BRCA1 and BRCA2 mutations across race and ethnicity: distribution and clinical implications

Abstract

PURPOSE OF REVIEW: To summarize evidence on the prevalence and spectrum of BRCA1 and BRCA2 BRCA1/2 mutations across racial and ethnic groups and discuss implications for clinical practice.
RECENT FINDINGS: The prevalence of BRCA1/2 mutations is comparable among breast cancer patients of African, Asian, white, and Hispanic descent: approximately 1-4% per gene. Among ovarian cancer patients in North America, BRCA1/2 mutations are present in 13-15%. Between racial/ethnic groups, there are important differences in the spectrum of BRCA1 compared with BRCA2 mutations, in BRCA1/2 variants of uncertain significance, and in the accuracy of clinical models that predict BRCA1/2 mutation carriage.
SUMMARY: Given the significant prevalence of BRCA1/2 mutations across race/ethnicity, there is a need to expand and customize genetic counseling, genetic testing, and follow-up care for members of all racial/ethnic groups.

Prevalence, incidence, and natural history of simple ovarian cysts among women >55 years old in a large cancer screening trial.

AdvoConnection :: When you need a patient advocate, you can find a patient advocate at AdvoConnection

It's Our Time - American Association for Cancer Research (AACR)

Odds Are, It's Wrong - Science News

Note: talks about statistics

“Determining the best treatment for a particular patient is fundamentally different from determining which treatment is best on average,” physicians David Kent and Rodney Hayward wrote in American Scientist in 2007."

CHUM (Montreal) turns cancer patients away

"The crisis at Notre Dame Hospital, a renowned cancer treatment centre, has reached such acute proportions that hospital officials are sending letters to women diagnosed with gynecological cancer to seek treatment elsewhere – in hospitals in Quebec City and Trois Rivières....."

"In fit of anger, (Dr.) Sauthier penned an open letter to his colleagues accusing the Quebec Health Department, the Quebec College of Physicians and his hospital of ignoring best practices in favour of balancing the books.

"Ovarian cancer survivor Suzanne Poulet read Sauthier’s letter aloud after Health Minister Yves Bolduc lauded his department’s successes inbreast and colon cancer screening programs as well as anti-smoking legislation. “What about problems operating on women with gynecological cancer?” Poulet demanded. Such delays are “intolerable” and “unacceptable,” Bolduc responded. “It’s an emergency and we are in the process of fixing it.”

Read more: http://www.montrealgazette.com/health/CHUM+turms+cancer+patients+away/2945070/story.html#ixzz0lzEiOwCF

Editorial - Faltering Cancer Trials - NYTimes.com

Medical News: AACR: No NSAID Link to Ovarian Cancer (data taken from California Teachers Study)

WASHINGTON -- Regular use of anti-inflammatory drugs did not reduce the risk of ovarian cancer, a large prospective cohort study showed.

Neither weekly nor daily use of aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs) influenced the relative risk of ovarian cancer, California investigators reported here at the American Association for Cancer Research meeting.

But self-reported daily use of acetaminophen almost doubled the risk of ovarian cancer, they found.

"Our results do not support the hypothesis that these medications reduce the risk of ovarian cancer," Lei Duan, PhD, of City of Hope in Duarte, Calif., and colleagues concluded. "Conversely, the finding that daily acetaminophen use was associated with increased risk of ovarian cancer differs from previous studies and may warrant further investigation."...cont'd
Action Points:

---

• Explain to interested patients that regular use of aspirin or nonsteroidal anti-inflammatory drugs did not influence the risk of ovarian cancer.
• Explain that daily use of acetaminophen was associated with an increased risk of ovarian cancer.
• Explain that the findings were based on a retrospective review of a large database and therefore cannot prove that acetaminophen caused the increased risk of ovarian cancer.
• Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.

The Canadian STOP-PAIN project - What is the cost of pain for patients on waitlists of multidisciplinary pain treatment facilities?

Review and revision of guidelines for ovarian cancer in Japan (abstract)

A survey of members of the Japan Society of Gynecologic Oncology revealed that 93% of the members use the present Guideline for Ovarian Cancer Treatment in practice.

Medical News: FDA Announces New Infusion Pump Safety Initiative - in Public Health & Policy, FDA General from MedPage Today

The FDA (U.S.) announced a new safety initiative Friday aimed at improving the safety of one of the most commonly recalled categories of medical devices: infusion pumps.

Of Value: A Discussion of Cost, Communication, and Evidence to Improve Cancer Care -- The Oncologist

Uncertainty in Assessing Value of Oncology Treatments -- The Oncologist

abstract:
Patients, clinicians, payers, and policymakers face an environment of significant evidentiary uncertainty as they attempt to achieve maximum value, or the greatest level of benefit possible at a given level of cost in their respective health care decisions. This is particularly true in the area of oncology, for which published evidence from clinical trials is often incongruent with real-world patient care, and a substantial portion of clinical use is for off-label indications that have not been systematically evaluated.
It is this uncertainty in the knowledge of the clinical harms and benefits associated with oncology treatments that prevents postregulatory decision makers from making accurate assessments of the value of these treatments. Because of the incentives inherent in the clinical research enterprise, randomized control trials (RCTs) are designed for the specific purpose of regulatory approval and maximizing market penetration.
The pursuit of these goals results in RCT study designs that achieve maximal internal validity at the expense of generalizability to diverse real-world patient populations that may have significant comorbidities and other clinically mitigating factors.
As such, systematic reviews for the purposes of coverage and treatment decisions often find relevant and high-quality evidence to be limited or nonexistent. For a number of reasons, including frequent off-label use of medications and the expedited approval process for cancer drugs by the U.S. Food and Drug Administration, this situation is exacerbated in the area of oncology.....

"Until scientific advancements in treatment occur, significant gaps in real-world evidence will be pervasive in the area of oncology. This situation has negative consequences for a variety of players in health care, from patients and physicians to payers and policymakers. Addressing these gaps would result in better decisions that improve patient outcomes and reduce unnecessary costs."

Beyond Costs and Benefits: Understanding How Patients Make Health Care Decisions -- The Oncologist

CONCLUSION:
Physicians are increasingly recognizing that many medical decisions are not purely medical decisions, but hinge on patient preferences. This recognition of patients' preferences has raised the challenge of finding ways to communicate the costs and benefits of treatments in ways that patients not only comprehend, but can also integrate with their own values to help the clinician determine what treatment choice is best for that given patient.

How Should We Define Value in Cancer Care? - The Oncologist

quote of the day

"the one path for which there is no good alternative is that of living and acting with integrity"

C. Norman Coleman M.D.
Radiation Research

open access - free: Imaging in Radiation Oncology: A Perspective -- The Oncologist

Note: not specific to ovarian cancer; paper addresses the importance of imaging techniques (ie; MRI/PET) while planning radiation therapies.  
some excerpts:
- Shortly after the discovery of the x-ray in 1895, the potential therapeutic benefits of the x-ray and possible toxicities were realized. More than a century later, we continue to struggle with how to balance the intensity of cancer treatment toward increasing the chance of cure with the potential for normal tissue toxicity. Imaging has improved our understanding of the complexities of cancer biology, cancer diagnosis, staging, and prognosis, and it is an essential component of present-day radiation oncology practice. Progress in radiation oncology has occurred in parallel to advances in imaging.
- The primary decisions that radiation oncologists make daily are to decide who to treat, what to treat, what to avoid, and how to deliver the intended doses safely. Imaging is considered in each of these decisions. Although the steps described in sequence below often occur simultaneously, they feed back to each other. Predictions about uncertainties and response in a specific patient can be made from experience in treating a population of similar patients or as more is learned about the patients themselves (e.g., with imaging obtained during therapy).
- How to define the gross tumor volume and volumes at risk for containing microscopic disease (clinical target volumes [CTVs]) is not an easy task. Different imaging tools demonstrate inherently different representations of the tumor

In the News (U.S.) NCI will offer cancer e-care record for providers

"The EHR is based on a early reference implementation of the Patient Outcomes Data Service, an open source “ultra-light record” derived from standards of NCI’s Cancer Biomedical Informatics Grid (caBIG).
The record, which is set up to provide data on patient demographics, disease and treatment results, could be used by providers and even consumers for data exchange.
“Because we use standards, anybody can push it or receive it,” Buetow said in remarks at a conference sponsored April 12 by the World Health Care Congress
The specifications and the software are available now through the NCI site but are not consumer-friendly, Buetow said. NCI plans to make it easily accessible to providers and consumers who would want to use it, within 60 days.
NCI is working with SAIC and Microsoft on the project, he added"

New wellness center to open in Middletown | New England Business Bulletin

MIDDLETOWN, R.I. — Women & Infants Hospital is opening a new wellness center at 333 Valley Road in Middletown this month, as part of its Integrative Care Program.
Operating within the hospital's Program in Women's Oncology, the Center for Health and Well-Being will offer a menu of complementary therapies for oncology patients as well as wellness programming to appeal to all women.
"We will offer the full range of complementary therapies, traditional and innovative health and wellness programming, and a women's health library full of resource materials on a variety of topics, from cancer to infertility to post-partum depression," said Sandra Scuncio, director of the Integrative Care Program.
Lymphedema therapy, specialized massage for women who have had surgery for breast or gynecologic cancer, is one of the treatments that will be offered at the Middletown site. Others include acupuncture, therapeutic massage, reiki, hypnotherapy, guided imagery, reflexology, meditation, facials and skin care.
In addition, there will be programs dedicated to weight loss, exercise, and nutrition, plus lectures, a weight loss clinic and yoga sessions. Eventually, there are plans to offer counseling services for cancer patients.
Funding to establish Newport the site was provided through a grant from the van Beuren Charitable Foundation.

