Saturday, October 09, 2010
abstract: Factors for Hematopoietic Toxicity of Carboplatin: Refining the Targeting of Carboplatin Systemic Exposure — JCO
Purpose Area under the curve (AUC) dosing is routinely carried out for carboplatin, but the chosen target AUC values remain largely empirical. This multicenter pharmacokinetic-pharmacodynamic (PK-PD) study was performed to determine the covariates involved in the interindividual variability of carboplatin hematotoxicity that should be considered when choosing individual target AUCs.
Patients and Methods Three hundred eighty-three patients received carboplatin as part of established regimens. A semi-physiologic population PK-PD model was applied to describe separately the time course of absolute neutrophil and platelet counts using NONMEM software. The plasma ultrafiltrable carboplatin concentration (CCarbo) was assumed to inhibit the proliferation of blood cell precursors through a linear model: drug effect = slope × CCarbo. The slope corresponds to the patients' sensitivity to carboplatin hematotoxicity. The relationships between the patients' sensitivity to the neutropenic or thrombopenic effects of carboplatin and various covariates, including associated chemotherapies, demographic, biologic, and pharmacogenetic data, were studied.
Results The sensitivity of carboplatin-induced thrombocytopenia decreased in the case of concomitant paclitaxel chemotherapy (slope decreased by 24%), whereas it increased with coadministration of etoposide and gemcitabine (slope increased by 45% and 133%, respectively). For neutropenia, the sensitivity increased when carboplatin was combined with other cytotoxics (slope increased by 76%).
Conclusion This study provides useful information to clinicians to better estimate the hematopoietic toxicity of carboplatin and thus choose more rationally carboplatin target AUCs as a function of pretreatment or concomitantly administered chemotherapies. For example, an AUC of 5 mg/mL · min is associated with a risk of grade 3 or 4 thrombocytopenia of 2% in combination with paclitaxel versus 38% with gemcitabine in a non-pretreated patient.
Investigational ovarian cancer drug (MLN8237) shows promise against platinum resistant disease
Phase II trial
A drug being developed as a treatment for ovarian cancer has shown single agent activity with durable disease control in some patients in a Phase-II clinical trial, an international research group has reported.Dr Ursula Matulonis from Dana-Farber Cancer Institute in the USA reported the results of the single-agent trial of the drug, called MLN8237, in a poster at the 35th Congress of the European Society for Medical Oncology (ESMO).
MLN8237 selectively inhibits an enzyme known as Aurora A kinase, which is a member of a family of kinase enzymes involved in normal cell division. Researchers have found that Aurora A kinase is over-expressed in some cancer cells, leading to growth of cancers.
"In epithelial ovarian cancer, Aurora A kinase has been reported to be frequently upregulated or overexpressed, and associated with worse clinical outcome," Dr Matulonis said. "This is why an effective Aurora A Kinase inhibitor is a potential new therapy to be used alone or in combination with other standard agents such as paclitaxel."...cont'd
abstract: Prospective immunohistochemical analysis of primary colorectal cancers for loss of mismatch repair protein expression
Background: Evaluation of patients for Lynch syndrome includes assessment of age and family cancer history as well as testing for microsatellite instability and alterations in mismatch repair (MMR) genes. We examined the value of routine immunohistochemistry (IHC) for MMR proteins in patients with colorectal cancer (CRC) undergoing resection at a single institution.
Patients and Methods: Beginning in July 2006, all patients aged < 50 years who were undergoing resection of primary CRC had their specimens routinely examined by IHC for MMR proteins. Patients aged 50-60 years were examined if histopathology suggestive of Lynch syndrome was reported, and patients of any age were examined if strong clinical suspicion was present. Family cancer history was analyzed and fulfillment of Amsterdam II criteria determined.
Results: Over an 18-month period, 96 patients aged < 50 years underwent CRC resection. Out of these, 72 patients (75%) had immunohistochemical testing, with an overall MMR protein loss rate of 19%. In selected patients aged 50-60 years and > 60 years, loss rates were 26% and 65%, respectively. Of all patients with MMR protein loss, 10 (32%) had reported histopathology, and 3 (10%) had family histories suggesting Lynch syndrome.
