rose-colored glasses."
Practical Model for Prognostication in Advanced Cancer Patients: Is Less More? -- Bruera and Hui 26 (36): 5843 -- Journal of Clinical Oncology
Practical Model for Prognostication in Advanced Cancer Patients: Is Less More? -- Bruera and Hui 26 (36): 5843 -- Journal of Clinical Oncology
"Thus, it is imperative for oncologists not only to refine the science of prognostication, but also to further the art of communication, gently guiding patients and families through times of uncertainty."
Dr. Daniel Gallahan, First Transatlantic Workshop on Multi-scale Cancer Modelling on ecancer tv
Watch Dr. Daniel Gallahan, First Transatlantic Workshop on Multi-scale Cancer Modelling on ecancer tv. Cancer journal: online cancer news, clinical oncology research, cancer information and latest
Dr. Daniel Gallahan
First Transatlantic Workshop on Multi-scale Cancer Modelling
First Transatlantic Workshop on Multi-scale Cancer Modelling: Dr. Daniel Gallahan, Deputy Director, Division of Cancer Biology, National Cancer Institute discusses the role of in-silico modelling in understanding the complexities of cancer
Tuesday, December 16, 2008
Association of Colonoscopy and Death from Colorectal Cancer
0000605-200901060-00306v1.pdf (application/pdf Object)
Conclusion:
In usual practice, colonoscopy is associated with fewer
deaths from CRC. This association is primarily limited to deaths
from cancer developing in the left side of the colon.
Flawed Inferences About Screening Mammography Benefit Based on Observational Data (Correspondence)
JCO.2008.17.9341v1.pdf (application/pdf Object)
"The article by Badgwell et al1 might have had minimal impact on
women were it not for the news media picking up the story. Coverage
was predictable and considerable. The media painted stronger conclusions
than the authors may have intended. The American Society of
Clinical Oncology fanned the flames with its totally inaccurate and
misleading press release entitled, “Women 80 and Older Benefit from
Mammography, but Few Are Screened.”
The Journal of Clinical Oncology erred in publishing this article. It
was a disservice to women, young as well as old. Such publication
reveals a seriously defective editorial process at the journal."
Hanging in the Balance: Making Decisions - Benefits/Harms of Breast Cancer Screening Amongst the Oldest Old Without Safety Net of Scientific Evidence
JCO.2008.19.4928v1.pdf (application/pdf Object)
"...The intensity about the controversy that followed this publication reflects the fact that we are
ill-prepared from a scientific knowledge perspective to provide health care rationally, ethically, equitably, and humanely to the “booming” older population."
Monday, December 15, 2008
The Cochrane Collaboration (International Consumer video)
The Cochrane Collaboration:
"A nine-minute video featuring members of the Cochrane Consumer Network describing how they work together and contribute to improve health care in communities around the world."
Cancer Surgery in Ontario, Chapter 7, Surgery for Ovarian Cancer
Cancer Surgery in Ontario, Chapter 7, Surgery for Ovarian Cancer.pdf (application/pdf Object)
Key Findings:
• Nearly three quarters (73 percent) of women
diagnosed with ovarian cancer in 2003/04 received
surgery within a year of diagnosis.
• Almost all procedures (96 percent) were done in an
inpatient hospital setting.
• Some Local Health Integration Networks (LHINs)
appeared to serve as referral centres for women with
ovarian cancer. For example, 223 surgical procedures
for the disease were done in facilities located in the
Toronto Central LHIN during the study period.
However, only 56 of these (25 percent) were for
patients who resided in the Toronto Central LHIN at
the time they were diagnosed.
• The most common surgical procedure performed
on women with ovarian cancer was unilateral or
bilateral salpingo-oophorectomy (USO/BSO) with
omentectomy; this was undergone by 58 percent
of women in the study cohort. Other procedures
included USO/BSO alone (27 percent) and USO/BSO
with pelvic or para-aortic lymph node excision
(8.1 percent). (blogger's comment: not standard of care)
• While gynecologic oncologists comprised just 6.5
percent of surgeons who performed surgery for
ovarian cancer in Ontario during the study period,
these sub-specialists did 49 percent of all procedures.
• Six out of 10 surgeries for ovarian cancer (60 percent)
were done in academic (teaching) hospitals.