New Articles -- EvidenceUpdates

Mujoomdar M Moulton K Nkansah E Positron emission tomography (PET) in oncology: a systematic review of clinical effectiveness and indications for use. Canadian Agency for Drugs and Technologies in Health (CADTH). 2010 Apr:1-36. (Review)

EXECUTIVE SUMMARY Context and Policy Issues In 2008, approximately 166,400 new cases of cancer were diagnosed in Canada. Radiological imaging modalities, including positron emission tomography (PET), are used in the diagnosis, staging, assessment of treatment response, and monitoring of recurrence of cancers. PET is a modality that is used to provide a three-dimensional image of functional changes in the body. PET can be used to track the deposition of radioactive molecules to sites in the body. The most common radioactive tracer is 2-[18F] Fluoro-2-deoxy- D-glucose (FDG). FDG is a glucose analogue that accumulates in tissues with high metabolic activity, such as tumour tissue. In addition to its use in cancer diagnosis, PET is commonly used to determine the stage or extent of disease for various types of cancers. The approach to treating the cancer will depend on the stage. Therefore, accurate information about diagnosis and staging is critical for planning the most appropriate treatment strategy. PET is also used to assess how a person is responding to treatment during or at the end of the treatment, and to monitor if the cancer has recurred after treatment. The use of PET is on the rise, and the number of possible indications for PET use is increasing. Access to PET varies across Canada. With an increasing number of Canadians being diagnosed with cancer each year, there is a need to review the evidence on the clinical effectiveness of PET for oncologic conditions compared with other imaging modalities including computed tomography (CT) and magnetic resonance imaging (MRI). Research Questions 1. What is the clinical effectiveness of positron emission tomography (PET) in oncology compared to computed tomography (CT) and magnetic resonance imaging (MRI) when used as an adjunct to CT or MRI? 2. What are the indications for PET use in oncology? Methods Published literature was obtained by crosssearching PubMed, MEDLINE, and Embase on the OVID search system between 2007 and December 4, 2008. Parallel searches were performed on The Cochrane Library (Issue 4, 2008), and the University of York’s Centre for Reviews and Dissemination (CRD) databases. Results were limited to English language publications only. Filters were applied to limit the retrieval to systematic reviews, health technology assessments (HTAs), meta-analyses, and guidelines. The websites of HTA and related agencies were searched, as were specialized databases such as those of the National Institute for Health and Clinical Excellence (NICE), ECRI Institute, and EuroScan. The Google search engine was used to search for information on the Internet. Two independent reviewers screened articles for selection. This report was peer-reviewed by two clinical experts. Summary of Findings Three HTAs were identified in our literature search. The first HTA assessed the clinical Positron Emission Tomography (PET) in Oncology: A Systematic Review of Clinical Effectiveness and Indications for Use v effectiveness of PET in breast, colorectal, head and neck, lung, lymphoma, melanoma, esophageal, and thyroid cancers. The use of FDG-PET for diagnosis, staging or restaging, and monitoring recurrence and treatment for each cancer type was evaluated. The authors concluded that the highest quality evidence on the clinical effectiveness of PET was in the detection of distant metastases, staging or restaging of colorectal cancer, detection of solitary pulmonary nodules, staging of non-small cell lung cancer (NSCLC), and restaging of Hodgkin disease. The second HTA reviewed the use of PET in monitoring the treatment response among women with breast cancer. The evidence suggested that PET may be useful in the identification of patients with advanced breast cancer who are not responding to neoadjuvant treatment and patients with metastatic disease who are responding to treatment. The third HTA examined the use of PET for monitoring the response to treatment of Hodgkin disease and non-Hodgkin lymphomas (NHLs). The authors concluded that a positive PET scan (specific uptake of FDG) during the monitoring of treatment of response is predictive of death or disease progression. Ten systematic reviews and three metaanalyses were indentified in our literature search. Overall, the systematic reviews and meta-analyses concluded that PET had the highest accuracy for the detection of cancers originating in the lung, pancreas, head and neck region, and cancers of unknown primary origin. PET was effective in the staging or restaging of breast cancer, colorectal cancer, esophageal cancer, head and neck cancer, lung cancer, lymphoma, and melanoma. The systematic reviews and meta-analyses described the clinical effectiveness of PET for the detection of lymphoma, residual or recurrent breast cancer, colorectal cancer, head and neck cancer, and thyroid cancer. PET was not

video- DiscoveryCME :: Chasing Zero: Winning The War On Healthcare Harm

In research: Medical News: AACR: Urinary Markers May Flag Ovarian Cancer - in Meeting Coverage, AACR from MedPage Today

Note: in research

"WASHINGTON -- A combination of patient age and urinary biomarkers predicted a 95% probability of ovarian cancer, according to a study reported here....."

In research: Medical News: AACR: Gene Copy Number May Predict Success in Ovarian Cancer - in Meeting Coverage, AACR from MedPage Today

Note: in research:
WASHINGTON -- The number of copies of certain genes -- especially those that are associated with apoptosis -- may signal whether a patient with ovarian cancer will respond to therapy, researchers suggested here.

Evaluating women with ovarian cancer for BRCA1 and BRCA2 mutations: missed opportunities.

CONCLUSION: Although dictated family history was accurate, interpretation of risk for BRCA1 or BRCA2 mutations and subsequent referral to genetic counseling was poor. Although there was significant improvement over time, 50% of substantial-risk patients still were missed. Systematic efforts to identify those ovarian cancer patients at substantial risk for a BRCA1 or BRCA2 are necessary.

Different anthracycline derivates for reducing cardiotoxicity in cancer patients. Cochrane Collaboration Database Systematic Review

CONCLUSIONS:
We are not able to favour either epirubicin or doxorubicin when given with the same dose. Based on the currently available evidence on heart failure, we conclude that in adults with a solid tumour liposomal-encapsulated doxorubicin should be favoured over doxorubicin. For both epirubicin versus doxorubicin and liposomal-encapsulated doxorubicin versus conventional doxorubicin no conclusions can be made about the effects of treatment in children treated with anthracyclines and also not in patients diagnosed with leukaemia. More research is needed. For other combinations of anthracycline derivates not enough evidence was available to make definitive conclusions about the occurrence of cardiotoxicity in patients treated with anthracyclines.

CCardiology

Probably an important review but it would have been more helpful for the general practitioner if the authors also reviewed or at least discussed the role of ACE-Inhibitors given before anthracycline treatment in these patients.

ommentary (1) at present:

Abstract/free full access: Comparison of numerical and verbal rating scales to measure pain exacerbations in patients with chronic cancer pain

Background
Numerical rating scales (NRS), and verbal rating scales (VRS) showed to be reliable and valid tools for subjective cancer pain measurement, but no one of them consistently proved to be superior to the other. Aim of the present study is to compare NRS and VRS performance in assessing breakthrough or episodic pain (BP-EP) exacerbations.

repost: Advanced ovarian carcinoma: Does a high-dose short-duration schedule of paclitaxel trump prolonged low-dose therapy? - Cancer Network

Ovarian Cancer

Oncology NEWS International. Vol. 19 No. 4
Pages: 1 2

Point / Counterpoint
"Advanced ovarian carcinoma: Does a high-dose short-duration schedule of paclitaxel trump prolonged low-dose therapy?"

(U.S.) Community cancer centers weather rough economy - Cancer Network

Colon Cancer: Microsatellite instability stymies doctors - Cancer Network

Note: MSI has been/is being studied also in ovarian cancer (w/without Lynch Syndrome genes)

PharmaMar Presents New Clinical Trials With Three Marine-Based Drugs at the American Association for Cancer Research Convention - yondelis/Trabectedin

Two trials provided new data on Yondelis(R) (trabectedin), a marine-based anti-tumor drug currently produced by chemical synthesis. Yondelis(R) (trabectedin) has European Commission approval for advanced and metastatic soft tissue sarcoma (STS) and for recurrent platinum-sensitive ovarian cancer in combination with Doxil/Caelyx

IOM releases recommendations for cancer clinical trials | HemOncToday

"After the release of the report, Richard L. Schilsky, MD, immediate past president of the American Society of Clinical Oncology released a statement.

Hormone Replacement Therapy: MedlinePlus (update)

Ovarian Cancer and Our Pets

Roxie's new baby ROCCO has just been added to our Montage (video)

Make photo slide shows at www.OneTrueMedia.com

Pfizer Inc., 4/9/10 FDA (U.S.) warning letter

Differences in tumor type in low-stage versus high-stage ovarian carcinomas.

Abstract:
"Although there are recognized differences in the type of ovarian carcinomas between those tumors diagnosed at low versus high stage, there is a lack of data on stage distribution of ovarian carcinomas diagnosed according to the current histopathologic criteria from large population-based cohorts. We reviewed full slide sets of 1009 cases of 2555 patients diagnosed with ovarian carcinoma that were referred to the British Columbia Cancer Agency over a 16-year period (1984 to 2000). On the basis of the reviewed cases we extrapolated the distribution of tumor type in low-stage (I/II) and high-stage (III/IV) tumors. We then compared the frequencies with those seen in a large hospital practice. The overall frequency of tumor types was as follows: high-grade serous-68.1%, clear-cell-12.2%, endometrioid-11.3%, mucinous-3.4%, low-grade serous-3.4%, rare types-1.6%. High-grade serous carcinomas accounted for 35.5% of stage I/II tumors and 87.7% of stage III/IV tumors. In contrast, clear-cell (26.2% vs. 4.5%), endometrioid (26.6% vs. 2.5%), and mucinous (7.5% vs. 1.2%) carcinomas were relatively more common among the low-stage versus high-stage tumors. This distribution was found to be very similar in 410 consecutive cases from the Washington Hospital Center. The distribution of ovarian carcinoma types differs significantly in patients with low-stage versus high-stage ovarian carcinoma when contemporary diagnostic criteria are used, with consistent results seen in 2 independent case series. These findings reflect important biological differences in the behavior of the major tumor types, with important clinical implications."

Metastatic ovarian serous carcinoma presenting as inflammatory breast cancer: a case report.

Gene link to cancer risk in families - protein RAD51C (news item) breast and ovarian

Note: this report is worthwhile reading especially for those who test negative for BRCA 1/2

"No significant mutations were found in RAD51C in the 620 families with breast cancer only.  However, when they looked at the breast and ovarian cancer families, things got really interesting.  In all, they were able to identify a total of 6 mutations in the 480 families that had sufficient evidence to implicate them in the breast and ovarian cancer susceptibility.  Thus, in this German study of women with unexplained familial breast and ovarian cancer, the cancer susceptibility in 1.3% of the families could be explained by heterozygous mutations in the RAD51C gene."

