Monday, August 23, 2010
Blanchard Valley Hospital, Ohio - media: offers test on genetic probability of breast cancer
Note: interesting the absence in the criteria of Ashenhashi Jewish heritage
"Blanchard Valley Hospital's Woman Wise mammography department has partnered with Myriad Genetics to offer a test to determine risk for hereditary breast and ovarian cancer. This new test is called the BRACAnalysisBlanchard Valley Hospital's Woman Wise mammography department has partnered with Myriad Genetics to offer a test to determine risk for hereditary breast and ovarian cancer. This new test is called the BRACAnalysis."
"Not everyone is a candidate for genetic testing, and the BRACAnalysis® is not appropriate for most people. Individuals at risk for carrying the BRCA gene tend to have personal or family histories which include the following:
* Breast cancer occurring at or below the age of 45
* Ovarian cancer at any age
* Male breast cancer
* Bilateral breast cancer (two separate breast cancers)
* Multiple affected family members (mother's or father's side)
* First or second degree relatives with the above criteria
The Myriad laboratory is the only lab in the nation that is able to perform that BRACAnalysis. This test is covered by most insurances."
media: Doctors call for patients' charter of rights + advocate Dr Durhane Wong-Rieger
Note: Dr. Durhane Wong-Rieger can also be referenced through WHO/PAHO/Canadian Patient Safety communities
"We do not have a system that at this point is focused towards timely, accessible, sustainable care from a patient perspective," said Durhane Wong-Rieger, president of the Canadian Organization for Rare Disorders, in an interview following her address to the CMA. "I think it's become a huge bureaucracy on its own."
Read more: http://www.montrealgazette.com/health
/Doctors+call+patients+charter+rights/3433232/story.html#ixzz0xTiAkQc0
U.S. - Shared decision making works: docs - Modern Physician
Note: this website requires registration (free)
CMAJ - Loaded expectations - author Wayne Kondro, CMAJ
"Two of the past three (CMAJ) presidents have lined up squarely in the camp favoring increased privatization of health care, while the third was believed to be very sympathetic to that cause."
CMAJ - Patient charters: the provincial experience (1st part of 3) CMAJ
CMAJ Editor’s note:
First in a series on patient charters
Tomorrow: Patients advocates say charters are an unnecessary distraction
Thursday: The international experience
The federal government's abandonment of health -- Canadian Medical Association Journal
Note: key excerpts; also interesting that until very recently the CMAJ was a proponent of privitisation and that fact will surely be on the minds and tongues of the critiques
"Stephen Harper has made no secret of his Conservative government’s
position on health care — health is a provincial matter.
Although this position has no basis in fact or law, many believe it,
especially when provincial and territorial leaders repeat and reinforce it.
The vacuum of federal leadership has resulted in a lack of overall
vision and coherent public policy, resulting in countless failures on
the part of national institutions and health systems coast to coast."
"To be fair, the status quo is not purely the fault of the federal government.
The list of challenges is daunting. Provincial and territorial leaders
have too readily adopted a “take the money and run” attitude rather than
collaborate to solve the major issues facing Canada’s health systems."
" The Harper Conservatives seem determined to focus on advancing a
law-and-order agenda, spending money on prisons and fighter jets as
well as tax cuts while ignoring health and health care. Regrettably, other
political parties have offered few if any substantive policy alternatives."
"A nationwide vision and action plan for health will require all
stakeholders to speak loudly with a common purpose — to remind
federal politicians that health is their responsibility."
MedEffect Canada - Aug 23rd 2010 - Advisories - Avastin (Bevacizumab) allergic reactions
Note: "authorized" which does not include a notation for those patients in clinical trials/ovarian cancer
August 2010
- AVASTIN (bevacizumab) - Association with Allergic Reactions - Hoffmann-La Roche Limited
- For Health Professionals [2010-08-23]
- For the Public [2010-08-23]
August 19, 2010
Dear Health Care Professional,
Subject: Association of AVASTIN® (bevacizumab) with Hypersensitivity Reactions and Infusion ReactionsHoffmann-La Roche Limited (Roche), in consultation with Health Canada, would like to inform you of an important update to the safety information regarding the use of AVASTIN. Hypersensitivity reactions and infusion reactions have been identified as risks in patients treated with AVASTIN.
AVASTIN is a recombinant humanized monoclonal antibody that is directed against the vascular endothelial growth factor (VEGF). It is authorized for intravenous administration in the following:
- first-line treatment of patients with metastatic carcinoma of the colon or rectum in combination with fluoropyrimidine-based chemotherapy;
- treatment of patients with unresectable advanced, metastatic or recurrent non-squamous non-small cell lung cancer in combination with carboplatin/paclitaxel chemotherapy regimen;
- treatment of patients with metastatic HER2-negative breast cancer who are ECOG Class 0-1 in combination with paclitaxel*;
- treatment of patients with glioblastoma after relapse or disease progression, following prior therapy*.
- A risk of developing serious hypersensitivity reactions, including anaphylactic and anaphylactoid reactions, has been reported in up to 5% of patients receiving AVASTIN in clinical trials. Post-marketing reports have also captured cases of serious hypersensitivity and infusion reactions.
- Infusion and hypersensitivity reactions may manifest as: dyspnea/difficulty breathing, flushing/redness/rash, hypotension or hypertension, oxygen desaturation, chest pain, rigors, and nausea/vomiting.
- Patients should be closely monitored for signs and symptoms of hypersensitivity or infusion reactions during and following the administration of AVASTIN infusion.
- If a reaction occurs, the infusion should be interrupted and appropriate medical therapies should be administered.
AVASTIN has been administered to more than 500,000 cancer patients. Although, for the overall population, the incidence of hypersensitivity was very similar between the AVASTIN and comparator groups, imbalances were noted in hypersensitivity reactions and infusion reactions reported in some clinical studies among patients treated with AVASTIN and chemotherapy. Medical assessment of all reports from the Roche safety database showed that the majority of cases were confounded by concomitant chemotherapy. Seven cases of positive rechallenge and two cases with a positive cutaneous test were identified. In light of this information, Roche considers there is sufficient evidence to confirm the causal role of AVASTIN in the occurrence of hypersensitivity reactions and infusion reactions.
Patients should be closely monitored during and after AVASTIN infusion as expected for any infusion of a therapeutic humanized monoclonal antibody. If a reaction occurs, the infusion should be interrupted and appropriate medical therapies administered. A systematic premedication specifically for AVASTIN administration, in general, is not warranted; however, use of premedication should be based on clinical judgment.
The Canadian Product Monograph (CPM) for AVASTIN has been revised to include this updated safety information.