Cancer surgery in Ontario
Cancer surgery in Ontario
Cancer surgery in Ontario
 | Urbach D, Simunovic M, Schultz S. December 2008
This atlas gives Ontario health service providers, policy makers, and the public new information on patterns of surgical care for Ontarians with cancer including regional distribution of services, types of providers and their scope of practice. This research was undertaken to support ongoing improvements in quality and accessibility of care for Ontarians being treated for cancer with a special focus on cancer related surgery. See Backgrounder, See Media Advisory
Hard copies of the Atlas will be available on Tuesday, December 2, 2008. |
Overview [2.62 MB PDF]
Chapter 1: Introduction [2.38 MB PDF]
Chapter 2: Surgery for Breast Cancer [3.79 MB PDF]
Chapter 3: Surgery for Prostate Cancer [3.25 MB PDF]
Chapter 4: Surgery for Colorectal Cancer [4.22 MB PDF]
Chapter 5: Surgery for Lung Cancer [3.45 MB PDF]
Chapter 6: Surgery for Uterine Cancer [3.03 MB PDF]
Chapter 7: Surgery for Ovarian Cancer [3.00 MB PDF]
Chapter 8: Surgery for Cervical Cancer [3.79 MB PDF]
Chapter 9: Surgery for Vulvar Cancer [2.37 MB PDF]
Chapter 10: Reflections and Recommendations [2.05 MB PDF]
Technical Appendix (abbreviated version) [2.38 MB PDF]
2008 Office of the Auditor General of Ontario report
ar_en08.pdf (application/pdf Object)
Wait times reported on the Ministry’s website
combined in-patient and out-patient wait
times, even though in-patients generally
received their scan within a day. At one hospital,
for example, the Ministry-reported wait
time for a CT was 13 days, but out-patients
actually waited about 30 days.
Elsewhere:
"....Wait times (MRI) are from five to six months...."
Central East LHIN report (2008)
http://www.centraleastlhin.on.ca/uploadedFiles/Home_Page/Board_of_Directors/Board_Meeting_Submenu/CEO_Report(1).pdf
Saturday, December 13, 2008
Thursday, December 11, 2008
National Invitational Workshop: Towards an agenda for Cancer Survivorship
slide set eg: LiveStrong, Canada vs U.S. etc
Survivorship_Linda E. Carlson.pdf (application/pdf Object)
Oral Sodium Phosphate (OSP) Products for Bowel Cleansing Information U.S. FDA warning
Oral Sodium Phosphate (OSP) Products for Bowel Cleansing Information
FDA ALERT [12/11/2008]
FDA has become aware of reports of acute phosphate nephropathy, a type of acute kidney injury, associated with the use of oral sodium phosphate products (OSP) for bowel cleansing prior to colonoscopy or other procedures. These products include the prescription products, Visicol and OsmoPrep, and OSPs available over-the-counter without a prescription as laxatives (e.g., Fleet Phospho-soda). In some cases when used for bowel cleansing, these serious adverse events have occurred in patients without identifiable factors that would put them at risk for developing acute kidney injury. We cannot rule out, however, that some of these patients were dehydrated prior to ingestion of OSPs or they did not drink sufficient fluids after ingesting OSP.
Tuesday, December 09, 2008
JAMA -- Randomized Trials of Antioxidant Supplementation for Cancer Prevention: First Bias, Now Chance--Next, Cause
although this Editorial and related research is specific to Prostate Cancer there are lessons to be learned:
JAMA -- Randomized Trials of Antioxidant Supplementation for Cancer Prevention: First Bias, Now Chance--Next, Cause, December 9, 2008, Gann 0 (2008): 2008.863
Intraepithelial T cells and prognosis in ovarian c...[Mod Pathol. 2008] - PubMed Result
Intraepithelial T cells and prognosis in ovarian c...[Mod Pathol. 2008] - PubMed Result
"The presence of intraepithelial CD8(+) T cells was not associated with improved survival in endometrioid or clear cell carcinomas."
Whole-body hyperthermia (WBH) in combination with carboplatin in patients with recurrent ovarian cancer - a phase 11 study
Whole-body hyperthermia (WBH) in combination with ...[Gynecol Oncol. 2008] - PubMed Result
"....There is no evidence yet, that whole-body hyperthermia contributes to any clinical improvement beyond chemotherapy alone. This question can only be addressed in a randomized phase III trial."
The effect of obesity on survival in patients with ovarian cancer
The effect of obesity on survival in patients with...[Gynecol Oncol. 2008] - PubMed Result
"CONCLUSION: Although obesity has been reported as an independent prognostic factor for survival, this data demonstrates that survival rates are similar between obese and non-obese patients when optimal debulking statuses are the same. Therefore, maximal effort should be directed towards optimal debulking obese patients with EOC."
UICC's Reel Lives: Bringing truths about cancer to new audiences
getStaticModFile.aspx (application/pdf Object)
"Jan knew little about cancer but a lot about friendship."