Ethics-Related Articles - Sunnybrook Health Sciences Centre Toronto

Hope, denial and ethics of care

By Karen Faith, MEd, MSc, RSW (HotSpots Volume 8 Issue 3 – August 2006)

“Someone has to give this patient a dose of reality therapy – she thinks she’s getting better!” exclaimed the physician after trying to discuss advance wishes with a seriously ill patient. In this scenario, the physician felt his patient’s denial, expressed in her hope for recovery, prevented her from facing her illness, appreciating the implications and exercising her autonomy. The patient and her physician were not in agreement about her poor prognosis. After expressing his frustration to me, the physician later acknowledged with sadness how much he cared about her and her struggle.

For many people, hope is a source of sustenance in the face of tragic circumstances – it is programmed into their souls. “Where there is life, there is hope” is an expression often coined by people facing the loss of a loved one. Underlying such expressions of hope can also be a tacit understanding that the hoped-for outcome will not be realized. Expressions of hope when the facts suggest otherwise may seem disturbingly inappropriate to those who believe that one must face the truth and accept reality.

A study conducted with dying patients concluded that “hope is based on something other than prognosis, or is a concept that suggests a greater emotional component than mere expectation, and is seen as an active process of conscious and unconscious meaning” (Chochinov, 2006). Patients with a life threatening illness may refuse to discuss a poor prognosis, holding onto hope until the very end for a variety of reasons. Everyone has heard at least one story about a patient who defied the statistics, miraculously outliving by years his/her projected survival time. In the face of all this, health care professionals are obligated to provide their patients with pertinent health information, to do no harm and to maximize the benefit to the patient in the care that is provided. How can such important ethical obligations be met when a patient with a poor prognosis maintains her spirit of hope and does not wish to discuss advance care wishes?

Care providers need to understand what hope means to their patient. Is hope expressed for the benefit of loving family members, to protect a spouse or child from emotional pain or anxiety? Can hope in the face of serious illness reflect the way this person has always faced and overcome adversity? Does hope stem from deeply held religious values about divinely inspired healing or salvation? Hope can serve an important role in the spiritual, emotional, psychological and relational experience of having a serious illness. Health care providers can support patients by providing information sensitive to the patient’s readiness to hear this information. However, there may be information that must be shared due to issues of safety, informed consent or according to law. Although capable, some patients prefer that a relative or loved one receive health information and participate in care decisions. Patients should be asked the kind of information they are prepared to receive and, where appropriate, whether a loved one could be told instead. Ultimately, these discussions addressing hope, prognosis and care require certain essential caregiver qualities. These qualities include an unhurried, sensitive and sincere engagement with the patient, and an interaction based on acceptance of the patient as she is, not as one would prefer her to be."

Multicenter Prospective Study on Efficacy and Safety of Octreotide for Inoperable Malignant Bowel Obstruction

Note: Octreotide(brand name Sandostatin)

In research - Medical News: AACR: SYK Gene Explored as Ovarian Cancer Target - in Meeting Coverage, AACR from MedPage Today

International Cancer Genome Consortium

Note: those studying ovarian cancer -  

Ovarian Cancer Australia

Ovarian Cancer United States

"Once thought of as a single disease, cancer is now understood to be the result of genetic mutations in cells which disrupt normal functions leading to uncontrollable growth. Because mutations are often specific to a particular type or stage of cancer, systematically mapping the changes that occur in each cancer could provide the foundation for research to identify new therapies, diagnostics and preventive strategies."

Granulosa cell tumors of the ovary: a clinicopathologic and immunohistochemical study of 21 cases.

Hereditary ovarian cancers: from BRCA mutations to clinical management. A modern appraisal

Emerging role of radiotherapy in the management of liver metastases

from the series The Art of Oncology: "Certain Death in Uncertain Time: Informing Hope by Quantifying a Best Case Scenario"

Note: Stephen Gould's writings were extraordinarily popular died in 2002)

"Research informs us that the majority of patients with metastatic cancer desire information about their likely survival duration. The literature also recommends that prognostic information be communicated to those who request it in a manner that is meaningful and realistic, but maintains hope.....The following edited extract from Edward Kennedy’s memoir (and others) conveys the importance of trying to answer these questions....."

"...But I wasn’t willing to accept the doctor’s prognosis for two reasons. The first was my own obstinate will to carry on in the face of adversity, one of the many habits of discipline that my father instilled in me…. The second was the way the message was delivered. Frankly, it made me furious. I am a realist, and I have heard bad news in my life. I don’t expect or need to be treated with kid gloves. But I do believe in hope...."

"....As Stephen Gould published 3 years after reading that his median survival with abdominal mesothelioma was 8 months, “the median isn’t the message.”7 He argued that median survival can be both misleading and discouraging and believed few people have sufficient understanding of statistics to evaluate what the term median
really means....."

from The Art of Oncology series: How Flipping Burgers Can Cure Leukemia -- JCO

Note: the message is not about leukemia nor 'flipping burgers'

Associations Among Cancer Survivorship Discussions, Patient and Physician Expectations, and Receipt of Follow-Up Care - JCO abstract

Note: abstract - 1)  pay-per-view/subscription journal; 2) selected key points:  total study # of patients= 431; breast cancer responses = 52%; gyn cancers = 4%; study did not break down differing gyn cancers; caucasian =94%

Equipoise Lost: Ethics, Costs, and the Regulation of Cancer Clinical Research - abstract

define: Equipoise - balance: equality of distribution
"In summary, current approaches squander research resources and discourage research participation, and the marked imbalance between potential life-years lost versus saved renders the regulatory burden potentially unethical. We outline suggested solutions."

Increased Incidence of Visceral Metastases in Scottish Patients With BRCA1/2-Defective Ovarian Cancer: An Extension of the Ovarian BRCAness Phenotype

Note: see abstract for further information

Results:
Seventy-nine patients with EOC/PPC and germline BRCA1/2 mutations were identified. Fifteen had inadequate clinical data, two had carcinosarcoma, 27 had previous breast cancer, and 16 were in remission. Of the remaining 19 patients who were BRCA1/2 deficient, 14 patients (74%) developed visceral metastases compared with six (16%) of 38 patients in the control group. The percentages of liver, lung, and splenic metastases were 53%, 32%, and 32%, respectively, in the patients compared with 5%, 3%, and 5%, respectively, in the controls.
Conclusion:
Although sporadic EOC commonly remains confined to the peritoneum, BRCA1/2-deficient ovarian cancer frequently metastasizes to viscera. These data extend the ovarian BRCAness phenotype, imply BRCA1/2-deficient ovarian cancer is biologically distinct, and suggest that patients with visceral metastases should be considered for BRCA1/2 sequencing.

NCI IoM Committee Recommends Overhaul of NCI Clinical Trials Cooperative Group Program

Second Opinion - In Reporting Symptoms, Don’t Patients Know Best? - NYTimes.com

Informational content, literacy demands, and usability of websites offering health-related genetic tests directly to consumers

Intraoperative Frozen-Section Evaluation of Lymph Nodes Is Not Associated With Underdiagnosis of Isolated Tumour Cells: Presented at ASBD

Health Canada Media Notices - 2010 'CARN' Canadian Adverse Reaction Newsletter

Tuesday, April 20, 2010
Health Canada today released the April 2010 issue of the Canadian Adverse Reaction Newsletter (CARN).
This issue includes an article on leflunomide, a prescription drug used in the treatment of rheumatoid arthritis, and a suspected association with peripheral neuropathy (damage to sensory nerves, especially to hands and feet).
It also contains the annual adverse reaction and incident reporting statistics for 2009, as well as a quarterly summary of health professional and consumer advisories.
The April 2010 edition of CARN can be viewed on the Health Canada Web site.

The Lois Hole Hospital for Women - Women's Health Programs (Edmonton)

Table 1 : Mismatch repair deficient colorectal cancer in the era of personalized treatment : Nature Reviews Clinical Oncology

NEJM -- Gene Patenting -- Is the Pendulum Swinging Back?

U.S. Cochrane Center - Colorado conference/advocates' forum

Message from Cochrane Collaboration Consumer Network:

Please save the date (October 17, 2010) for an international Consumer Advocacy Summit, sponsored by Consumers United for Evidence-based Healthcare (CUE), immediately preceding the Cochrane and Campbell Colloquium in Keystone, Colorado.  We will have more program details for you soon!  Your participation in the full day meeting will make it a success!!

Questions can be directed to Janie Gordon, CUE Coordinator at jlgordon@jhsph.edu , (410) 502-4640.

 Thank you!

 Janie Gordon, ScM.

Cochrane Outreach Coordinator

US Cochrane Center

Johns Hopkins Bloomberg School of Public Health

615 North Wolfe Street, Mail Room W 5010

Baltimore, Maryland 21205 USA

Phone:410-502-4640

Email: jlgordon@jhsph.edu

Fax: 410-502- 4623

abstract: Policy and advocacy in the quest for effective translational breast care research.

Twitter study highlights need for monitoring health info dissemination | Healthcare IT News

Advocates And Researchers Educate Community About Cancer In Game Show Format

University Hospital Zürich First In The World To Treat Cancer Patients With New TrueBeam™ System From Varian Medical Systems

Studies clash on vitamin benefits - CNN.com

from website: mybiopsy.org: CAP and ASCO ER/PgR Test Guideline - College of American Pathologists

What to Know: The CAP and ASCO Guideline on Estrogen and Progesterone Receptor Testing for Breast Cancer Introduction To help doctors give their patients the best possible care, the College of American Pathologists and the American Society of Clinical Oncology (ASCO) developed evidence-based recommendations to improve the accuracy of testing for estrogen and progesterone receptors for breast cancer. This guide for patients is based on CAP’s and ASCO’s recommendations. Key Points: * Estrogen and progesterone receptors are found on breast cancer cells that depend on estrogen and related hormones to grow. * All patients with invasive breast cancer or a breast cancer recurrence should have their tumors tested for estrogen and progesterone receptors. * This testing should be performed by an accredited laboratory that follows specific testing procedures and handles the samples in a consistent way.