Managing marketed health product-related adverse reactions depends on health care professionals and consumers reporting them. Reporting rates determined on the basis of spontaneously reported post-marketing adverse reactions are generally presumed to underestimate the risks associated with health product treatments. Any case of serious hypersensitivity reactions, infusion reactions, or other serious or unexpected adverse reactions in patients receiving AVASTIN should be reported to Roche or Health Canada at the following addresses:
Hoffmann-La Roche Limited
Drug Safety Department
2455 Meadowpine Boulevard
Mississauga, Ontario, L5N 6L7
or call toll free at: 1-888-762-4388
or fax at: 905-542-5864
or email to: mississauga.drug_safety@roche.com
You can report any suspected adverse reactions associated with the use of health products to the Canada Vigilance Program by one of the following three ways:
For other health product inquiries related to this communication, please contact Health Canada at:
Marketed Health Products Directorate (MHPD)
E-mail: mhpd_dpsc@hc-sc.gc.ca
Telephone: 613-954-6522
Fax: 613-952-7738
To change your mailing address or fax number, contact the Market Authorization Holder (Industry).
Should you have any questions or require additional
information regarding the use of AVASTIN, please contact the Drug
Information Department at Hoffmann-La Roche Limited at 1-888-762-4388,
Monday to Friday, between 8:30 a.m. and 4:30 p.m. (Eastern Standard
Time).Drug Safety Department
2455 Meadowpine Boulevard
Mississauga, Ontario, L5N 6L7
or call toll free at: 1-888-762-4388
or fax at: 905-542-5864
or email to: mississauga.drug_safety@roche.com
You can report any suspected adverse reactions associated with the use of health products to the Canada Vigilance Program by one of the following three ways:
- Report online at www.healthcanada.gc.ca/medeffect
- Call toll-free at 1-866-234-2345
- Complete a Reporting Form and:
- Fax toll-free to 1-866-678-6789, or
- Mail to: Canada Vigilance Program
Health Canada
Postal Locator 0701E
Ottawa, Ontario K1A 0K9
For other health product inquiries related to this communication, please contact Health Canada at:
Marketed Health Products Directorate (MHPD)
E-mail: mhpd_dpsc@hc-sc.gc.ca
Telephone: 613-954-6522
Fax: 613-952-7738
To change your mailing address or fax number, contact the Market Authorization Holder (Industry).
Sincerely,
original signed by
Lorenzo Biondi,Vice President, Medical and Regulatory Affairs
Hoffmann-La Roche Limited
Genomics of Drug Sensitivity in Cancer - as per Libby's Hope blog reference mutations/ovarian cancer
Mutation Prevalence
Click here to download a spreadsheet (Excel) showing the prevalence of mutations in 52 cancer genes across tissue types.
Critical Reviews in Oncology/Hematology : A novel perspective for an orphan problem: Old and new drugs for the medical management of malignant ascites
Abstract
Malignant ascites is defined as a condition in which fluid containing cancer cells accumulates in the abdomen. The cancers most commonly associated to ascites are ovarian (37%), pancreato-biliary (21%), gastric (18%), oesophageal (4%), colorectal (4%), and breast (3%). Treatment of malignant ascites remains a challenge. In the majority of patients systemic chemotherapy is ineffective and diuretics and paracentesis are still the only approaches, but new promising option are appearing, as cytoreductive debulking surgery and intraperitoneal (IP) or intravenous biological (target) therapies. More promising, after the recognition of potential epithelial targets as Epithelial Cell Adhesion Molecule (EpCAM), are the trifunctional antibodies able to bind these cell adhesion molecules and, at the same, time the immune system cells. These agents have been developed for malignant ascites with the aim also to prolong the need for subsequent paracentesis. So patients with malignant ascites may look at the future with hope and growing optimism.
Serous and mucinous borderline ovarian tumors (LMP): are there real differences between these two entities?
Objective
To evaluate the clinical outcome and pathological features of patients with borderline ovarian tumors (BOT) with special emphasis on serous and mucinous histology.
Conclusions
Serous tumors present more unfavorable anatomopathological characteristics but are associated with better prognosis than mucinous tumors. If mucinous BOT diagnosis is retained physicians should be aware that their aggressive potential is not negligible.
Blumenthal: Yale data breach a reminder of 'legal and moral obligation to protect privacy' | Healthcare IT News
Note: the same issues (patient data/unencryption) have been occurring recently, including Canada
ACR Appropriateness Criteria palpable abdominal mass.
Note: the recommendations/evidence depending on the imaging technique (eg. ultrasound/CT/MRI....) is worth reviewing
repost with update: National Guideline Clearinghouse | ACR Appropriateness Criteria® staging and follow-up of ovarian cancer
Note: focus is on:
Major Outcomes Considered
Utility of radiologic examinations in differential diagnosis
Guideline Title
ACR Appropriateness Criteria® staging and follow-up of ovarian cancer.
Bibliographic Source(s)
Expert Panel on Women's Imaging. Staging and follow-up of ovarian cancer.: American College of Radiology (ACR). |
National Guideline Clearinghouse | Estrogen and progestogen use in postmenopausal women: 2010 position statement of The North American Menopause Society.
Recommendations
Major Recommendations
Variations from 2008 Position Statement
Each section of the 2010 position statement has been updated using new studies and findings. Specifically, the sections on breast cancer, cognitive aging/decline and dementia, coronary heart disease, stroke, and discontinuance received special attention by the Advisory Panel in light of recently published literature. New sections added are Ovarian cancer and Lung cancer.
Ovarian Cancer
Published data on the role of HT and risk of ovarian cancer are conflicting. Most epidemiologic studies have shown no association or a modest increase. There is a relatively large volume of observational trial data that points to an association between HT use and increased ovarian cancer risk.
The association between ovarian cancer and HT beyond 5 years, if any, would fall into the rare or very rare category. Women at increased risk of ovarian cancer (e.g., those with a family history) should be counseled about this rare association.
Research: Effect of Anaesthetic and Other Perioperative Factors on Cancer Recurrence: Abstract and Introduction
Note: in research; long article
Sunday, August 22, 2010
TIME magazine: Why cancer biomarkers haven’t lived up their hype - Wellness - TIME.com
In a recent paper in the Journal of the National Cancer Institute, clinical biochemist Eleftherios Diamandis uncovers some of bigger blunders in cancer-diagnosis techniques -- explaining how experimental data could be misinterpreted and how, as a result, once-touted breakthroughs turned out to be far less than met the eye. Diamandis spoke to TIME earlier this week about his findings, and about how fizzled hopes can affect medicine
Ovarian Cancer Awareness Speaker - Dr Ilana Cass (California) Sept 2nd 7:30 pm
Thursday, September 2nd at 7:30pm in the Social Hall
RSVP - see website or: (805) 497-7101
Come join us as Dr. Ilana Cass discusses the latest research and developments towards finding a cure. Most importantly, she will be educating us about the “silent symptoms” of Ovarian Cancer.
Medical News: Pay-for-Performance Prods Faster Imaging Reports - in Radiology, Diagnostic Radiology from MedPage Today
Note: pay for performance is a widely discussed issue
media: Cancer patient finds new life in crusade (how many attempts?)
Blogger note: how many attempts at a diagnosis??
"The first eight doctors Joan Wyllie saw for her persistent intestinal distress told her she was fine.
The ninth doctor, a psychologist, suggested the pain in her stomach was really all in her head and prescribed the antidepressant Elavil.