Physicians' Experiences With BRCA1/2 Testing in Community Settings
Physicians' Experiences With BRCA1/2 Testing in Community Settings -- Keating et al. 26 (35): 5789 -- Journal of Clinical Oncology
"Conclusion: Community-based physicians seem to be successfully incorporating BRCA1/2 testing into their practices. Physicians’ recommendations for surveillance of mutation carriers are generally consistent with practice guidelines, yet recommendations for preference-based procedures such as prophylactic mastectomy vary by physician characteristics such as specialty and geographic region. The providers whom patients see for testing may contribute to variations in prophylactic treatments."
Feasibility of Screening for Lynch Syndrome Among Patients With Colorectal Cancer
Feasibility of Screening for Lynch Syndrome Among Patients With Colorectal Cancer -- Hampel et al. 26 (35): 5783 -- Journal of Clinical Oncology
Conclusion:
One of every 35 patients with CRC has LS, and each has at least three relatives with LS; all of whom can benefit from increased cancer surveillance. For screening, IHC is almost equally sensitive as MSI, but IHC is more readily available and helps to direct gene testing. Limiting tumor analysis to patients who fulfill Bethesda criteria would fail to identify 28% (or one in four) cases of LS.
"Patient First" Review Launched - First of its Kind in Canada
Without patient input, the benefits to the patients, organization, clinician and the healthcare system as a whole may never be fully realized. Decision-makers must begin to enact this commitment to collaborative patient-centred care by engaging patients in discussions....
JCO Editorial: Palliative Care and Oncology: Growing Better Together
JCO.2008.20.2671v1.pdf (application/pdf Object)
"....Caution is warranted amid our enthusiasm, lest
those of us seeking to advance and expand palliative care inadvertently
propagate a provider-centric orientation, rather than the patient- and
family-centered approach we desire. Palliative care programs and
clinics are instrumental, but are not ends in themselves. Simply stated:
it is not about us, and never was. Specialist clinicians and teams
represent structures and related processes of health care. Although
worthy foci for health service research, the structures and processes of
care must not divert attention from the outcomes that matter most to
people living with cancer and their families......Naturally, people do not always fit neatly into one of these
categories— being treated for cure, living with, dying from, or surviving
cancer—and the clinicians who serve them must resist being
constrained within arbitrary silos of services....." cont'd
Monday, December 08, 2008
news item - HPV vaccinations ‘not safe’ says former Health Canada employee
The Bracebridge Examiner and Gravenhurst Banner - HPV vaccinations ‘not safe’ says former Health Canada employee
"One of Canada’s leading experts in vaccines and antibiotics is calling the federally funded human papillomavirus (HPV) immunization campaign for Grade 8 girls a giant public health experiment.
“People are the guinea pigs for this vaccine,” says Shiv Chopra, a former Health Canada microbiologist.
His advice to the public: “Do not take it (the HPV vaccination). We don’t know anything about it. It’s nothing but a money-making device.”"
The Bracebridge Examiner and Gravenhurst Banner - HPV vaccinations ‘not safe’ says former Health Canada employee
The Bracebridge Examiner and Gravenhurst Banner - HPV vaccinations ‘not safe’ says former Health Canada employee
"One of Canada’s leading experts in vaccines and antibiotics is calling the federally funded human papillomavirus (HPV) immunization campaign for Grade 8 girls a giant public health experiment.
“People are the guinea pigs for this vaccine,” says Shiv Chopra, a former Health Canada microbiologist.
His advice to the public: “Do not take it (the HPV vaccination). We don’t know anything about it. It’s nothing but a money-making device.”"
Sunday, December 07, 2008
Ovarian Cancer National Alliance - Regulatory - FDA HE4
Ovarian Cancer National Alliance - Regulatory - FDA HE4
"Our survey showed that most women are unaware of ovarian cancer symptoms......Survey results show that 50 percent of the respondents did not know about the specialty of gynecologic oncologists. Furthermore, 48 percent of the respondents reported that the doctors they contacted to evaluate symptoms did not refer them to gynecologic oncologists...."
Time to stop ovarian cancer screening in BRCA 1/2 mutation carriers?
HighWire Press -- Medline Abstract
"Annual gynecological screening of women with a BRCA1/2 mutation to prevent advanced stage ovarian cancer is not effective."
Saturday, December 06, 2008
Social Media: ABC News: Bloggers are People of the Year
Social Media: ABC News: Bloggers are People of the Year
"ABC News has declared bloggers to be their People of the Year. A nice job of grasping the long-term import of citizens media, something not often seen in the mainstream media."