ASCO And The CAP Issue Joint Guideline To Improve Hormone Receptor Testing For Patients With Breast Cancer

""There is clearly a need to accurately identify breast cancer subtypes as ER and/or PgR-positive to help us identify those patients most likely to benefit from endocrine therapy and minimize the risk of potentially denying effective and life-saving therapy to patients incorrectly labeled as having ER/PgR-negative invasive disease, while allowing patients with true ER/PgR-negative disease to be considered for other therapies." said Antonio C. Wolff, MD, FACP, co-chair of the ASCO/CAP Hormone Receptor Testing in Breast Cancer Panel and associate professor of oncology at the Johns Hopkins Kimmel Comprehensive Cancer Center. The guideline recommends the following:" (see article for further information)

Should Doctors Google Their Patients? - WSJ

FR Doc 2010-8386 Falsification of Data- complentary and alternative medicine NCCAM

U.S.
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Office of the Secretary
Findings of Research Misconduct
AGENCY: Office of the Secretary, HHS.
ACTION: Notice.

"...research  misconduct in research supported by National Center for Complementary
and Alternative Medicine (NCCAM), National Institutes of Health (NIH),
grant R01 AT001846 and Predoctoral Fellowship Award F31 AT003977-01,
and National Institute of Diabetes and Digestive and Kidney Diseases
(NIDDK), NIH, grant R01 DK082773-01."

A Tweak to the Figures - falsifying data and figures

"The Scientist notes that the papers that include the falsified figures, which appeared in Endocrinology and Molecular Endocrinology, are in the process of being retracted. Writedit also reports that a former Wyeth researcher, Boris Cheskis, has accepted to a two-year agreement after Office of Research Integrity found that he falsified figures submitted to NIH."

The Role of a Clinician-Led Reflective Interview on Improving Self-Efficacy in Breast Cancer Survivors: A Pilot Study

Arch Surg -- Interpreting Comparative Effectiveness Studies: Does Surgeon Expertise Matter?: Comment on "Comparison of Laparoscopic and Open Repair With Mesh for the Treatment of Ventral Incisional Hernia", April 2010

Interpreting Comparative Effectiveness Studies: Does Surgeon Expertise Matter?:
Comment on - Comparison of Laparoscopic and Open Repair With Mesh for the Treatment of Ventral Incisional Hernia April 2010

Abstract: Total Extraperitoneal Laparoscopic Inguinal Hernia Repair Without Mesh Fixation: Prospective Study With 1-Year Follow-up Results, April 2010

Abstract: Comparison of Laparoscopic and Open Repair With Mesh for the Treatment of Ventral Incisional Hernia: A Randomized Trial, April 2010

Defining ventral hernia: An incisional hernia occurs in an area of weakness caused by an incompletely-healed surgical wound. Since median incisions in the abdomen are frequent for abdominal exploratory surgery, ventral incisional hernias are termed ventral hernias.

Medical News: Obama Nominates Berwick to Head CMS - in Washington-Watch, Washington

Note: good choice

(ovarian cancer) Scientists Study Psychedelic Mushrooms to Help Cancer Patients Face Death - ABC News

News - Coventry News - Women in the dark over ovarian cancer

"WOMEN in Coventry and Warwickshire are more likely to know more and about male cancers than ovarian cancer, new figures show.
The research by Ovarian Cancer Action also reveals that most women in the area cannot name a single symptom of ovarian cancer."

Proteins linked to ovarian cancer outcomes - (short) news item

financial news: Abstracts Highlighting Sunesis' Phase 2 Voreloxin Data Accepted for Presentation at 2010 ASCO Meeting

The presentations include an oral presentation of final data from the Company's Phase 2 trial of voreloxin in ovarian cancer....

Empowerment The relation between patient-centeredness and patient empowerment: A discussion on concepts

A Guide to Women's Health: Fifty and Forward - Harvard Health Publications

Figure 1 

This diagram shows the top 10 causes of death (expressed as a percentage of total deaths) in women at different ages. You can see how the risk of the three leading killers for all ages combined — heart disease, stroke, and cancer — changes with age by following the red, yellow, and pink boxes. Chronic lung diseases include asthma and chronic obstructive pulmonary disease (COPD), which includes bronchitis and emphysema. Septicemia refers to blood infections.

Case Studies Reveal that Patents Can Hinder Genetic Research and Patient Care: Scientific American

Young Women undergoing Breast Reconstructions after Being Tested for BRCA genes

$1.25m boost for cancer fight (ovarian) Melbourne, Australia news article

See the Differences Between Internet Explorer and Firefox

Resources for Financial Assistance for Patients and Their Families (U.S.)

Note: no date on this website page

Six-figure salaries the norm at top charities - The Globe and Mail

Note: this is timely

Intensity-modulated whole abdominal radiotherapy after surgery and carboplatin/taxane chemotherapy for advanced ovarian cancer: phase I study

CONCLUSIONS: The results of this Phase I study showed for the first time, to our knowledge, the clinical feasibility of intensity-modulated whole abdominal radiotherapy, which could offer a new therapeutic option for consolidation treatment of advanced ovarian carcinoma after adjuvant chemotherapy in selected subgroups of patients. We initiated a Phase II study to further evaluate the toxicity of this intensive multimodal treatment.

Memory changes during and after cancer treatment - MayoClinic.com

video: Ovarian Cancer Clinical Trials - SHARE

55 minute video: Breakfast with the Chiefs Andre Picard/The Globe and Mail :“What Do Patients Want? A Critical Look at Health Care Delivery in Canada.”

includes discussion on Patient Safety (group)/patient centered groups

Abstract and full free text available: Pelvic mass associated with raised CA 125 for benign condition: A case report

Note: this paper also discusses differences between ultrasound/CT/MRI

Abstract
Background
Raised CA 125 with associated pelvic mass is highly suggestive of ovarian malignancy, but there are various other benign conditions that can be associated with pelvic mass and a raised CA 125.
Case presentation
We present a case of 19 year old

Impact of the Cost of Cancer Treatment: An Internet-Based Survey -- Markman et al (U.S.)

Note: ovarian cancer patients were not included in this study
Conclusion: This survey suggests that a substantial proportion of patients and their families experience considerable distress associated with the cost of cancer care delivery. Furthermore, these costs affect the decision of patients with cancer to receive recommended treatment. This is a particularly serious issue for individuals with a modest annual income.

Journal of Oncology Practice - Home Page - Survey of Cooperative Groups regarding NCI trials

Note: as of the timing of this post, these articles are freely available

Early Release Articles *NEW*

1) Timing Is Everything Zon
2) Challenges to National Cancer Institute–Supported Cooperative Group Clinical Trial Participation: An ASCO Survey of Cooperative Group Sites Baer et al

Multidisciplinary Cancer Conferences: Exploring Obstacles and Facilitators to Their Implementation -- Journal of Oncology Practice

Conclusion: Variation exists in the enthusiasm of health professionals and the administrative capacity of institutions regarding routine implementation of MCCs. A systematic implementation plan for MCCs is needed involving both cancer care providers and administrators.

Marjorie Williams: 'Woman at the Washington Zoo' : NPR

Note: This article was brought to my (and others) attention. It's not about ovarian cancer but liver cancer - excellent reading with many common thoughts ?? Your views?

An apple (and four other fruit and vegetables) a day… : The Lancet

CT scanning—safer when used properly : The Lancet

"In The Lancet today, Rethy Chhem and colleagues write that the increase in use of CT is because scans are being used for appropriate and inappropriate reasons. Adopting best practice standards appropriate for local settings will lead to better, safer, and more effective use of CT scanning in diagnosis and treatment."

A collapse in integrity of scientific advice in the UK : The Lancet

"Politics has been allowed to contaminate scientific processes and the advice that underpins policy."

ACS :: Ovarian Cancer Treatment Decision Tool - Cancer Profiler

from the JCO series 'The Art of Oncology' - "Art Informs Medicine"

reference to ovarian cancer (artist)

Multidisciplinary Meeting on Male Breast Cancer: Summary and Research Recommendations -- JCO

"Therefore, the Breast International Group and North American Breast Cancer Group have joined efforts to develop an International Male Breast Cancer Program and to pool epidemiologic data, clinical information, and tumor specimens. This international collaboration will also facilitate the future planning of clinical trials that can address essential questions in the treatment of male breast cancer."

Editorial: Conventional and Complementary Therapies: A Tale of Two Research Standards? -- Levine 28 (12): 1979 -- Journal of Clinical Oncology

"Recently, there has been a shift from single CAM modalities for cancer management to a more comprehensive approach called integrative oncology, which is "an evolving, evidence-based specialty that uses CAM therapies in concert with biomedical cancer treatments to enhance its efficacy, improve symptom control, alleviate patient distress and reduce suffering. I am encouraged that the leaders of the Society of Integrative Oncology (Dundas, Ontario, Canada) have developed evidentiary levels to gauge the strength of evidence for CAM therapies. It is not surprising that these levels are based on the foundational principles of evidence-based medicine established by Sackett et al.15 I look forward to future well-designed clinical trials that provide high-quality evidence on how CAM therapies can improve the quality of life of our patients."

Toronto hospital goes global to understand cancer treatments - Healthcare in Canada - C-Health

"The research will target lung, prostate, breast, colorectal, gynecological as well as certain blood cancers."

3rd Annual Conference CAM for Cancer.mp4 - Ann Fonfa

Decoding genomes from 25,000 cancer samples

The International Cancer Genome Consortium (ICGC) today set out its bold plan to decode the genomes from 25,000 cancer samples and create a resource of freely available data that will help cancer researchers around the world. The publication outlines research design and projects as well as the important ethical framework for this science.
The ICGC also announced that new projects in Italy and the European Union will contribute to efforts already underway in Australia, Canada, China, France, Germany, India, Japan, Spain, the United Kingdom, and the United States. As the UK's arm of the ICGC, the Wellcome Trust Sanger Institute will decode hundreds of breast cancer genomes as part of the Consortium's international efforts.
Other funded projects will examine more than 10,000 tumours for cancer types that affect organs including blood, brain, breast, colon, kidney, liver, lung, pancreas, stomach, oral cavity and ovary.
The paper, by over 200 authors participating in ICGC projects, is published today in the journal Nature. The paper describes how the projects will proceed, outlining the ethical framework, study design and policies. ICGC leaders will also present progress on their projects at the annual conference of the American Association for Cancer Research in Washington DC, 17 - 21 April, 2010.