Conclusion: We demonstrate the feasibility of routine immunohistochemical testing for MMR proteins in patients with CRC. As only a minority of patients with MMR protein loss met Amsterdam II criteria or had suggestive histopathology reported, routine IHC may identify patients with Lynch syndrome who might otherwise be missed.
Updated AMG 386 Data Demonstrate Promising Antitumor Activity in Patients With Recurrent... PRNewswire/ --
Oct. 9 /PRNewswire/ -- Amgen today announced AMG 386, combined with paclitaxel, demonstrated antitumor activity in a randomized Phase 2 trial involving 161 patients with recurrent ovarian cancer. The updated results, now including data on overall survival, are being presented in a poster discussion at the 35th European Society for Medical Oncology (ESMO) Congress being held in Milan, Italy. (Abstract Number: 975PD)...."cont'd
The relevant distinction between “progression” in ovarian cancer drug trials and the clinical decision to change therapy - Markman (very short abstract)
abstract: "It is rational to suggest that the decision to alter treatment in advanced ovarian cancer should be based on the totality of evidence that the disease is worsening, on patient tolerability of the therapy, and on a determination that the current regimen is providing no benefit or unacceptably limited benefit to the specific individual. Knowledge of an objective measure of “progression” should play an important, but not a singular, role."
U.S. FDA: About the Center for Drug Evaluation and Research > Carboplatin dosing
Carboplatin dosing
"This communication is to inform members of the oncology community of recent changes in the measurement of serum creatinine which may have an impact on carboplatin dosing. Based on preliminary communications with the National Cancer Institute/Cancer Therapy Evaluation Program, a potential safety issue with carboplatin dosing has been identified. By the end of 2010, all clinical laboratories in the US will use the new standardized Isotope Dilution Mass Spectrometry (IDMS) method to measure serum creatinine. The IDMS method appears to underestimate serum creatinine values compared to older methods when the serum creatinine values are relatively low (e.g., ~0.7 mg/dL). Measurement of serum creatinine by the IDMS-method could result in an overestimation of the Glomerular Filtration Rate (GFR) in some patients with normal renal function. If the total carboplatin dose is calculated based on IDMS-measured serum creatinine using the Calvert formula, carboplatin dosing could be higher than desired and could result in increased drug-related toxicity...."cont'dFriday, October 08, 2010
Practice-Changing Results to Be Presented at ESMO - Medscape Medical News from the: * 35th European Society for Medical Oncology (ESMO) Congress
October 8, 2010 (Milan, Italy) — A record number of abstracts were submitted and accepted, and a record number of attendees expected, here at the 35th European Society for Medical Oncology Congress. In addition, findings from major phase 3 trials may change clinical practice in lung, breast, ovarian, and prostate cancer.....
CANHELP Tool - questionnaires/tools/end of life care - patients, caregivers, bereavement, healthcare providers
View the questionnaire measuring SATISFACTION only:
Documents (pdf):
* CANHELP Patient Questionnaire
* CANHELP Caregiver Questionnaire
* CANHELP Bereavement Questionnaire
View the Questionnaire measuring IMPORTANCE and SATISFACTION:
* CANHELP Patient Questionnaire
* CANHELP Caregiver Questionnaire
Canadian Health Reference Guide-Patients and caregivers want more support at the end of life
New tool helps patients and families communicate their needs
free full access: Health care providers (doctors and nurses) underestimate symptom intensities of cancer patients
Note: plain english format (easy to read) "The differences between patient and provider assessments can be caused by providers not being able to exactly interpret the patients' symptoms or that different instruments are used for patients and health care providers. Agreement on rating of symptoms was associated with demographic- and disease-related factors. Clinicians involved in care for patients with cancer should be aware of the potential factors associated with a risk of symptom underestimation."
Thursday, October 07, 2010
prior abstract - new commentary: EvidenceUpdates - Phase III trial of carboplatin plus paclitaxel with or without gemcitabine in first-line treatment
Commentary:
Oncology - Gynecology - "This negative study extends the evidence base indicating that triplet chemotherapy increases toxicity without significant survival benefit in ovarian cancer patients. Further increases in survival for this group will need to come from alternate strategies."
alternate link to abstract:
Phase III trial of carboplatin plus paclitaxel with or without gemcitabine in first-line treatment of epithelial ovarian cancer
abstract: “When patients and families feel abandoned”
Conclusions
These strategies can help us maintain healing relationships with our patients by maintaining their trust, confidence, and satisfaction. Cultivating relational aspects of medical practice requires an interchange and takes time. Experienced doctors know this and continue to do so because being present and staying with the patient during difficult times is a pillar of moral and ethical training and a fundamental attribute of a good physician.