Friday, December 05, 2008
Thursday, December 04, 2008
Uptake of clinical genetic testing for ovarian cancer in Ontario: A population-based study
Kelly A. Metcalfe
Received 7 August 2008.
Available online 3 December 2008.
Abstract
Background
Approximately 13% of ovarian cancers in Canada are attributable to a mutation in BRCA1 or BRCA2. In 2001, genetic testing for BRCA1 and BRCA2 became freely available to all women in Ontario with a diagnosis of invasive ovarian cancer. It is unknown what proportion of women with ovarian cancer receive genetic testing as a result of this recommendation.
Methods
Patients in Ontario who had been diagnosed with epithelial ovarian cancer from 2002 to 2004 were identified using the Ontario Cancer Registry. Information was collected on demographic and risk factors, including information on previous testing for BRCA1 and BRCA2. Women were asked to provide a blood sample for genetic testing or to provide a genetic test result if clinical testing had been done. Genetic testing for BRCA1 and BRCA2 mutations was conducted on all blood samples.
Results
Of the 416 women, 80 women (19%) had undergone previous clinical genetic testing for BRCA1 and BRCA2. Of these 80 women, 30% had a positive genetic test result, compared to 5% of 336 women who had not had clinical genetic testing (p <>
Conclusions
Genetic testing is available in Ontario to all women with invasive ovarian cancer. However, only a small proportion of women are being referred for testing. This study suggests that increased public awareness directed at physicians and at women with cancer may expand the use of genetic testing.
Keywords: BRCA1; BRCA2; Ovarian cancer; Genetic testing
Tuesday, December 02, 2008
The Canadian Press: Ovarian cancer subtypes distinct diseases, should be treated as such: study
The Canadian Press: Ovarian cancer subtypes distinct diseases, should be treated as such: study
.....He said for several years his research group has believed the habit of
treating ovarian cancer subtypes as one disease for research purposes was
"the single greatest obstacle towards finding new biomarkers for ovarian
carcinoma and also eventually new treatments."....
PLoS Medicine - Ovarian Carcinoma Subtypes Are Different Diseases: Implications for Biomarker Studies
PLoS Medicine - Ovarian Carcinoma Subtypes Are Different Diseases: Implications for Biomarker Studies
Background
Although it has long been appreciated that ovarian carcinoma subtypes (serous, clear cell, endometrioid, and mucinous) are associated with different natural histories, most ovarian carcinoma biomarker studies and current treatment protocols for women with this disease are not subtype specific. With the emergence of high-throughput molecular techniques, distinct pathogenetic pathways have been identified in these subtypes. We examined variation in biomarker expression rates between subtypes, and how this influences correlations between biomarker expression and stage at diagnosis or prognosis.
Monday, December 01, 2008
Correspondence: Cultural Challenges in Caring for Our Patients in Advanced Stages of Cancer
JCO.2008.19.9455v1.pdf (application/pdf Object)
Stern adherence to scientific methods cannot fully encompass the depth and breadth of our tasks in supportive, palliative, and end-of-life care.
Does Age Really Matter? Recall of Information Presented to Newly Referred Patients With Cancer -- Jansen et al. 26 (33): 5450 -- Journal of Clinical Oncology
Does Age Really Matter? Recall of Information Presented to Newly Referred Patients With Cancer -- Jansen et al. 26 (33): 5450 -- Journal of Clinical Oncology
"Conclusion: Recall is not simply a function of patient age. Age only predicts recall when controlling for amount of information presented. Both prognosis and information about prognosis are better predictors of recall than age. These results provide important insights into intervention strategies to improve information recall in patients with cancer"
GenomeWeb News: International Cancer Genome Consortium Announces Eight New Projects
GenomeWeb News: International Cancer Genome Consortium Announces Eight New Projects
International Cancer Genome Consortium Announces Eight New Projects
November 19, 2008By a GenomeWeb staff reporter
NEW YORK (GenomeWeb News) – The International Cancer Genome Consortium announced today that eight countries and 11 funding agencies have signed on to participate in comprehensive analyses of the genomic changes underlying eight types of cancer.
The new projects are designed to complement the Cancer Genome Atlas pilot projects on brain, lung, and ovarian cancers. The goal is to map the genetic and genomic changes occurring in different types and stages of cancer in an effort to understand disease biology and develop new preventive strategies, diagnostics, and therapies.
Each participating organization will tackle one or more types of cancer using samples collected from about 500 individuals. Data collection and analysis will be standardized and is to follow ICGC guidelines released in April. Participating countries and agencies will also use common informed consent and ethical oversight standards. The estimated cost of each project is $20 million.
The ICGC anticipates additional countries and groups joining the effort through other projects in the next decade and eventually plans to study 50 types of cancer. Overall, the ICGC expects to generate some 25,000 times more data than the Human Genome Project.