The 10th doctor diagnosed stage 3C and 4 ovarian cancer. Wyllie was given a 50 percent chance of surviving the 7½-hour surgery needed to remove hundreds of tumors, many of which had metastasized........."cont'd
EvidenceUpdates-Cochrane Collaboration review: Interventions for treating oral mucositis for patients with cancer receiving treatment
Note:"* Ratings pending – login to http://plus.mcmaster.ca/evidenceupdates in a few days if interested."
Abstract
Background
Treatment of cancer is increasingly effective but associated with short and long term side effects. Oral side effects, including
oral mucositis (mouth ulceration), remain a major source of illness despite the use of a variety of agents to treat them.
Objectives
To
assess the effectiveness of interventions for treating oral mucositis
or its associated pain in patients with cancer receiving
chemotherapy or radiotherapy or both.Plain language summary:
Interventions for treating oral mucositis for patients with cancer receiving treatment
Using a low level laser may reduce the severity of ulcers caused by cancer treatment.
Treatments for cancer can cause severe ulcers (sores) in the mouth. These can be painful and slow to heal. The review found weak and unreliable evidence that using a laser may relieve or cure the ulcers. Morphine can control the pain. Although using morphine automatically on a constant drip, or self controlled use, provide similar relief, people use less morphine when they are controlling it themselves.
NCCN Receives $4 Million in Oncology Research Funding from GlaxoSmithKline
"Pazopanib is currently approved by the FDA to treat patients with advanced renal cell carcinoma. The research grant to NCCN will evaluate the effectiveness of pazopanib in solid tumors including renal, sarcoma, thyroid, neuroendocrine, and ovarian cancers."
(abstract) From randomized trial to practice: single institution experience using the GOG 172 i.p. chemotherapy regimen for ovarian cancer — Ann Oncol
Background: The objective of the study was to evaluate completion rates and toxic effects of an i.p. chemotherapy regimen in a cross-section of nonselected patients with ovarian cancer (OC).
Saturday, August 21, 2010
Molecular Markers in Solid Tumors: What Clinicians Need to Know: Introduction - solid tumors
For ovarian cancer, in vitro chemotherapy sensitivity and resistance assays are cited as Category 3 recommendations (reflecting major disagreement among NCCN panel members) for the selection of chemotherapy when multiple appropriate chemotherapy choices exist. Such assays are used in a few NCCN Member Institutions but should not supplant standard of care chemotherapy choice due to the lack of evidence for clinical benefit.[100,101] The NCCN Guidelines™ also recommend that patients with ovarian cancer undergo measurement of serum carbohydrate antigen (CA)-125 levels and "other tumor markers as clinically indicated" at diagnosis, during treatment as markers of response, and as surveillance for disease recurrence.[102,103] Of note, the European Organization for Research and Treatment of Cancer (EORTC) 55955 trial showed no survival benefit when an elevation in CA-125 levels alone was used to prompt initiation of second-line treatment in 1442 patients with ovarian cancer in remission after first-line platinum-based chemotherapy, suggesting against a role for this marker in surveillance for recurrence.[104] Other serum markers may include inhibin for sex cord-stromal tumors and HCG, AFP, and LDH for germ cell tumors of the ovary.[103,105]
National Guideline Clearinghouse | Initial evaluation and referral guidelines for management of pelvic/ovarian masses 2009
Guideline Title
Initial evaluation and referral guidelines for management of pelvic/ovarian masses.
Bibliographic Source(s)
| Le T, Giede C, Society of Obstetricians and Gynaecologists of Canada (SOGC), Gynecologic Oncologists of Canada (GOC), Society of Canadian Colposcopists (SCC). Initial evaluation and referral guidelines for management of pelvic/ovarian masses. Practice guideline. J Obstet Gynaecol Can 2009 Jul 01;(230):668-73. |
Guideline Status
This is the current release of the guideline.
U of Toronto researcher discovers key protein involved in DNA repair Discovery gives insight into the way cells protect their own genetic material
Note: in research
"In a groundbreaking study, U of T researchers including Professors Daniel Durocher, Anne‐Claude Gingras and Frank Sicheri have uncovered a protein called OTUB1 that blocks DNA damage in the cell—a discovery that may lead to the development of strategies to improve some cancer therapies.
Lead author Durocher, a senior investigator at Mount Sinai Hospital’s Samuel Lunenfeld Research Institute and the Thomas Kierans Research Chair in Mechanisms of Cancer Development, as well as colleagues at U of T, Mount Sinai Hospital and the Keio University in Japan, have revealed pivotal new information on how cells regulate their genetic material. In addition, the discovery improves understanding of familial breast and ovarian cancer, as the research shows that OTUB1 inhibits the action of BRCA1, a DNA repair protein often mutated in these cancers...."cont'd
Health Reform Subsidy Calculator - Kaiser (U.S.)
"...Beginning in 2014, tax
credits will be available for people under age 65 who purchase coverage
on their own in a health insurance Exchange and are not covered through
their employer, Medicare or Medicaid. The tool allows the user to
examine the impact at different income levels, ages, family sizes, and
regional costs....." see calculator/website for more information
Epidemiology and prognosis of ovarian metastases in colorectal cancer (abstract)
Define: metachronous - multiple occurrences/multiple primary cancers
BACKGROUND: National guidelines for prophylactic oophorectomy in women with colorectal cancer are lacking. The aim of this population-based cohort study was to report on the prevalence, incidence and prognosis of ovarian metastases from colorectal cancer, providing information relevant to the discussion of prophylactic oophorectomy.
METHODS: All 4566 women with colorectal cancer in Stockholm County during 1995-2006 were included and followed until 2008. Prospectively collected data regarding clinical characteristics, treatment and outcome were obtained from the Regional Quality Registry.
RESULTS: The prevalence of ovarian metastases at the time of diagnosis of colorectal cancer was 1.1 per cent (34 of 3172) among women with colonic cancer and 0.6 per cent (8 of 1394) among those with rectal cancer (P = 0.105). After radical resection of stage I-III colorectal cancer, metachronous ovarian metastases were found during follow-up in 1.1 per cent (22 of 1971) with colonic cancer and 0.1 per cent (1 of 881) with rectal cancer (P = 0.006). Survival in patients with ovarian metastases was poor.
Friday, August 20, 2010
As I see it: Ten reasons to be happy about hormone replacement therapy: a guide for patients - Menopause International
"Discussion of side-effects should not be avoided, particularly the 1% extra lifetime risk of breast cancer. This should be balanced against the fewer heart attacks, fewer deaths and less osteoporotic fractures in those who start HRT below the age of 60."
Editorial: Note from the editors: change is afoot -- Menopause International
Note: in the absence of available full paper/s (pay per view/subscription) of the several related articles blogged, there is no reference to those with genetic predispositions/risks/advantages with hormone replacement therapy. The one abstract (Review - Hinds/Price) discusses risks related to sarcoma/granulosa but no mention of genetics eg. BRCA's/familial colorectal cancers and/or prior research regarding ERT/colorectal cancers.