Advanced ovarian carcinoma: Does a high-dose short-duration schedule of paclitaxel trump prolonged low-dose therapy? - Cancer Network

Note: This is a good discussion debating pros/cons (requires registration to view/free) - some excerpts from article:

Point / Counterpoint

Impact of gene patents and licensing practices on access to genetic testing for inherited susceptibility to cancer: Comparing breast and ovarian cancer

Genetics in Medicine:
April 2010 - Volume 12 - Issue 4
Article
Impact of gene patents and licensing practices on access to genetic testing for inherited susceptibility to cancer:
Comparing breast and ovarian cancers with colon cancers

Abstract

Genetic testing for inherited susceptibility to breast and ovarian cancer can be compared with similar testing for colorectal cancer as a “natural experiment.” Inherited susceptibility accounts for a similar fraction of both cancers and genetic testing results guide decisions about options for prophylactic surgery in both sets of conditions.

One major difference is that in the United States, Myriad Genetics is the sole provider of genetic testing, because it has sole control of relevant patents for BRCA1 and BRCA2 genes, whereas genetic testing for familial colorectal cancer is available from multiple laboratories.

Colorectal cancer-associated genes are also patented, but they have been nonexclusively licensed.

Prices for BRCA1 and 2 testing do not reflect an obvious price premium attributable to exclusive patent rights compared with colorectal cancer testing, and indeed, Myriad's per unit costs are somewhat lower for BRCA1/2 testing than testing for colorectal cancer susceptibility. Myriad has not enforced patents against basic research and negotiated a Memorandum of Understanding with the National Cancer Institute in 1999 for institutional BRCA testing in clinical research. The main impact of patenting and licensing in BRCA compared with colorectal cancer is the business model of genetic testing, with a sole provider for BRCA and multiple laboratories for colorectal cancer genetic testing.

Myriad's sole-provider model has not worked in jurisdictions outside the United States, largely because of differences in breadth of patent protection, responses of government health services, and difficulty in patent enforcement.

Note: see abstract for authors which include: Robert Cook-Deegan, MD. Director, IGSP Center for Genome Ethics, Law & Policy.

Clinical pathways: effects on professional practice, patient outcomes, length of stay and hospital costs. Cochrane Database Systemati Rev. 2010

Note: there are many different comments from a variety of healthcare professionals and more than a normal number of comments

Abstract

BACKGROUND: Clinical pathways are structured multidisciplinary care plans used by health services to detail essential steps in the care of patients with a specific clinical problem. They aim to link evidence to practice and optimise clinical outcomes whilst maximising clinical efficiency. OBJECTIVES: To assess the effect of clinical pathways on professional practice, patient outcomes, length of stay and hospital costs.
CONCLUSIONS: Clinical pathways are associated with reduced in-hospital complications and improved documentation without negatively impacting on length of stay and hospital costs.

Front-line Bevacizumab in Serous Epithelial Ovarian Cancer: Biomarker Analysis of the FINAVAST Trial — Anticancer Research

Background: Potential tissue and serum biomarkers were assessed for predicting efficacy of bevacizumab in ovarian cancer (OC).

Conclusion: Our results indicate differences in MMP-9 and HIF-1α expression in relation to duration of PFS (progression free survival) and effects on serum VEGF when bevacizumab (Avastin) is used in combination with chemotherapy.

Meat, fish, and ovarian cancer risk: results from 2 Australian case-control studies, a systematic review, and meta-analysis

ABSTRACT

Background: Variation in meat and fish intakes has been associated with a risk of some cancers, but evidence for ovarian cancer is limited and inconsistent.
Objective: We examined the association between intakes of total meat, red meat, processed meat, poultry, and fish and ovarian cancer risk.
Conclusion: Our results suggest that low consumption of processed meat and higher consumption of poultry and fish may reduce the risk of ovarian cancer.

News from People First -Total Solutions: Effective People "Volunteers may wreck your work"

How Not to Cheer Up a Cancer Patient - Seattle - Seattle Weekly

"During my recovery from surgery a couple years ago, I received a basket of limes....Our Friend's Friend's Piano Teacher's Life Coach: Yes, I know your sister's neighbor's dog's master's hairdresser survived cancer 20 years ago. But I don't have ovarian cancer. "

Phase I dose escalation study of MK-0457, a novel Aurora kinase inhibitor, in adult patients with advanced solid tumors.

RESULTS: Twenty-seven patients received a total of 86 infusions of MK-0457. Dose-limiting toxicity at 96 mg/m(2)/h included grade 4 neutropenia and grade 3 herpes zoster (shingles). The MTD was identified as 64 mg/m(2)/h. The most common adverse events were nausea, vomiting, diarrhea, and fatigue. Pharmacokinetic analyses revealed that CIV infusion MK-0457 had an estimated mean terminal half-life of approximately 6.6-10.2 h and that end-of-infusion concentrations and mean AUCs were approximately dose proportional. The estimated mean oral bioavailability of MK-0457 was 7.9%.
One patient with advanced ovarian cancer attained prolonged stable disease for 11 months.  
CONCLUSIONS: MK-0457 was well tolerated in this schedule. Almost half the patients attained stable disease. Further development of this class of agents will likely occur in combination with other anti-cancer treatments.

Letter to the Edfitor: Leader Post April 14th Loss of gynecologic specialist putting women's lives at risk

media item: Magee-Womens Hospital - ovarian cancer recruitment - ABT-888/PARP

Drug Tested Against Women's Cancers
Pittsburgh Post-Gazette (PA) - Apr. 14, 2010

Apr. 14--Magee-Womens Hospital of UPMC is recruiting patients with recurrent ovarian, fallopian tube or peritoneal cancers who have already had chemotherapy for a national, Phase 2 clinical trial of the drug ABT-888.

ABT-888 works by targeting the PARP family of enzymes, which are responsible for a wide variety of cancer cell processes, principal investigator Kristin Zorn said. The PARP pathway is one of the mechanisms used by cancer cells to repair damage caused by chemotherapy....cont'd

full access (2 reports) U.S. 2009 National Healthcare Disparities and Quality Reports

full access: U.S. - Agency for Healthcare Research and Quality (AHRQ) Home

Highlights . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
1. Introduction and Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1 .7
2. Effectiveness. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
Diabetes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44
End Stage Renal Disease (ESRD) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4 .9
Heart Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
HIV and AIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
Maternal and Child Health. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6 .4
Mental Health and Substance Abuse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7 .1
Respiratory Diseases. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7. 7
Lifestyle Modification . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8 .3
Functional Status Preservation and Rehabilitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8. 7
Supportive and Palliative Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9 .2
3. Patient Safety. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107
4. Timeliness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123
5. Patient Centeredness. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1 .2 9
6. Efficiency . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139

on a lighter note for the day: It’s Official: Cats Love iPads [VIDEO]

2 short videos

Cancer prevention: major initiatives and looking into the future

2nd article: The interface of primary and oncology specialty care: from diagnosis through primary treatment.

The interface between primary and oncology specialty care: treatment through survivorship

What keeps you up at night? Genetics professionals' distressing experiences in patient care

Abstract 
PURPOSE:
 To explore specific patient care experiences that genetics professionals associate with distress and the emotions engendered by those experiences.
METHODS:: We conducted semistructured telephone interviews with clinical geneticists, genetic counselors, and genetic nurses that focused on a single distressing experience. RESULTS:: Fourteen clinical geneticists, 25 genetic counselors, and 14 nurses were interviewed. We categorized the situations that interviewees associated with distressing patient care experiences into seven major types: patient/family decisions (27% of total situations), giving bad news (17%), colleague behavior (15%), end-of-life issues (12%), unintended outcomes (12%), difficult patients (8%), and injustice/inhumanity (8%). Interviewees reported experiencing a variety of negative emotions during these situations, including anger, guilt, helplessness, and inadequacy.
CONCLUSIONS:: The distress and resulting emotions experienced by genetic service providers must be acknowledged. Interventions are needed to assist the clinician in becoming self-aware by reflecting on experienced emotions, examining belief systems and values, and understanding the connection between their emotions and behavior. Involvement in mindfulness meditation, reflective writing, peer support groups or additional communication skill-based training could address this need. In addition, clinicians should seek ways to increase personal meaning derived from providing patient care.

media item: Stress hormones may suppress tumor growth: Study - stress hormones

Full text - The hope of progress

Note: not specific to ovarian/cancer

Abstract/full text - Reporting bias in medical research - a narrative review

Review
Reporting bias in medical research - a narrative review
Published: 13 April 2010
Abstract (provisional) (click on pdf for full access)

Reporting bias represents a major problem in the assessment of health care interventions. Several prominent cases have been described in the literature, for example, in the reporting of trials of antidepressants, Class I anti-arrhythmic drugs, and selective COX-2 inhibitors. The aim of this narrative review is to gain an overview of reporting bias in the medical literature, focussing on publication bias and selective outcome reporting. We explore whether these types of bias have been shown in areas beyond the well-known cases noted above, in order to gain an impression of how widespread the problem is. For this purpose, we screened relevant articles on reporting bias that had previously been obtained by the German Institute for Quality and Efficiency in Health Care in the context of its health technology assessment reports and other research work, together with the reference lists of these articles. We identified reporting bias in 40 indications comprising around 50 different pharmacological, surgical (e.g. vacuum-assisted closure therapy), diagnostic (e.g. ultrasound), and preventive (e.g. cancer vaccines) interventions. Regarding pharmacological interventions, cases of reporting bias were, for example, identified in the treatment of the following conditions: depression, bipolar disorder, schizophrenia, anxiety disorder, attention-deficit hyperactivity disorder, Alzheimer's disease, pain, migraine, cardiovascular disease, gastric ulcers, irritable bowel syndrome, urinary incontinence, atopic dermatitis, diabetes mellitus type 2, hypercholesterolaemia, thyroid disorders, menopausal symptoms, various types of cancer (e.g. ovarian cancer and melanoma), various types of infections (e.g. HIV, influenza and Hepatitis B), and acute trauma. Many cases involved the withholding of study data by manufacturers and regulatory agencies or the active attempt by manufacturers to suppress publication. The ascertained effects of reporting bias included the overestimation of efficacy and the underestimation of safety risks of interventions.  
In conclusion, reporting bias is a widespread phenomenon in the medical literature.
Mandatory prospective registration of trials and public access to study data via results databases need to be introduced on a worldwide scale. This will allow for an independent review of research data, help fulfil ethical obligations towards patients, and ensure a basis for fully-informed decision making in the health care system.