ICGC data will be made available to the research community freely and rapidly, and participants are expected to agree that they will not file patents or make intellectual property claims on ICGC project primary data.
The new ICGC projects include:
- An Australian study funded by the National Health and Medical Research Council (the tumor type to has not yet been announced)
- A Canadian study funded by the Ontario Institute for Cancer Research on pancreatic cancer
- A Chinese study funded by the Chinese Cancer Genome Consortium on stomach cancer
- French studies on alcohol-related liver cancer and HER2-positive breast cancers funded by the Institut National du Cancer
- An Indian study on oral cavity cancer funded by the Department of Biotechnology Ministry of Science and Technology
- A study of virus-related liver cancer in Japan, funded by RIKEN, the National Cancer Center, and the National Institute of Biomedical Innovation
- A Spanish study of chronic lymphocytic leukemia funded by the Spanish Ministry of Science and Innovation
- A study of several breast-cancer subtypes in the UK, funded by the Wellcome Trust and the Wellcome Trust Sanger Institute
Sunday, November 30, 2008
Avoiding Drug Interactions
Avoiding Drug Interactions
There are three main types of drug interactions:
* Drugs with food and beverages
* Drugs with dietary supplements
* Drugs with other drugs
Saturday, November 29, 2008
Friday, November 28, 2008
Cancer researchers change focus to target the more stubborn killers - UK news item
Cancer researchers change focus to target the more stubborn killers - Health News, Health & Wellbeing - The Independent
"Mr Kumar said: 'Growing obesity cannot be the whole explanation [for the rise] because our rates are higher than in the US and obesity is a bigger problem there.'"
EvidenceUpdates - Risk of Venous Thromboembolism with the Angiogenesis Inhibitor Bevacizumab (Avastin) in Cancer Patients: A Meta-analysis
New Articles -- EvidenceUpdates
"CONCLUSION: The use of bevacizumab was significantly associated with an increased risk of developing venous thromboembolism in cancer patients receiving this drug."
Thursday, November 27, 2008
Ovarian cancer detection and treatment: current situation and future prospects - abstract
Ovarian cancer detection and treatment: current si...[Anticancer Res. 2008 Sep-Oct] - PubMed Result: "Ovarian cancer detection and treatment: current situation and future prospects.
Argento M, Hoffman P, Gauchez AS.
Pôle de Biologie, CHU Grenoble, BP217 38043 Grenoble cedex 9, France.
Between 70 and 75% of ovarian carcinomas are not discovered until they have reached an advanced stage III or later. Efforts should therefore be concentrated on earlier diagnosis. Ovarian cancer is not an entirely silent disease. Today, it is known that there are key symptoms which, depending on their frequency and intensity, can serve as warning signs to clinicians and patients. Mass screening for ovarian cancer is not currently possible because of a lack of specific markers for use in biological and imaging techniques, although new markers are now being developed. Screening every six or twelve months with the CA 125 blood test plus a transvaginal ultrasound is restricted to women at risk. Certain teams have proposed preventive bilateral adnexectomy for such women. The ovary is a complex organ subjected to a hormonal environment and affected by immune system dysfunctions. There now appears to be consensus on the influence of hormones in ovarian cancer, namely the beneficial role of pregnancy, breast feeding and in particular oral contraception, as well as the deleterious role of hormone replacement therapy(HRT).
However, the two main arguments put forward, incessant ovulation and exposure to gonadotropins, do not explain all the epidemiological data. It is through a better understanding of the etiology of ovarian cancer that new therapies can be developed. The theory of cancer immune surveillance, whereby lymphocytes have a sentinel role of recognizing and constantly suppressing malignant cells, provided a starting point for research into antitumoral immunotherapy. The first trials of vaccination by direct injection of tumor antigens or "loaded" dendritic cells today offer considerable hope for patients.
How Peer Review Failed at Redding Medical Center, Why It Is Failing Across the Country and What Can Be Done About It
While this is not specific to ovarian cancer, I expect it will be value for many:
redding-failure.pdf (application/pdf Object)
Wednesday, November 26, 2008
The withdrawal from oncogenetic counselling and testing for hereditary and familial breast and ovarian cancers
The withdrawal from oncogenetic counselling and te...[J Exp Clin Cancer Res. 2008] - PubMed Result
"CONCLUSIONS: The study revealed the importance to pay attention to the whole persona and their family system as well as provide information highlighting usefulness of early diagnosis."