"Our understanding of the menopause and the management of its issues is in a continual state of flux. Since the publication of the original Women's Health Initiative study and the immediate conclusions and position statements from various specialist societies and regulatory authorities, clinicians have had little choice other than to significantly change their clinical management. So, is this a change for good? Whether you were a supporter or detractor of hormone replacement therapy (HRT), or even sat on the academic fence you will be aware that many clinicians have withdrawn from even discussing the place of HRT in the management of menopausal issues with their patients. This cannot be a good thing...."cont'd
Compliance with estrogen hormone replacement therapy after oophorectomy: a prospective study -- Menopause International
Results. The median age of women at the time of hysterectomy was 42 (range 22–46) years
Menopause, hormone replacement and gynaecological cancers -- Menopause International
Note: abstract, full access via subscription ($$$)
Reviews
Menopause, hormone replacement and gynaecological cancers
Belfast City Hospital, Northern Ireland
Correspondence: Dr Lynsey Hinds, 1 Strawhill Manor, Donaghcloney, Belfast BT66 7GH Northern Ireland. Email: hindslynsey@hotmail.co.uk
Approximately 18,000 women are diagnosed with a gynaecological cancer in the UK each year. Predisposing risk factors for some of these gynaecological cancers include an early menarche/late menopause and hormone replacement therapy (HRT). Furthermore, treatment of gynaecological malignancies often induces an iatrogenic menopause, which may be more severe than a natural onset. HRT is an extremely effective treatment that may dramatically improve physical and psychological symptoms and ultimately quality of life in patients with cancer. However, the safety of using HRT in patients with gynaecological cancer is a controversial issue and not entirely clear. The main concern is the theoretical risk of the stimulation of residual cancer cells by estrogen replacement. The review of the evidence in this article found that for most gynaecological cancers this hypothesis was not proven. No study to date has found HRT to have a detrimental effect on survival in patients with early stage endometrial cancer, epithelial ovarian cancer, cervical cancer and vulval tumours. HRT is only an absolute contraindication in low-grade endometrial stromal sarcomas and is best avoided in granulosa cell ovarian tumours. Therefore, HRT should not be withheld in the majority of patients with gynaecological cancer. If quality of life is being adversely affected by symptoms of the menopause, then patients with cancer should be counselled regarding the known risks and benefits of HRT to enable them to make an informed decision on their treatment.
In research - Georgia Tech Team Claims 100 Percent Accuracy for Metabolomic Ovarian Cancer Test in Initial Trial ProteoMonitor GenomeWeb
........"In ovarian cancer, the single protein that's commonly used [as a biomarker], CA-125, is not a very accurate test," he said. "The reason for that is that all cancers are variable. So if you're relying on a single biomarker, it's very unlikely that that single biomarker will be 100 percent accurate or even 99 or 95 percent accurate."
"Even going from one to five [biomarkers] increases accuracy tremendously. In our case we're using at the minimum 2,000 to 3,000 features. That should in theory give us an even higher degree of accuracy," he said.
By comparison, most protein-based tests that are commercially available or under development use a handful of markers. Vermillion's OVA1, for example, analyzes five protein markers, including CA-125. The HealthLinx OvPlex test also uses five proteins, including CA-125, and the company is currently evaluating two additional markers to add to the test (PM 6/18/2010)....cont'd
Donald Berwick takes charge of Medicare and Medicaid : The Lancet
Berwick's Institute for Healthcare Improvement (IHI) developed programmes in the US and around the world that focused on improved delivery systems. Among the group's innovations is the “100 000 Lives” campaign, which challenged hospitals to reduce medical errors. Altman said the programme “almost single handedly” changed attitudes among hospital administrators towards a focus on patient safety.
Ashamed To Admit It: Owning Up To Medical Error
"But emotions can’t be legislated away." (blogger's note: for anyone)
Detection of the HE4 protein in urine as a biomarker for ovariannext term neoplasms (abstract)
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 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.
Patient Willingness to Be Seen by Physician Assistants, Nurse Practitioners, and Residents in the Emergency Department: Does the Presumption of Assent Have an Empirical Basis? - The American Journal of Bioethics
Note: the journal has a number of similar papers regarding this issue, however, this is a subscription/pay-per-view journal without access to abstracts in many cases
Thursday, August 19, 2010
Journal of Ovarian Research Full free access Scope of nanotechnology in ovarian cancer therapeutics
Note: Table 1 includes cumulative toxicity and other comparisons between commonly prescribed ovarian cancer chemotherapies
Abstract
This review describes the use of polymer micelle nanotechnology based chemotherapies for ovarian cancer. While various chemotherapeutic agents can be utilized to improve the survival rate of patients with ovarian cancer, their distribution throughout the entire body results in high normal organ toxicity. Polymer micelle nanotechnology aims to improve the therapeutic efficacy of anti-cancer drugs while minimizing the side effects....... An important feature of polymer micelle nanotechnology is the small size (10-100 nm) of particles which improves circulation and enables superior accumulation of the therapeutic drugs at the tumor sites. This review provides a comprehensive evaluation of different types of polymer micelles and their implications in ovarian cancer therapeutics.
Massive Free Health Clinic Registration is Now Open for Gulf Coast Area Uninsured - press release
Patients Are Urged to Call Now for Appointments
The National Association of Free Clinics (NAFC) will sponsor the free medical clinic on Aug. 31 from 11:00 a.m. to 7:00 p.m. and on Sept. 1 from 2:00 p.m. to 7:00 p.m. at the Ernest N. Morial Convention Center.
"This free clinic is not just for the sick but also for anyone who is uninsured and has not seen a doctor recently," NAFC Executive Director Nicole Lamoureux said. "All participants will receive preventive primary medical care and be connected to the area's safety-net providers such as free clinics."...cont'd
NCCN Clinical Practice Guidelines in Oncology
Ovarian Cancer
You Must Login First (free)
* Epithelial Ovarian Cancer (including Fallopian Tube Cancer and Primary Peritoneal Cancer)
* Borderline Epithelial Ovarian Cancer (Low Malignant Potential)
* Less Common Ovarian Histologies
full free access: Preparing for a Consumer-Driven Genomic Age Health Policy and Reform
"Advances in genomic technologies permit the simultaneous analysis of millions of variants across the genome and may soon allow for meaningful estimation of one’s risks of developing cancer, diabetes, and other common diseases. These advances are converging with the movement toward consumer-driven health care and patient empowerment. Whereas in the past, medical testing was firmly under the control of medical practitioners, genomic information is now increasingly available outside traditional medical settings. Patients are no longer subordinate, passive recipients of physician-initiated genetic testing; rather, patients can instigate their own testing and often know more than their clinicians about particular genetic topics. Indeed, health care providers are increasingly bypassed altogether, as patients embrace direct-to-consumer (DTC) genetic tests and turn to social networks for help in interpreting their results. In the future, a primary role of health care professionals may be to interpret patients’ DTC genetic test results and advise them about appropriate follow-up. How can we maximize the benefits of these new developments and minimize the harms? How can we encourage patients’ involvement and autonomy yet establish appropriate safeguards while avoiding inappropriate paternalism? How do we promote the understanding that interpretations of genomic information may evolve as research unravels the meaning of gene–gene and gene–environment interactions and the roles of noncoding DNA sequences, copy-number variants, epigenetic mechanisms, and behavioral factors in health and disease?..."cont'd
Wednesday, August 18, 2010
Taste Alterations in Cancer Patients Receiving Chemotherapy: A Neglected Side Effect? abstract
"Although TAs (taste alterations) have been incorporated in the National Cancer Institute Common Toxicity Criteria since 1999, the literature on underlying biological mechanisms, on physical and physiological consequences, and even on prevalence is scarce. It has to be taken into account that even though taste and smell are anatomically distinct systems, in the sensory perception of food, they are intimately connected ."