Is the Kaiser Permanente model superior in terms of clinical integration?: a comparative study of Kaiser Permanente, Northern California and the Danish healthcare system

Note: full access "Finally, further research needs to be conducted on the nature of integration, and on its effect on costs and benefits to healthcare delivery systems and most importantly to the patients."

Abstract/fulll text: Four minutes for a patient, twenty seconds for a relative - an observational study at a university hospital

Abstract/full text - In vivo intratumor angiogenic treatment effects during taxane-based neoadjuvant chemotherapy of ovarian cancer

Conclusion
Taxane-based chemotherapy appears to promote tumor vascularization when administered every 3 weeks. A possible explanation is the secondary recovery of MVD in response to immediate cytotoxic and antiangiogenic effects of taxane-based chemotherapy. If confirmed prospectively, these findings favor shorter treatment intervals of taxane-based chemotherapy to counteract proangiogenic recovery.

Association between DNA damage response and repair genes and risk of invasive serous ovarian cancer.

Note: in research/technical

Ethics committees for biomedical research in some African emerging countries: which establishment for which independence? A comparison with the USA and Canada

Ethics committees for biomedical research in some African emerging countries: which establishment for which independence? A comparison with the USA and Canada

Dignity: not such a useless concept -abstract- Journal of Medical Ethics

abstract: Imaging ovarian cancer and peritoneal metastases - current and emerging techniques Nature Reviews Clinical Oncology

Sorafenib in combination with carboplatin and paclitaxel as neoadjuvant chemotherapy in patients with advanced ovarian cancer

Note: this would have been a phase 1 trial Results
Four patients were enrolled. After preoperative treatment and cytoreductive surgery, all patients were excluded from protocol due to severe toxicities. Three patients had life threatening events (cardiac output failure, myocardial infarction, anastomotic leak); two patients had primary progressive disease. The study was terminated on the basis of the recommendation of an independent data safety monitoring board.
Conclusion
The addition of sorafenib to carboplatin/paclitaxel chemotherapy was not feasible within this neoadjuvant regimen in primary advanced ovarian cancer. Although the occurrence of serious adverse events might have emerged at random, a detrimental effect of preoperative study medication could not be denied. Further evaluations of sorafenib in ovarian cancer are warranted.

A Phase Ib trial of CA4P (combretastatin A-4 phosphate), carboplatin, and paclitaxel in patients with advanced cancer

Conclusion:
The combination of CA4P with carboplatin and paclitaxel was well tolerated in the majority of patients with adequate premedication and had antitumour activity in patients who were heavily pretreated.

Facebook | Darlene Gray: Sask Minister of Health Questioned in Leg Assembly Over the Closure of Regina Gyne Onc Office

Sask Minister of Health Questioned in Leg Assembly Over the Closure of Regina Gyne Onc Office

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THIRD SESSION - TWENTY-SIXTH LEGISLATURE
of the
Legislative Assembly of Saskatchewan
N.S. VOL. 52 NO. 42A MONDAY, APRIL 12, 2010, 1:30 p.m.
LEGISLATIVE ASSEMBLY OF SASKATCHEWAN 4697 April 12, 2010
April 12, 2010 Saskatchewan Hansard 4705

ROUTINE PROCEEDINGS
INTRODUCTION OF GUESTS

Ms. Junor: — Mr. Speaker, I too on behalf of the opposition want to welcome the members from the Red Hat Society, all the women that have come today. From what I know about this group, not only are they very visible because of their hats — and it’s unfortunate that the member didn’t wear hers; that would have been entertaining — I understand that these women are extremely enthusiastic and they have a lot of fun. That’s what I always hear, that you have a lot of fun. Look at all the hats nodding. So I too would like to welcome all the women here today to the legislature.

While I’m on my feet, Mr. Speaker, I want to introduce others who are in the gallery. On the very top row is Darlene Gray, the director of OCATS, the Ovarian Cancer Awareness and Treatment in Saskatchewan, and Elan Morgan board member. Wave? And sitting beside Elan are Joan and Harvey Schneider, also board members. I just want to say about Joan before I sit down and welcome them, Joan was the executive secretary to the president of SUN [Saskatchewan Union of Nurses] when that was me. So I’m very happy to see Joan here today and welcome them all to the Assembly.

QUESTION PERIOD
Gynecologic Oncologists

Ms. Junor: — Mr. Speaker, for two years the minister has ignored the pleas of women with ovarian cancer and gyne-oncologists to address substandard working conditions in southern Saskatchewan. As a result, Dr. Brydon, one of only two gyne-oncologists practising in southern Saskatchewan, has closed her practice because she is burned out. To quote Dr. Brydon, “Physically and emotionally, I can’t cope any more.”
Mr. Speaker, the minister’s incompetence and failure to address the substandard working conditions of gyne-oncologists in Regina is putting at risk the lives of women with ovarian cancer. Why?

The Speaker: — I recognize the Minister of Health.
Hon. Mr. McMorris: — Thank you, Mr. Speaker. First of all, Mr. Speaker, on behalf of the government, we want to thank Dr. Brydon for all the work that she has done in southern Saskatchewan. These people are very specialized doctors. They are, Mr. Speaker, gynecology oncologists, which is a very specialized area. We have had four in our province, Mr. Speaker. Dr. Brydon is closing her practice to move on to other options. The health region, the health region as well as the government, is working hard to ensure that that position will be filled, Mr. Speaker.
But what I will say is that in the last two and a half years of our government, we have done more to recruit physicians into this province compared to the 16 years. And especially when you look at the front page of the Leader-Post, from 2001 to 2006 the net out-migration of health care workers in Saskatchewan was 1,160 health care workers out, Mr. Speaker. In our first two and a half years, we have attracted 164 more physicians to our province than under that government, Mr. Speaker.

The Speaker: — I recognize the member from Saskatoon Eastview.
Ms. Junor: — Mr. Speaker, that tired rhetoric is no consolation to women who have ovarian cancer. Mr. Speaker, in every other jurisdiction, including Saskatoon, gyne-oncologists work in a hospital setting with the proper support around them — not so in Regina where the specialists have to find their own office space and work without the support of a nurse.

Mr. Speaker, to the minister: is he going to provide immediate office space and examining room space in the Regina General Hospital along with the proper nursing support, or is he going to continue to ignore the issue until the second gyne-oncologist closes her practice?

The Speaker: — I recognize the Minister of Health.
Hon. Mr. McMorris: — Mr. Speaker, we have a gynecological oncology program working group that was established, Mr. Speaker, under our government. This working group has patient support, is represented through patient support groups. It also has a gynecology oncologist, the four that were in the province, working on this group as well as the health authorities of Regina Qu’Appelle, Saskatoon, and the Saskatchewan Cancer Agency to deal with this issue to have an ongoing program.

Mr. Speaker, the ministry officials have informed me that progress is being steadily made, Mr. Speaker. And yes, there are going to be decisions made by physicians to step aside. But, Mr. Speaker, we’re going in the right direction. It isn’t the working of that group . . .
[Interjections]

The Speaker: — Order. Order. I’d ask the opposition members to give the minister the same opportunity to respond as the government gave the member to ask the question. I recognize the minister.
Hon. Mr. McMorris: — Mr. Speaker, it isn’t the working of that group that would get into the micromanagement of what happens within a health region or the Cancer Agency. That is the auspices of the Cancer Agency or the regional health authority in their particular area, Mr. Speaker.

The Speaker: — I recognize the member from Saskatoon Eastview.
Ms. Junor: — Mr. Speaker, this is clearly a lack of leadership. The working group has been ongoing for over two years. They’re going to just keep spinning their wheels unless the minister says, do this. The minister’s incompetence and failure to address the problems means there’s now only one gyne-oncologist looking after all of southern Saskatchewan women. This will put additional pressures on the remaining gyne-oncologist and potentially will increase the wait time for women who are waiting for even an initial diagnosis.

My question to the minister is this: will the Sask Party government be forced to send women out of the province for diagnosis and treatment because of their incompetence and failure?

The Speaker: — I recognize the Minister of Health.
Hon. Mr. McMorris: — As I had mentioned earlier that the health region, the Saskatchewan Cancer Agency, the Regina Qu’Appelle Health Region will be working hard in the next . . . in the past but as we move forward over the next month or so to attract another gyne-oncologist into the province. I am very proud of our government having set up a physician recruitment agency that will deal with this very issue, these very issues, Mr. Speaker.

Unfortunately that hadn’t been done for many, many years — never even contemplated under the former government when we saw hundreds and hundreds of doctors leaving this province, Mr. Speaker. In the last two and a half years, we’ve seen more doctors come to the province than leave — an increase of about 164. There is more work to do. That’s why we set up a recruitment agency, Mr. Speaker. And that’s why we’ve also increased the number of training seats in the College of Medicine and the number of residency positions, up to 108 residency positions in the province, Mr. Speaker, that will bode this province very well into the future.

The Speaker: — I recognize the member from Saskatoon Eastview.
Ms. Junor: — Mr. Speaker, ducking and weaving, I mean there is no answer in the minister’s rhetoric. And Dr. Brydon’s leaving her practice now because the province will not set up a gyne-cancer unit in Regina. This unit would allow women to be diagnosed, treated, and receive follow-up care in one place. To quote Dr. Brydon:
I actually don’t think that the way the system is structured in this province at this time allows anybody to do the job that needs to be done properly and that is because we do not have a gynecologic women’s cancer unit the way all other provinces do.
Mr. Speaker, to the minister: is the minister going to establish a gyne women’s cancer unit in the province now, or is he going to wait and wait and wait, and talk and talk, and talk and continue to risk the lives of women with ovarian cancer?