Aggressive and complex surgery for advanced ovarian cancer: an economic analysis
Aggressive and complex surgery for advanced ovaria...[Gynecol Oncol. 2008] - PubMed Result
"CONCLUSIONS: Complex surgery for ovarian cancer cytoreduction carries a survival benefit at increased direct medical cost. However, preliminary cost-effectiveness results suggest complex surgery provides good value for money spent. Future research on the cost and quality of life implications of surgical morbidity during follow-up is warranted to formally assess the cost-effectiveness of complex vs. simple surgical procedures."
Cause-Specific Survival for Women Diagnosed With Cancer During Pregnancy or Lactation: A Registry-Based Cohort Study
Cause-Specific Survival for Women Diagnosed With C...[J Clin Oncol. 2008] - PubMed Result
"CONCLUSION: In general, the diagnosis of most cancer types during pregnancy or lactation does not increase the risk of cause-specific death. Breast and ovarian cancer diagnosed during lactation represents an exception."
Tuesday, November 25, 2008
Monday, November 24, 2008
news item regarding Commonwealth Fund publication Nov 2008
excerpts:
Only one-quarter (26%) of U.S. and Canadian patients reported same-day access to doctors when they were sick—and one-fourth or more reported long waits. In contrast, about half or more of Dutch (60%), New Zealand (54%), and U.K. (48%) patients were able to get a same-day appointment.
In the past two years, 59 percent of U.S. patients visited an emergency room; only Canada had higher rates (64%). In both countries, one in five said they went to the ER for a condition that could have been cared for by a regular doctor if one had been available.
Interval debulking surgery for advanced epithelial...[Gynecol Oncol. 2008] - PubMed Result
Interval debulking surgery for advanced epithelial...[Gynecol Oncol. 2008] - PubMed Result
"CONCLUSIONS: Our review could not conclude whether IDS would improve the survival of women with advanced EOC compared with conventional treatment. IDS appeared to yield benefit only in the patients whose primary surgery was not performed by expert surgeons."
Oophorectomy as a risk factor for coronary heart disease
Conclusion
The existing evidence is inconclusive to determine the effect of BSO on risk of CHD.
Sunday, November 23, 2008
The Role of Antioxidants and Vitamin A in Ovarian Cancer: Results From the Women's Health Initiative - Nutrition and Cancer
The Role of Antioxidants and Vitamin A in Ovarian Cancer: Results From the Women's Health Initiative - Nutrition and Cancer
"The results from this prospective study of well-nourished, postmenopausal women suggest that intake of dietary antioxidants, carotenoids, and vitamin A are not associated with a reduction in ovarian cancer risk."
Uptake of clinical genetic testing for ovarian cancer in Ontario: a population based study
Uptake of clinical genetic testing for ovarian can...[Gynecol Oncol. 2008] - PubMed Result:
"CONCLUSIONS: Genetic testing is available in Ontario to all women with invasive ovarian cancer. However, only a small proportion of women are being referred for testing. This study suggests that increased public awareness directed at physicians and at women with cancer may expand the use of genetic testing."
ICES - search results "ovarian"
| 1 | Health care delivery in Canada and the United States: are there relevant differences in health care outcomes? | 5% | Investigative Reports | September, 2003 |
| At a Glance | ||||
| 2 | At A Glance - October 2008 | 39% | At a Glance | October, 2008 |
| Journal Publications | ||||
| 3 | Outcomes in surgery for ovarian cancer | 12% | Journal Publications | September, 2003 |
| 4 | Surgical outcomes in women with ovarian cancer | 10% | Journal Publications | October, 2008 |
| Other | ||||
| 5 | Chapter 7: Surgery for Ovarian Cancer | 100% | Other | November, 2008 |
| 6 | Egg race | 16% | Other | April, 2006 |
| 7 | More than skin deep | 12% | Other | December, 2003 |
| 8 | Overview | 3% | Other | November, 2008 |
| 9 | Technical Appendix (abbreviated version) | 2% | Other | November, 2008 |
| 10 | Chapter 1: Introduction | 2% | Other | November, 2008 |
| 11 | Chapter 10: Reflections and Recommendations | 2% | Other | November, 2008 |
| 12 | HC 2008 - Urbach - Cancer surgery services | 2% | Other | February, 2008 |
Cancer Surgery in Ontario, Chapter 7, Surgery for Ovarian Cancer 2008 December report
Cancer Surgery in Ontario, Chapter 7, Surgery for Ovarian Cancer.pdf (application/pdf Object)
Implications:
More research is needed to better
understand why the use of cancer
staging procedures—such as
omentectomy and lymph node
excision—varied among women in
the study cohort who underwent
surgery for ovarian cancer.