Menopausal symptoms in women undergoing chemotherapy-induced and natural menopause: a prospective controlled study - abstract
CONCLUSIONS: Women undergoing chemotherapy-induced menopause may experience worse symptoms than women undergoing natural menopause.
Postmenopausal Hormone Therapy: An Endocrine Society Scientific Statement - multinational/abstract/eletters/response
This version published online on June 21, 2010
Journal of Clinical Endocrinology & Metabolism , doi:10.1210/jc.2009-2509
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Accepted on April 21, 2010
Postmenopausal Hormone Therapy: An Endocrine Society Scientific Statement
Richard J. Santen*,Division of Endocrinology and Metabolism (R.J.S.), Department of Obstetrics and Gynecology (J.V.P.), University of Virginia, Charlottesville, Virginia 22908; Tufts University School of Medicine (R.H.K.), Molecular Cardiology Research Institute, Tufts Medical Center, Boston, Massachusetts 02111; Jean Hailes Research Centre (H.T.), School of Public Health, Melbourne, Australia 3168; Prince Henry's Institute of Medical Research (H.G.B.), Monash Medical Centre, Melbourne, Australia 3168; Department of Medicine/Women's Health Program (S.R.D.), Monash University, Melbourne, Australia 3181; Departments of Health Research and Policy (Epidemiology) and of Neurology and Neurological Sciences (V.W.H.), Stanford University, Stanford, California 94305; Departments of Pathology and Immunology (D.C.A.) and Surgery (G.A.C.), Washington University School of Medicine, St. Louis, Missouri 63110; Department of Nutrition Sciences (B.A.G.), University of Alabama at Birmingham, Birmingham, Alabama 35294; St. Joseph Hospital (M.K.), Internal Medicine, Reichert Health Center, Ypsilanti, Michigan 48197; Division of Immunology and Rheumatology, Ohio State University School of Medicine (W.N.J., S.P.A.), Columbus, Ohio 43219; University of Pisa (M.G.), Department of Obstetrics and Gynecology, Pisa I-56100, Italy; University of Toronto (N.B., L.M.), Department of Nutritional Sciences, Department of Medicine, Toronto, Ontario, Canada M5G 2C1; Cedars-Sinai Medical Center (G.D.B.), Department of Medicine, Los Angeles, California 90048; Columbia University Medical Center (R.A.L.), Department of Obstetrics and Gynecology, New York, New York 10037; Eastern Virginia Medical School (D.F.A.), Clinical Research Center, Norfolk, Virginia 23507; North American Menopause Society (W.H.U.), Mayfield Heights, Ohio 44124; Massachusetts General Hospital (K.A.M.), UptoDate, Waltham, Massachusetts 02453; University of North Carolina at Chapel Hill (D.R.R.), Chapel Hill, North Carolina 27516; Section of Dermatology (D.M.T.), Hershey Medical Center, Pennsylvania State University School of Medicine, Hershey, Pennsylvania 17033; King's Breast Care (J.M.), King's College Hospital, London SE5 9RS, United Kingdom; and Harvard Medical School (J.E.M.), Brigham and Women's Hospital, Boston, Massachusetts 02215
Objective: Our objective was to provide a scholarly review of the published literature on menopausal hormonal therapy (MHT), make scientifically valid assessments of the available data, and grade the level of evidence available for each clinically important endpoint.
Participants in Development of Scientific Statement: The 12-member Scientific Statement Task Force of The Endocrine Society selected the leader of the statement development group (R.J.S.) and suggested experts with expertise in specific areas. In conjunction with the Task Force, lead authors (n = 25) and peer reviewers (n = 14) for each specific topic were selected. All discussions regarding content and grading of evidence occurred via teleconference or electronic and written correspondence. No funding was provided to any expert or peer reviewer, and all participants volunteered their time to prepare this Scientific Statement.
Evidence: Each expert conducted extensive literature searches of case control, cohort, and randomized controlled trials as well as meta-analyses, Cochrane reviews, and Position Statements from other professional societies in order to compile and evaluate available evidence. No unpublished data were used to draw conclusions from the evidence.
Consensus Process: A consensus was reached after several iterations. Each topic was considered separately, and a consensus was achieved as to content to be included and conclusions reached between the primary author and the peer reviewer specific to that topic. In a separate iteration, the quality of evidence was judged using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) system in common use by The Endocrine Society for preparing clinical guidelines. The final iteration involved responses to four levels of additional review: 1) general comments offered by each of the 25 authors; 2) comments of the individual Task Force members; 3) critiques by the reviewers of the Journal of Clinical Endocrinology & Metabolism; and 4) suggestions offered by the Council and members of The Endocrine Society. The lead author compiled each individual topic into a coherent document and finalized the content for the final Statement. The writing process was analogous to preparation of a multiauthored textbook with input from individual authors and the textbook editors.
Conclusions: The major conclusions related to the overall benefits and risks of MHT expressed as the number of women per 1000 taking MHT for 5 yr who would experience benefit or harm. Primary areas of benefit included relief of hot flashes and symptoms of urogenital atrophy and prevention of fractures and diabetes. Risks included venothrombotic episodes, stroke, and cholecystitis. In the subgroup of women starting MHT between ages 50 and 59 or less than 10 yr after onset of menopause, congruent trends suggested additional benefit including reduction of overall mortality and coronary artery disease. In this subgroup, estrogen plus some progestogens increased the risk of breast cancer, whereas estrogen alone did not. Beneficial effects on colorectal and endometrial cancer and harmful effects on ovarian cancer occurred but affected only a small number of women. Data from the various Women's Health Initiative studies, which involved women of average age 63, cannot be appropriately applied to calculate risks and benefits of MHT in women starting shortly after menopause. At the present time, assessments of benefit and risk in these younger women are based on lower levels of evidence.
eLetters:
Read all eLetters
- Statistical Analysis in the Postmenopausal Hormone Therapy
- Joseph W. Goldzieher
- JCEM Online, 17 Aug 2010 [Full text]
"It is to be hoped that this monumental, desperately needed report will help to counter the persistent damaging effect of the 2002 WHI publication, and have an influence that ranges from generators of policy and guidelines to the most remote doctor/patient interaction...."
How to follow up advanced-stage borderline tumours? Mode of diagnosis of recurrence in a large series stage II-III serous borderline tumours of the ov
BACKGROUND: The aim of this study was to describe how recurrences were diagnosed in the largest series of patients treated for an advanced-stage serous borderline ovarian tumour.