The Speaker: — I recognize the Minister of Health.
Hon. Mr. McMorris: — Mr. Speaker, we know and understand the very importance of this issue, Mr. Speaker. That’s why we set up a working group that has patient representative groups on it, that has the oncologists on it, that has the Cancer Agency, that has the health regions, to look at how to best manage this project, Mr. Speaker. There has been progress made, absolutely. But it’s interesting that they would stand and criticize the way the program and the way the health system is being run, when they have been in government for 16 years prior, setting up the very program they’re criticizing now, Mr. Speaker.
Mr. Speaker, we’re looking at how we can improve this program as we move forward. We’re looking at how we can have the proper complement of gyne-oncologists within the province, Mr. Speaker, because we know that it is a very important issue, and we’re working to improve the health of women in our province, Mr. Speaker.

Detection of the HE4 protein in urine as a biomarker for ovarian neoplasms

Abstract

The HE4 protein is overexpressed in ovarian carcinomas and can be detected in serum by an ELISA with sensitivity similar to CA125 and higher specificity for malignant disease. We now demonstrate that HE4 can also be detected in the urine at a specificity level of 94.4%, including 13/15 (86.6%) with stage I/II and 57/64 (89.0%) with stage III/IV disease and including 90.5% of patients with serous ovarian carcinoma. Assaying serum and urine from the same patients showed similar sensitivity. Our data indicate that measuring HE4 in urine may aid diagnosis and the monitoring of response to therapy.

Which factors predict bowel complications in patients with recurrent epithelial ovarian cancer being treated with bevacizumab? (Avastin)

EpCAM-autoantibody levels in the course of disease of ovarian cancer patients.

Med Oncol. 2010 Apr 10
EpCAM-autoantibody levels in the course of disease of ovarian cancer patients.

Heubner M, Errico D, Kasimir-Bauer S, Herlyn D, Kimmig R, Wimberger P.
Clinic of Obstetrics and Gynaecology, Medical Faculty, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany, Martin.heubner@uk-essen.de.

Abstract

EpCAM is a tumor-associated antigen, which is frequently expressed in ovarian cancer.

Feasibility of extension of platinum-free interval with weekly bolus topotecan and subsequent platinum retreatment outcomes in recurrent ovarian cance

Abstract

PURPOSE: The goal of this study was to evaluate the outcomes and response in a cohort of patients with presumed platinum-sensitive disease who were subsequently retreated with platinum after receiving weekly bolus topotecan at the time of initial recurrence.

Restless legs syndrome and its relationship with anxiety, depression, and quality of life in cancer patients undergoing chemotherapy

Full text - Biology-driven cancer drug development: back to the future

Response: An opportunity to refine our understanding of "response shift" and to educate researchers on designing quality research studies

Journal Quality of Life Research
Issue Volume 19, Number 4 / May, 2010

Commentary
An opportunity to refine our understanding of “response shift” and to educate researchers on designing quality research studies: response to Ubel, Peeters, and Smith

Bryce B. Reeve1 Contact Information
(1) Outcomes Research Branch, Applied Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, EPN 4088, 6130 Executive Blvd., MSC 7344, Bethesda, MD 20892-7344, USA

Abstract
There is no advantage at this time to abandon the term “response shift” as suggested by Ubel et al. (Qual Life Res, 2010). The term is well known in the research field and has impacted the way we think about measuring quality of life (QOL) longitudinally. However, Ubel et al. (Qual Life Res, 2010) have provided the incentive to start an open dialogue on the subject with opportunities to refine the language of response shift and educate researchers. In this article, we identify opportunities in designing research studies to minimize or account for response shifts by considering the (1) selection of QOL concepts to measure, (2) questionnaires used to assess the QOL concepts, (3) design of the research study, (4) target population, and (5) analyses and reporting of results. Careful consideration of each of these issues will help us identify new methodologies and improved study designs that will move the QOL research field forward.

Thomas J. Herzog, MD, Columbia University College of Physicians and Surgeons talks about liposomal doxorubicin, bevacizumab, and temsirolimus in patients with advanced malignancy/GOG reference to trials

Note: This is a repost of the video. Dr Herzog speaks briefly about the direction of GOG trials including the numerous drug combinations and trying to assess the best approaches.

QOL Research Journal: Abandoning the language of “response shift”: a plea for conceptual clarity in distinguishing scale recalibration from true changes in quality of life

"..they have shed light on important mysteries relevant to understanding the experiences of people with chronic illness and disability. And they have focused researchers on the challenge of explaining why people with disabilities often provide quality of life reports that seem to belie their objective circumstances....The term ('response shift') suggests that the high quality of life reported by many people with chronic illness and disability are measurements artifacts - their "responses" have "shifted" - and that such people are not really experiencing high quality of life. We think such connotations, even if not originally intended, are misleading."

commentary/Japanese study - Carbo/Taxol - Dose-Dense Chemotherapy for Ovarian Cancer - National Cancer Institute

"...Women with advanced ovarian cancer lived longer and without their tumors growing after receiving a modified regimen of a standard chemotherapy drug combination, Japanese researchers have reported. In a large phase III clinical trial, the researchers randomly assigned women to receive six cycles of carboplatin and paclitaxel (Taxol) every 3 weeks (standard regimen) or six cycles of carboplatin every 3 weeks and a lower dose of paclitaxel (Taxol) once a week (dose-dense regimen). Women in the dose-dense group had a 29 percent reduction in the risk of progression and a 25 percent reduction in the risk of death after 3 years of follow-up. The results were published online September 18, 2009, in The Lancet (see the journal abstract).
Although the dose-dense regimen had more toxic effects than the standard regimen, survival benefits of this magnitude "have been rare in women with advanced ovarian cancer," wrote. Noriyuki Katsumata, M.D., and colleagues from the Japanese Gynecologic Oncology Group (JGOG).
The results, explained Ted Trimble, M.D., M.P.H., from NCI's Division of Cancer Treatment and Diagnosis, are consistent with what has been seen in breast cancer using a dose-dense chemotherapy regimen. The idea, he continued, is "to balance efficacy and toxicity by using a weekly schedule rather than every 3 weeks."...."

Women's Health Matters: Women’s College scientist reports on the quality of medical studies

Methods of consumer involvement in developing healthcare policy and research, clinical practice guidelines and patient information material.

Authors’ conclusions There is little evidence from randomised controlled trials of the effects of consumer involvement in healthcare decisions at the population level. The trials included in this review demonstrate that randomised controlled trials are feasible for providing evidence about the effects of involving consumers in these decisions.
   Comment 1:This paper is an issue for public health policy-makers not clinicians. Consumer involvement has a great risk of being tokenistic.  Comment 2:As a community health professional, the results will serve as an evidence to involve health care consumers in the process of policy and guideline formulation.  Comment 3:
The evidence presented that face-to-face interactions with consumers is the most effective type of involvement for developing patient educational materials is helpful for clinicians.

Risk and epidemiological time trends of gastric cancer in Lynch syndrome carriers in the Netherlands.

CONCLUSIONS: Lynch syndrome mutation carriers have a substantial risk for gastric cancer, in particular patients with an MLH1 or MSH2 mutation. Family history for gastric cancer is a poor indicator for individual risk. Surveillance gastroscopy for Lynch syndrome patients carrying an MLH1 or MSH2 mutation should therefore be considered.

Does risk-reducing bilateral salpingo-oophorectomy leave behind residual tube?

CONCLUSION: The majority of the uterine cornua had a tubal remnant which suggests that RRSO may leave behind residual tubal epithelium. The clinical significance of this tubal remnant is unclear given the current understanding of tubal carcinogenesis

Referral and ascertainment bias in patients with synchronous and metachronous endometrial malignancy.

Abstract
The purpose of this study was to evaluate the frequency in patients with endometrial cancer of other malignancies and the influence of referral and ascertainment biases on these associations.
Analysis of 1,028 local and referred patients who had a hysterectomy for endometrial cancer was based on residence at the time of diagnosis.
Altogether, 208 patients had a history of another malignancy, most frequently breast, colon, and ovary. At the time of surgery for endometrial cancer, the prevalence of lymphoma and breast and ovarian cancers was greater than expected although the higher prevalence of lymphoma was limited to referred patients. During follow-up after hysterectomy, the incidence of lung cancer was lower than expected, whereas the incidence of lymphoma was higher. Breast, colorectal, and bladder cancers were more common than expected although this finding was limited to local patients.
We concluded that results of epidemiologic studies from tertiary care centers may be misleading if they do not account for referral and ascertainment biases.

Pure Sertoli cell tumor. a case report and review of the literature.

Treatment of ovarian cancer by monoclonal antibodies

"As the preclinical results of mAb's therapeutic effects on ovarian cancer have been encouraging, further investigations are needed to establish a more effective, specific, and less toxic treatment strategy for this malignancy."

Identification of early predictive imaging biomarkers and their relationship to serological angiogenic markers in patients with ovarian cancer with re

dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI)

"CONCLUSIONS: Imaging markers have a potential role in early prediction of disease progression in patients with residual ovarian cancer and may supplement current measures of progression. The correlation of DCE-MRI and serological biomarkers suggests that tumour angiogenesis affects these markers through common biological means and warrants further investigation."

Low malignant potential tumors with micropapillary features are molecularly similar to low-grade serous carcinoma of the ovary.

CONCLUSION: The gene expression profile of LMP-MP is similar to LGSC and distinct from LMP, reflecting their more aggressive clinical behavior. *Low-grade serous carcinoma (LGSC) *LMP with micropapillary features (LMP-MP)

Primary peritoneal and ovarian cancers: an epidemiological comparative analysis.