Plans for expanding surgical services
related to the treatment of ovarian
cancer in Ontario should factor in the
existing referral patterns among Local
Health Integration Networks (LHINs).
There are relatively few gynecologic
oncologists in Ontario; these subspecialists
provide care to a large
number of women with ovarian cancer.
Further evaluation is required—both
in terms of the role of gynecologic
oncologists in treating women with
ovarian cancer, and also whether the
supply of these specialists will be
sufficient to meet future demand.
Findings
• While the incidence of ovarian cancer among Ontario women increased with age in 2003/04, the probability of surgical treatment decreased. About three-quarters (73 percent) of women in the Overall Ovarian Cancer Cohort underwent a surgical procedure related to the diagnosis and treatment of their disease.
• There was no clear relationship between women’s socioeconomic status and whether they had surgery for ovarian cancer. However, those living in regions with the lowest neighbourhood income were less likely than all others to have ovarian cancer-related surgery. (duh?)
• Rates of ovarian cancer-related surgery ranged across Local Health Integration Networks (LHINs) of patient residence—from a low of 58 percent among women living in the North West LHIN to a high of 88 percent among those residing in the Erie St. Clair LHIN.
Lymph node excision was done in just eight percent of women with ovarian cancer
During the study period, gynecologic oncologists comprised about seven percent of all physicians performing ovarian cancer
surgery in Ontario. Yet these sub-specialists performed nearly half (49) percent of all the surgeries among women in the
Ovarian Cancer Surgery Cohort.
Obstetrician/gynecologists performed 40 percent of surgeries on women in this study cohort; the remaining 12 percent of
procedures were done by physicians with other specialties.
Gynecologic oncologists were more likely than obstetrician/gynecologists to perform omentectomy (70 percent vs. 44 percent respectively) and lymph node excision (13 percent vs. six percent
Canadian Medicine: New study adds weight to call for boys to get HPV vaccine too
Canadian Medicine: New study adds weight to call for boys to get HPV vaccine too
"The study’s failure to demonstrate the vaccine’s effect on cancer is a function of the same problem that some critics of the HPV vaccine identified in the trials on girls: the trials’ follow-up periods aren’t long enough to determine whether there will actually be a drop in cancers, and, if so, how long the vaccine’s protection will last."
Note: nor long-term side effects
Commentary: Hormone Receptor Testing in Breast Cancer: A Distress Signal from Canada
Commentary: Hormone Receptor Testing in Breast Cancer: A Distress Signal from Canada -- Allred 13 (11): 1134 -- The Oncologist
Note: this response addresses the clinical aspects but not the political landscape and lack of transparency.
original article:
Breast Cancer Testing Scandal Shines Spotlight on Black Box of Clinical Laboratory Testing
http://jnci.oxfordjournals.org/cgi/content/full/100/12/836?ijkey=bfa78dfa42fd694d7cd597c944b59f7b421076d4&keytype2=tf_ipsecshaFriday, November 21, 2008
Macleans.ca - The angry breast cancer survivors
Macleans.ca - The angry breast cancer survivors
Women with post-treatment maladies find no one really wants to hear ‘downbeat’ stories
Thursday, November 20, 2008
AFP: European patent office restores breast cancer gene patent
AFP: European patent office restores breast cancer gene patent
"Only a handful of countries -- including Brazil and Chile -- do not allow patents on genes in any form."
Wednesday, November 19, 2008
The impact of positron emission tomography (PET) on expected management during cancer treatment: findings of the National Oncologic PET Registry.
http://www.ncbi.nlm.nih.gov/pubmed/19016303?dopt=AbstractPlus"
Tuesday, November 18, 2008
[Bowel Perforation Associated with Bevacizumab Therapy in Recurrent Ovarian Cancers without Bowel Obstruction or Bowel Involvement
http://www.ncbi.nlm.nih.gov/pubmed/19011357?dopt=AbstractPlus
Rare Appendix Tumor - Pseudomyxoma Peritonei (PMP)
http://www.cancerwise.org/april_2007/display.cfm?id=119563e8-6f93-48bd-9c3f22598df717dc&method=displayfull&color=green
"How is PMP diagnosed?
The disease is challenging to diagnose. A lot can be hidden inside the abdomen, and it develops slowly over time. Many patients are originally misdiagnosed with ovarian cancer (women) or metatastatic colon cancer."
Monday, November 17, 2008
Family history can trump breast cancer gene test - Yahoo! News
http://news.yahoo.com/s/ap/20081117/ap_on_he_me/med_breast_cancer_3
Family history can trump breast cancer gene test
By LAURAN NEERGAARD, AP Medical Writer Lauran Neergaard, Ap Medical Writer Mon Nov 17, 3:28 pm ET
WASHINGTON – If breast cancer runs in the family, women can be at high risk even if they test free of the disease's most common gene mutations, sobering new research shows. The genes BRCA1 and BRCA2 are linked with particularly aggressive hereditary breast cancer, and an increased risk of ovarian cancer, too.