PATIENTS AND METHODS: From 1973 to 2006, 45 patients with a serous borderline tumour and peritoneal implants relapsed among 162 patients with a follow-up exceeding 1 year. Data concerning recurrences and the mode of diagnosis were reviewed.
CONCLUSIONS: This study demonstrates that ultrasound is the most relevant follow-up procedure in this context. Nevertheless, the blood CA 125 test is of particular interest for detecting invasive recurrent disease, which is the most crucial event.
How medical specialists appraise three controversial health innovations: scientific, clinical and social arguments (abstract)
How medical specialists appraise three controversial health innovations: scientific, clinical and social arguments.
Department of Health Administration, University of Montreal, Montreal, Quebec, Canada. pascale.lehoux@umontreal.ca
Abstract
Medical specialists play a pivotal role in health innovation evaluation and policy making. Their influence derives not only from their expertise, but also from their social status and the power of their professional organisations. Little is known, however, about how medical specialists determine what makes a health innovation desirable and why. Our qualitative study investigated the views of 28 medical specialists and experts from Quebec and Ontario (Canada) ...cont'd (not specific to ovarian cancer)Vermillion's OVA1 2010 Sales Target Is Looking Like a Moon Shot. How Will it Hit It? GenomeWeb (financial)
The test, approved last September, costs $650 and is reimbursed at $540 by Medicare, according to the company. (assuming U.S. dollars)
Tuesday, August 17, 2010
full free access: More stakeholder engagement is needed to improve quality of research, say US experts
Blogger's note: Agree based on years of RCT reviews
"Researchers need to overcome the evidence paradox of 18 000 randomised trials being published each year but almost every review concluding that not enough hard evidence exists to actually inform decision making, experts have said."
"We can’t just keep putting band aids on this system," she said. "Either health care is going to be subject to scientific methods and actually become evidence based or we are just going to keep generating little bits of evidence here and there and valiantly try to assemble them into some kind of path forward."
Identification of a Danish breast/ovarian cancer family double heterozygote for BRCA1 and BRCA2 mutations
Abstract
Mutations in the two breast cancer susceptibility genes BRCA1 and BRCA2 are associated with increased risk of breast and ovarian cancer. Patients with mutations in both genes are rarely reported and often involve Ashkenazi founder mutations. ......Since the BRCA1 Arg1699Gln mutation is also suggested to be disease-causing, we consider this family double heterozygote for BRCA1 and BRCA2 mutations.
What Happens to Liability Costs When A Hospital Admits Errors? - Health Blog - WSJ
Note: comment section is open for you to express your views, as you wish
abstract: A 67-Year-Old Woman with BRCA 1 Mutation Associated with Pancreatic Adenocarcinoma case report/discussion
Abstract
INTRODUCTION: There are approximately 40,000 new cases of pancreatic adenocarcinoma diagnosed in the USA each year. It is estimated that 5-10% of all patients with pancreatic cancer have a first-degree relative with the disease, while up to 20% of cases have a hereditary component. Individuals who carry a germline mutation in the BRCA 1 or 2 genes have an increased lifetime risk of developing pancreatic adenocarcinoma when compared with the general population.
CASE REPORT: Here, we present a case of metastatic pancreatic adenocarcinoma arising in a 67-year-old carrier of a BRCA 1 germline mutation.
DISCUSSION: In patients with known BRCA 1 or 2 mutation-associated pancreatic adenocarcinoma, the addition of a DNA cross-linking agent such as cisplatin, oxaliplatin, or mitomycin to a standard gemcitabine chemotherapy backbone should be considered. Poly ADP-ribose inhibitors are a novel class of drug, which have demonstrated promising efficacy in trials of BRCA 1 and 2 mutant breast and ovarian cancer, and are currently undergoing prospective evaluation in advanced pancreatic cancer.
For Women with Ovarian Cancer: A Toll Free Educational Teleconference. Free press release - Sept 20th Monday
Monday, September 20, from 8:00 pm – 9:00 pm (EST) The program is free. Women interested in participating should call Support Connection IN ADVANCE to register and receive instructions. On the night of the teleconference, participants will call a special toll-free number and be connected with the group. To learn more or to register, call Support Connection at 914-962-6402 or 1-800-532-4290. For Women with Ovarian Cancer: A Toll Free Educational Teleconference. Free. For women with ovarian cancer: A toll-free teleconference presentation & discussion with Dr. Thomas J. Herzog of Columbia University Herbert Irving Comprehensive Cancer Center at The New York-Presbyterian Hospital. Free. Topics to be discussed include: Women facing recurrence; Highlights of some new targeted molecular therapies with a focus on a clinical trial that includes the role of Bevacizumab (Avastin) in the treatment of ovarian cancer; and the role of bio markers and molecular profiling. Participants will have the opportunity to ask questions, interact with one another and share common life experiences. A Support Connection Peer Counselor will facilitate the discussion.
Lymphedema beyond breast cancer - - Cancer (journal) abstract
BACKGROUND:
Secondary lymphedema is a debilitating, chronic, progressive condition that commonly occurs after the treatment of breast cancer. The purpose of the current study was to perform a systematic review and meta-analysis of the oncology-related literature excluding breast cancer to derive estimates of lymphedema incidence and to identify potential risk factors among various malignancies.
RESULTS:
A total of 47 studies (7779 cancer survivors) met inclusion criteria: melanoma (n = 15), gynecologic malignancies (n = 22), genitourinary cancers (n = 8), head/neck cancers (n = 1), and sarcomas (n = 1). The overall incidence of lymphedema was 15.5% and varied by malignancy (P < .001): melanoma, 16% (upper extremity, 5%; lower extremity, 28%); gynecologic, 20%; genitourinary, 10%; head/neck, 4%; and sarcoma, 30%. Increased lymphedema risk was also noted for patients undergoing pelvic dissections (22%) and radiation therapy (31%). Objective measurement methods and longer follow-up were both associated with increased lymphedema incidence.
CONCLUSIONS:
Lymphedema is a common condition affecting cancer survivors with various malignancies. The incidence of lymphedema is related to the type and extent of treatment, anatomic location, heterogeneity of assessment methods, and length of follow-up.
Review: Cochrane Collaboration - Palliative surgery versus medical management for bowel obstruction in ovarian cancer
Surgery compared to non-surgical treatment to relieve symptoms of bowel obstruction in ovarian cancer
Authors' conclusions
We found only low quality evidence comparing palliative surgery and medical management for bowel obstruction in ovarian cancer. Therefore we are unable to reach definite conclusions about the relative benefits and harms of the two forms of treatment, or to identify sub-groups of women who are likely to benefit from one treatment or the other. However, there is weak evidence in support of surgical management to prolong survival.
2010 Review: Cochrane Collaboration Topotecan for ovarian cancer
Background
Chemotherapeutic agents such as topotecan can be used to treat ovarian cancer. The effects of using topotecan as a therapeutic agent have not been previously been systematically reviewed.
Objectives
To evaluate the effectiveness and safety of topotecan for the treatment of ovarian cancer.