Cancer Causes Control. 2010 Mar 23

"We performed case-control analyses using data from the North Carolina Ovarian Cancer Study to determine risk factors that distinguish primary peritoneal cancer (PPC) from epithelial ovarian cancer (EOC).
Our risk factor analyses were restricted to invasive serous cancers including 495 EOC cases, 62 PPC cases and 1,086 control women....Although many case-control associations for the invasive serous PPC cases were similar to those of the invasive serous EOC cases, some differences were observed including a twofold increase in risk of invasive serous PPC in women who were >/=35 years at last pregnancy, whereas a decreased risk was observed for invasive serous EOC risk.
We could not confirm a previous report of an association between tubal ligation and PPC, a factor consistently associated with a decreased risk of EOC. The difference in the risk factor associations between invasive serous PPC and EOC cancers suggests divergent molecular development of peritoneal and ovarian cancers.
A larger study to determine risk factors for invasive serous PPC is warranted."

Underdiagnosis of Lynch Syndrome Involves More than Family History Criteria.

CONCLUSIONS:: Lynch syndrome is under-recognized, even when patients have clear criteria unrelated to family history. Multifaceted strategies focused on reducing providers' cognitive errors and harnessing EHR (electronic health record) capabilities to improve recognition of Lynch syndrome are needed "Among 244 patients with uncertainty, a suspicion for Lynch syndrome was documented in the EHR of 6 patients (2.5%); 3 received counseling."

Endometrial and ovarian carcinomas with undifferentiated components: clinically aggressive and frequently underrecognized neoplasms

"Endometrial and ovarian carcinomas with undifferentiated components have a broad histologic differential diagnosis, but they show specific histologic features that should enable accurate diagnosis. These tumors can occur in young women, may be associated with microsatellite instability and behave in a clinically aggressive manner." Modern Pathology

Potent preclinical impact of metronomic low-dose oral topotecan combined with the antiangiogenic drug pazopanib for the treatment of ovarian cancer.

Abstract

Low-dose metronomic chemotherapy has shown promising activity in many preclinical and some phase II clinical studies involving various tumor types. To evaluate further the potential therapeutic impact of metronomic chemotherapy for ovarian cancer, we developed a preclinical model of advanced human ovarian cancer and tested various low-dose metronomic chemotherapy regimens alone or in concurrent combination with an antiangiogenic drug, pazopanib. Clones of the SKOV-3 human ovarian carcinoma cell line expressing a secretable beta-subunit of human choriogonadotropic (beta-hCG) protein and firefly luciferase were generated and evaluated for growth after orthotopic (i.p.) injection into severe combined immunodeficient mice; a highly aggressive clone, SKOV-3-13, was selected for further study. Mice were treated beginning 10 to 14 days after injection of cells when evidence of carcinomatosis-like disease in the peritoneum was established as assessed by imaging analysis. Chemotherapy drugs tested for initial experiments included oral cyclophosphamide, injected irinotecan or paclitaxel alone or in doublet combinations with cyclophosphamide; the results indicated that metronomic cyclophosphamide had no antitumor activity whereas metronomic irinotecan had potent activity. We therefore tested an oral topoisomerase-1 inhibitor, oral topotecan, at optimal biological dose of 1 mg/kg/d. Metronomic oral topotecan showed excellent antitumor activity, the extent of which was significantly enhanced by concurrent pazopanib, which itself had only modest activity, with 100% survival values of the drug combination after six months of continuous therapy. In conclusion, oral topotecan may be an ideal agent to consider for clinical trial assessment of metronomic chemotherapy for ovarian cancer, especially when combined with an antiangiogenic drug targeting the vascular endothelial growth factor pathway, such as pazopanib. Mol Cancer Ther; 9(4); 996-1006. (c)2010 AACR.

CA 125 and the detection of recurrent ovarian cancer. Robert C. Bast Jr. 2010; Cancer - Wiley InterScience

Commentary

CA 125 and the detection of recurrent ovarian cancer A reasonably accurate biomarker for a difficult disease

Robert C. Bast Jr, MD

Department of Experimental Therapeutics, The University of Texas M. D. Anderson Cancer Center, Houston, Texas

Abstract

Rising cancer antigen 125 (CA125) levels have been used to detect recurrence of ovarian cancer. A recent study questions the value of this practice, but the clinical trial has significant limitations and discounts the value of early detection to permit treatment of recurrence with novel and conventional agents.

British Journal of Cancer -Age of mother and grandmother in relation to a subject's breast cancer risk

Background:  On theoretical grounds, the age of the grandmother and the age of the mother at delivery of her daughter may affect the breast cancer risk of the granddaughter.

Conclusion: This study does not suggest a major role of maternal age at delivery or grandmaternal age at delivery of the mother for the (grand)daughters' breast cancer risk.

The winners of the 2010 Gairdner Awards : The Lancet

Medical researchers from the USA, Canada, UK, and France are recognised in this year's Gairdner Awards for their pioneering work in global health and biomedicine
.

Canada's Gairdner Foundation honoured seven medical researchers on April 6 with some of the world's largest annual international research awards.

Gairdner International Awards valued at CAN$100 000 each went to William Catterall of the University of Washington, WA, USA; Pierre Chambon of the Institut de Génétique et de Biologie Moléculaire et Cellulaire near Strasbourg, France; William Kaelin of the Harvard Cancer Center, MA, USA; Peter Ratcliffe of Oxford University, UK; and Gregg Semenza at the Johns Hopkins Institute for Cell Engineering in Baltimore, MD, USA.

Also recognised were Nicholas White of the Mahidol Oxford Tropical Medicine Research Unit at Mahidol University in Bangkok, Thailand, who won the Canada Gairdner Global Health Award, and Cal Stiller, chair of the Ontario Institute for Cancer Research, who won the Canada Gairdner Wightman Award for leadership in medicine in Canada.

Next to the Nobel Prize in Medicine, the Canada Gairdner Awards are the most prestigious global medical research awards, according to the Gairdner Foundation, which was established by Toronto stockbroker James Arthur Gairdner in 1957. The foundation began recognising pioneers in basic science in 1959. In 2008, the Government of Canada endowed CAN$20 million to support the awards.

Patient Safety: April 2010 Medication Events Related to Cancer Chemotherapy

U.S. Sebelius Continues Work to Implement Health Reform, Announces First Steps to Establish Temporary High Risk Pool Program

FDA & Digital Mammography: Why Has FDA Required Full Field Digital Mammography Systems to Be Regulated as Potentially Dangerous Devices for More Than 10 Years?

author: Bioptics Inc.

(Promestriene) Urogenital disorders associated with oestrogen deficiency: the role of promestriene as topical oestrogen therapy; Gynecological Endocrinology

"Given the absence of systemic activity, promestriene may be a good choice in women requiring purely locally oestrogen, and those who have survived, or who are at risk of breast cancer and who have severe vulvo-vaginal symptoms."

Strength in Numbers | Canadian Women's Health Network

Strength in Numbers

Project plans to unite support services for women with breast and reproductive cancers
By Jane Shulman

Cancer support networks in different parts of the country are looking at grouping women’s gynaecological cancers with breast cancer for the purpose of offering more support to women who have had a cervical, ovarian or uterine cancer diagnosis. Manitoba has been working on this for some time, explains Barbara Clow, director of the Atlantic Centre of Excellence for Women’s Health, and now New Brunswick and Newfoundland and Labrador are looking at their own models for delivering programming under the same umbrella.

In a 2008 report for Canadian Partnership Against Cancer, called “Where Do We Go From Here? Support services for women with breast, cervical, ovarian and uterine cancer in Atlantic Canada,” Clow and co-authors looked at the idea of merging services to meet the needs of the underserved gynaecological cancer population.

The idea is not without its detractors. Some have expressed concern that breast cancer groups might jeopardize their funding or lose their identity if they expand their mandate, or stretch their already overextended resources.

But the focus on breast cancer over the past several years, with fundraisers and awareness campaigns popping up all over the country, means that the disease has a lot of attention, and Clow notes that it’s the kind of attention that gynaecological cancers desperately need. While she says that fewer women are diagnosed with cervical, ovarian and uterine cancers combined than breast cancer in Canada each year, with the exception of cervical cancer, their prognosis is not as good. And the psychosocial support specific to their kind of cancer just does not exist.

Clow cites the work of volunteer-based Ovarian Cancer Canada as the only national gynaecologically-based cancer group. There are no national groups for people with cervical or uterine cancer. The needs are different, but there’s overlap, which is why a program that pools resources for cancers that affect women is so appealing.

The report recommendations included:
Foster new research on the needs of women from vulnerable and disadvantaged communities who are faced with a diagnosis of cancer;

Explore the possibility of adopting and adapting the processes and products developed by breast cancer support networks in Atlantic Canada to meet the needs of those with other women’s cancers;

Promote the creation of publicly funded cancer patient navigator programs throughout Atlantic Canada.

Clow says the next step is to look at how feasible this idea is, and where the desire lies. So far, nurses and service providers involved with the planning and delivering of programming are most passionate about it because they see the possibilities that lie in making the most of the services they can offer.

Jane Shulman is a the Director of Knowledge Exchange at the Canadian Women’s Health Network and a former staff member of Breast Cancer Action Montreal

Emerging drugs for the management of cancer treatment induced bone loss; Expert Opinion on Emerging Drugs

Take home message: The very high rate of bone loss and the high incidence of fractures indicate that cancer patients at risk of CTIBL (cancer treatment induced bone loss) need to be carefully monitored and stratified for fracture risk. Although there is a strong evidence of efficacy in prevention of bone loss and reduction of fracture risk for many drugs approved for postmenopausal osteoporosis (PMO) and male osteoporosis, for CTIBL there are actually no drugs approved for this indication.

Statin use and cancer risk: a comprehensive review; Expert Opinion on Drug Safety

Note: this study did not include ovarian cancer but numerous other cancers

Take home message: Few strong or consistent associations between statins and cancer incidence overall or for any of the sites reviewed were detected. Data for any effects of statins on cancer prognosis and secondary prevention are lacking; with the exception of consistent evidence that statins are associated with reduced risk of advanced/aggressive prostate cancer. Statins appear safe in relation to cancer risk but any chemopreventive effect in humans remains to be established and should not be recommended outside the context of clinical trials. It is encouraging that numerous trials are ongoing. The prospect of reducing the incidence and burden of some of the most prevalent cancers with safe, affordable and tolerable medication that already reduces the risk of the leading cause of death and cardiovascular disease warrants further exploration in clinical trials and observational studies of prognosis and survival.