When a breast cancer patient is found to carry one of those gene mutations, her relatives tend to breathe a sigh of relief if they test gene-free.
But those headline-grabbing genes account for only about 15 percent of all breast cancer cases. Even in families riddled with breast cancer, a BRCA gene is the culprit only in roughly one family of every five that gets tested, said University of Toronto cancer specialist Dr. Steven Narod.
So clearly members of those families remain at risk from other yet-to-be-found genes, but how much risk?
Narod tracked nearly 1,500 women from 365 breast cancer-prone families, who tested negative for BRCA1 and BRCA2 mutations.
After five years, those women had a fourfold higher risk than average women of developing breast cancer, Narod reported Monday at a meeting of the American Association for Cancer Research.
This is crucial information for women considering gene testing, said Georgetown University genetics counselor Beth Peshkin, who wasn't part of the study.
"This is contrary to what I think the common perception is," Peshkin said. "Unless a mutation is identified in the family, a negative test result doesn't provide reassurance."
The good news: Narod's study showed these women didn't have an increased risk of ovarian cancer, like BRCA1- and BRCA2-carriers do.
While the $3,000 BRCA tests are well-accepted, newer tests for other genes linked to breast cancer are coming on the market.
But "the family history is a much stronger predictor," stressed Narod. He recommends that such women take the anti-cancer drug tamoxifen and undergo MRI cancer checkups instead of easier mammograms "regardless of what other gene tests showed."
Oncology: percentage of visits for patients, regardless of age, with a diagnosis of cancer currently receiving chemotherapy or radiation therapy ....
http://www.qualitymeasures.ahrq.gov/summary/summary.aspx?ss=1&doc_id=12046
Oncology: percentage of visits for patients, regardless of age, with a diagnosis of cancer currently receiving chemotherapy or radiation therapy who report having pain with a documented plan of care to address pain.
Cancer in Canada in 2008 -- Marrett et al. 179 (11): 1163 -- Canadian Medical Association Journal
http://www.cmaj.ca/cgi/content/full/179/11/1163?etoc#T122
Pandora's box: ethics of PGD for inherited risk of late-onset disorders
http://www.ncbi.nlm.nih.gov/pubmed/18983739?ordinalpos=8&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum
Metabolic syndrome after risk-reducing salpingo-oophorectomy in women at high risk of hereditary breast ovarian cancer
A controlled observational study:
http://www.ncbi.nlm.nih.gov/pubmed/19008092?ordinalpos=2&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum
A serum based analysis of ovarian epithelial tumorigenesis
http://www.ncbi.nlm.nih.gov/pubmed/19007974?dopt=Abstract
Helping Doctors and Patients Make Sense of Health Statistics
http://www.psychologicalscience.org/journals/pspi/pspi_8_2_article.pdf">pspi_8_2_article.pdf
SUMMARY
We show that information pamphlets,
Web sites, leaflets distributed to doctors by the pharmaceutical
industry, and even medical journals often report
evidence in nontransparent forms that suggest big benefits
of featured interventions and small harms. Without understanding
the numbers involved, the public is susceptible
to political and commercial manipulation of their anxieties
and hopes, which undermines the goals of informed consent
and shared decision making.
Methods of consumer involvement in developing healthcare policy and research, clinical practice guidelines and patient information material -Cochrane
http://mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD004563/frame.html
"Two studies, which compared using consumer interviewers with staff interviewers as data collectors for patient satisfaction surveys, found small differences in satisfaction survey results, with less favourable results obtained when consumers were the interviewers."
Laparoscopy versus laparotomy for FIGO Stage I ovarian cancer - Cochrane Review
http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD005344/frame.html
The Canadian Press: Surgeons aren't following all guidelines to lower infection risks: survey
http://www.google.com/hostednews/canadianpress/article/ALeqM5g0WNRYszHEFxjZugztFqtiNXi-wg"
Fighting cancer with the internet and social networking : The Lancet Oncology
http://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(08)70275-4/fulltext
Very rapidly, social networking applications, such as Wikipedia, FaceBook, YouTube, and MySpace, have risen to be in the top-ten most-used sites on the Web, reshaping how we communicate, learn, and live.
Note: there was no specific mention of one of the original online cancer sites: Association of Online Cancer Resources:
http://www.acor.org
Subscribe to:
Posts
(
Atom
)