Results:
Participants were more likely to respond to topotecan on a 21-day cycle as opposed to a 42-day cycle (RR 7.23, 95% CI 0.94 to 55.36). Small tumor diameter, sensitivity to platinum-based chemotherapy was associated with better prognosis. Small sample size, methodological flaws and poor reporting of the included trials made measurement bias of the trials difficult to assess.
Plain language summary
Topotecan is an active second line chemotherapeutic drug, used to treat patients with relapsed ovarian carcinoma
It appears to have a similar level of effectiveness as paclitaxel and pegylated liposomal doxorubicin, though with different patterns of side effects. Larger, well-designed randomised controlled trials (RCTs) are required to define an optimal regime.
Abstract: Which staging system to use for gynaecological cancers: a survey with recommendations for practice in the UK
Aims
There are two commonly used staging systems for gynaecological cancers, namely Federation Internationale de Gynecologie et d'Obstetrique (FIGO) and TNM. The authors wished to ascertain which staging system is most commonly used in dealing with gynaecological cancers in the UK.
Methods
The authors undertook a survey among participants in the National Gynaecological Pathology EQA scheme to investigate whether gynaecological pathologists in the UK use FIGO or TNM staging in their routine reporting of gynaecological cancers.
Results
There were 105 respondents out of 278 participants (38%). Of the analysed results, a majority of respondents (64%) use FIGO staging, while 32% use both FIGO and TNM. 80% of respondents stated that their multidisciplinary team meeting uses FIGO staging, while 18% use both FIGO and TNM. Only an extremely small minority of pathologists and multidisciplinary team meetings use TNM alone. A survey of members of the British Gynaecological Cancer Society revealed similar findings.
Conclusions
Since FIGO and TNM are not always equivalent, and there may be confusion when more than one staging system is used, it is recommended that FIGO staging be used for gynaecological cancers. The survey revealed support for the use of TNM, as well as FIGO, only for cervical cancer, since FIGO does not take the lymph node status into account. Given the prevalent practice in the UK, the British Association of Gynaecological Pathologists, British Gynaecological Cancer Society and gynaecological clinical reference group of the National Cancer Intelligence Network recommend that FIGO staging be used for gynaecological cancers with recording of the lymph node status for cervical cancer. This may be done by providing a TNM stage for this cancer type only or by recording the lymph-node status at the multidisciplinary team meeting.
Cancer Patients' Roles in Treatment Decisions: Do Characteristics of the Decision Influence Roles? JCO
Purpose
Patients with more active roles in decisions are more satisfied and may have better health outcomes. Younger and better educated patients have more active roles in decisions, but whether patients' roles in decisions differ by characteristics of the decision itself is unknown.
Conclusion
Patients making decisions about treatments for which no evidence supports benefit and decisions about noncurative treatments reported more physician control, which suggests that patients may not want the responsibility of deciding on treatments that will not cure them. Better strategies for shared decision making may be needed when there is no evidence to support benefit of a treatment or when patients have terminal illnesses that cannot be cured.
Monday, August 16, 2010
Research uncovers possible new targets for attacking ovarian cancer - Cancerwise | Cancer blog from MD Anderson Cancer Center
Note: in research
Two studies led by scientists at MD Anderson open new areas of research that could potentially improve ovarian cancer treatment.
The discoveries published today in the journal Cancer Cell are preclinical - they employ laboratory experiments to better understand the molecular processes that drive formation and growth of cancer. Both studies found previously unknown roles for two proteins, singling them out for further research and possible drug development. ...cont'd
Understanding Patient Perspectives on Communication About the Cost of Cancer Care: A Review of the Literature — JOP
Conclusion: To my knowledge, patient preferences surrounding discussion of cost of cancer care have gone largely unstudied and are thus unknown. If the goal is to provide high-quality care while controlling rising health care costs, more research is needed to better understand patient perspectives on communication surrounding the cost of oncologic care, particularly given the significant impact such discussions may have on cancer outcomes, cost, and overall patient satisfaction.
short video (45 seconds): Health 2.0 Washington DC Conference: Interview with Gilles Frydman
Interview with Gilles Frydman, Founder and President of ACOR
E-Health Insider :: Government to scrap Audit Commission UK
"It is less clear where its medication and patient safety work will go, since the government has already announced that it will be scrapping the National Patient Safety Agency as part of its bid to reduce the number of arms length bodies in the health service."
A phase II study of sunitinib in patients with recurrent epithelial ovarian and primary peritoneal carcinoma: an NCIC Clinical Trials Group Study
Results: Of 30 eligible patients, most had serous histology (67%), were platinum sensitive (73%) and had two prior chemotherapies (60%). One partial response (3.3%) and three CA125 responses (10%) were observed, all in platinum-sensitive patients using intermittent dosing. Sixteen (53%) had stable disease. Five had >30% decrease in measurable disease. Overall median progression-free survival was 4.1 months. Common adverse events included fatigue, gastrointestinal symptoms, hand–foot syndrome and hypertension. No gastrointestinal perforation occurred.
Conclusions: Single-agent sunitinib has modest activity in recurrent platinum-sensitive ovarian cancer, but only at the 50 mg intermittent dose schedule, suggesting that dose and schedule may be vital considerations in further evaluation of sunitinib in this cancer setting.
Cancer epigenomics: Implications of DNA methylation in personalized cancer therapy - Cancer Science
Note: in research; see Table 1 for references to ovarian cancer/cisplatin
"Methylation of FANCF has been found in 20% of primary ovarian cancers not previously exposed to cisplatin, but the correlation between chemosensitivity and FANCF methylation in primary tumors remains to be determined."
Review Symptom research in gynecologic oncology: A review of available measurement tools (abstract)
define: heterogeneity - diverse and not comparable
Results
Nine studies examined symptom assessment, quality-of-life assessment, or symptom indexes for various gynecologic cancers. Studies varied in design, patient profiles, symptoms assessed, and outcomes measured. Meta-analysis was not performed due to heterogeneity in the studies.Conclusion
Although pain is well-studied and well-characterized, other disease-specific and general systemic symptoms of gynecologic cancers need better understanding and assessment. Accordingly, assessment of symptoms throughout the course of disease is crucial for treatment decisions and outcomes monitoring for patients with gynecologic cancer. This is especially true for survivors of gynecologic cancer, for patients whose treatment was unsuccessful, or for choosing between treatments with comparable survival outcomes. However, measurement and assessment of cancer-related symptoms is challenging because of the complex interaction between disease progression, multi-modality treatments, and symptoms. In this review, we evaluate the currently available symptom assessment tools for gynecologic cancers, along with quality-of-life assessment tools that include symptom items, and we give recommendations for further research.Informa Healthcare - Summary: Standardized FDG uptake as a prognostic variable and as a predictor of incomplete cytoreduction in primary advanced ovar
Discussion
FDG uptake in the primary tumor of patients with advanced ovarian cancer was not a prognostic variable and the FDG uptake did not predict complete cytoreduction after primary surgery. Future prospective clinical trials will need to clarify if other PET tracers can serve as prognostic variables in ovarian cancer.
Sunday, August 15, 2010
Chemotherapy Options in the Management of Platinum-Sensitive Recurrent Ovarian Cancer
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Chemotherapy Options in the Management of Platinum-Sensitive Recurrent Ovarian Cancer | |||||
abstract: Expert Opinion on Drug Metabolism & Toxicology - Effects of herbal products on the metabolism and transport of anticancer agents
What the reader will gain: Potential interactions of herbal medicines with anticancer agents have become a safety concern in cancer chemotherapy.
Take home message: Further studies are warranted to investigate the efficacy and safety profiles of herbal medicines commonly used by cancer patients.
full free access: A KRAS-Variant in Ovarian Cancer Acts as a Genetic Marker of Cancer Risk — Cancer Res
Note: in research; discusses HBOC (BRCA/mutation not found); KRAS has been studied extensively in colorectal cancer but not mentioned in this research eg. Lynch Syndrome
Medicine, Health Care and Philosophy A European Journal Editorial: The language of medicine and bioethics
"...The contributions in this section clearly show the new stage in the development of global bioethics, with an increasing body of documents, guidelines, publications at the level of international law. The language of human rights is becoming the new language of bioethics."
How do you rank and use medical evidence? short discussion on clinical trials
Randomized clinical trials are the gold standard ; Mixed bag of evidence to determine drug safety
The Cancer Biomarker Conundrum: Too Many False Discoveries
The Cancer Biomarker Conundrum: Too Many False Discoveries
14 Aug 2010
"The boom in cancer biomarker investments over the past 25 years has not translated into major clinical success. The reasons for biomarker failures include problems with study design and interpretation, as well as statistical deficiencies, according to an article published online August 12 in The Journal of the National Cancer Institute...".cont'd including several references to ovarian cancer
Saturday, August 14, 2010
Expert Opinion on Medical Diagnostics - KRAS mutations - Summary
What the reader will gain: KRAS mutations in mCRC and NSCLC primary tumors predict resistance to EGFR-targeted therapy. In pancreatic cancer, KRAS may prove useful as a diagnostic biomarker to screen for early neoplasia. Furthermore, quantitative KRAS mutation analysis could have the potential to distinguish pancreatic cancer from other conditions such as chronic pancreatitis.
With respect to ovarian and endometrial cancer, further studies should focus on determining reliable biomarkers for predicting response to EGFR-targeted therapy. Besides EGFR inhibition, KRAS may also serve as a diagnostic and predictive biomarker for evolving therapies directed against mutant RAS proteins.
Take home message: KRAS has been recognized as an outstanding predictive biomarker to select mCRC and NSCLC patients for EGFR-targeted therapies; however, multi-determinant approaches including other molecular markers should facilitate the identification of patients likely to respond to such therapies.
See also blog post:
Wednesday, July 21, 2010
A KRAS-Variant in Ovarian Cancer Acts as a Genetic Marker of Cancer Risk (full access)
REPOST: updated to include commentaries - Missing an Ovarian Cancer Diagnosis Should Be Criminal
Note:
The reposted blog includes commentaries from a number of well known ovarian cancer advocates/survivors/family and is open for comment
Protocol: Cochrane Collaboration - Vitamin D supplementation for prevention of cancer in adults
Objectives
To assess the beneficial and harmful effects of vitamin D supplementation for prevention of cancer in adults.
Abstract
This is the protocol for a review and there is no abstract. The objectives are as follows:
To assess the beneficial and harmful effects of vitamin D supplementation for prevention of cancer in adults.
Why it is important to do this review
The available evidence on vitamin D and cancer incidence is intriguing but inconclusive. Results of recently completed randomised clinical trials testing the influence of vitamin D supplementation for cancer prevention are inconsistent. Lappe et al found that vitamin D supplementation is associated with significantly decreased cancer incidence (Lappe 2007). On the contrary, another large randomised clinical trial found no effect of vitamin D and calcium supplementation on cancer incidence (Wactawski-Wende 2006). A recent meta-analysis by Autier and Gandini of 18 randomised clinical trials found significantly lower mortality in vitamin D supplemented participants (Autier 2007). We have been unable to identify any systematic reviews of randomised trials on vitamin D supplementation for cancer prevention.
full access: Ovarian Cancer Metastatic to the Breast Presenting as Inflammatory Breast Cancer: A Case Report and Literature Review - Journal of Cancer
Conclusion. Although ovarian metastasis to the breast presenting as inflammatory breast cancer is rare, it should be included in the differential diagnosis for any patient with a personal history of ovarian cancer. Accurate differentiation is necessary because treatment differs significantly for patients with ovarian metastasis to the breast, as compared with patients with primary inflammatory breast cancer. Ovarian metastasis to the breast confers a poor prognosis...cont'd
Friday, August 13, 2010
Technique to Preserve Fertility in Young Women May Be Unsafe for Patients With Leukemia (AML/CML)-- press release
Note: study of 18 patients (AML/CML)
WASHINGTON, Aug. 13 /PRNewswire-USNewswire/ --
Although the use of ovarian tissue cryopreservation and transplantation has lead to 13 live births in women with lymphoma or solid tumors, this method of fertility preservation may be unsafe for patients with leukemia, according to a recent study published online in article: Blood, the journal of the American Society of Hematology "Reimplantation of cryopreserved ovarian tissue from patients with acute lymphoblastic leukemia is potentially unsafe". The method involves removing and freezing ovarian tissue before the patient undergoes aggressive chemotherapy and radiotherapy, and then reimplanting the tissue once the cancer has been brought under control. One major concern with leukemia patients is the risk that their frozen-thawed ovarian tissue might harbor malignant cells that could induce a recurrence of the disease after reimplantation.
"Our study provides clear evidence that cancer cells in women with acute and chronic leukemias can contaminate the ovaries," said Marie-Madeleine Dolmans, MD, professor at the Universite Catholique de Louvain in Brussels and lead author of the study. "If this tissue is reimplanted in these women when they're ready to have children, there's a good possibility that the cancer will come back." ...cont'd
"Moreover, chemotherapy before ovarian cryopreservation does not exclude malignant contamination. Finally, reimplantation of cryopreserved ovarian tissue from ALL and CML patients puts them at risk of disease recurrence."
Expert Opinion on Investigational Drugs - Summary: Histone deacetylase (HDAC) inhibitors
Take home message: There are extensive preclinical studies with transformed cells in culture and tumor-bearing animal models, as well as limited clinical studies reported to date, which indicate that HDAC inhibitors will be most useful when used in combination with cytotoxic or other targeted anticancer agents.
Don Berwick to Head Medicare - Great Choice by President Obama - blogger's notes
Note: having been involved in WHO's (World Health Organization) Patients for Patient Safety I had the ocassion several times to hear Don Berwick speak. Here are some notes from Trisha's blog:
Patient Empowerment Blog
By Trisha Torrey, Patient Empowerment GuidePatient Empowerment Blog
Here's an example of Dr. Berwick's point of view. From the IHI website, this is the No Needless List:
No needless deaths No needless pain or suffering No helplessness in those served or serving No unwanted waiting No waste No one left out
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