Correspondence/Response: Patient Information and Decision Aids in Oncology: Need for Communication Between Patients and Physicians — JCO
1):
Correspondence (Vodermark):
"In their recent contribution to Journal of Clinical Oncology, Brace et al1 report on the knowledge and opinions of physicians caring for patients with cancer in the province of Ontario, Canada, about patient decision aids......Brace et al1 must be congratulated for collecting this comprehensive data set on the oncologists' perspective on this important topic. However, it is possible that the rates of decision aid use by patients may actually be higher than suggested by the percentages for physicians responding to the questionnaire. Access to disease-specific patient decision aids is provided freely on the Internet, and patients may make use of these tools without discussing them with their treating oncologists..."cont'd
2):
Response to Vodermark (Erin D. Kennedy):
We appreciate the comments by Vordermark1 about our recent contribution to Journal of Clinical Oncology.2
"...We agree that the Internet certainly has the potential to be an excellent and accessible information resource for both patients and physicians. The results presented by Vordermark et al3 and Adler et al4 are both interesting and timely, given that these data suggest that patients seeking information on the Internet are not comfortable discussing the information with their physicians. This is similar to our own group's experience in which patients seem to be increasingly more confident in the information they find on the Internet rather than in their own physicians. This is somewhat concerning, and we must begin to question whether we as physicians are slowly losing the ability to connect with our patients.......To accomplish this, researchers need to involve (not avoid) physicians in both the development and implementation of pDAs and decision support tools. "
Phase I Study of Vorinostat in Patients With Advanced Solid Tumors and Hepatic Dysfunction: A National Cancer Institute Organ Dysfunction Working Group Study — JCO
Note: abstract does not indicate if ovarian cancer patients were included in this phase 1 study
Women's Health Matters Network: Women's College Hospital (Toronto) patient survey (n=1,000)
Some background:
The new facility will include the Women’s College Research Institute (WCRI), making women’s health research a key focus.
‘Our research institute is one of the few in the world – and the only one in Canada – devoted to women’s health and innovations in ambulatory care,’ said Dr. Lorraine Lipscombe, an endocrinologist at Women’s College Hospital and a scientist at the WCRI who spoke at the event.
‘Our scientists ask questions that are not only unique to women’s lives, but that are specific to distinct communities of women.’
Selected results:
"Some notable results:
* Only 30 per cent of respondents said they felt empowered when dealing with health-care providers. A great many women had less positive feelings: 45 per cent said they felt isolated when visiting a hospital, 57 per cent said they felt afraid, 63 per cent felt frustrated and 76 per cent felt anxious.
* Sixty-five per cent of women felt they were treated like a number rather than a person, and 70 per cent felt the focus was on rushing them through their appointments and treatments rather than discussing their needs and circumstances.
* The vast majority – 88 per cent of respondents – said it was essential to approach health care holistically, treating the whole person rather than isolated body parts. However, less than half that number (43 per cent) felt that hospitals and health-care facilities actually achieved this.
* Most women prefer to remain in the community – and in their lives – while their conditions are treated. Ambulatory care – or outpatient treatment, as opposed to being admitted to hospital – was the preference of 90 per cent of respondents.
* A health-care facility that is knowledgeable about, sensitive to, and actively addresses diverse cultures was important to 80 per cent of respondents.
* More than 85 per cent of women feel women’s health issues should be a research priority for a health-care institution. However, only 56 per cent think institutions successfully keep women’s health at the forefront of research programs."
Wednesday, October 06, 2010
revamped website: (U.S.) Science Serving People - National Cancer Institute
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Cancer Research ProgressInformation on research advances and a look at the future of cancer prevention, detection, treatment, and survivorship. |
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NCI Budget InformationNational Cancer Institute (NCI) budget requests, data on NCI spending, and an overview of how the institute’s annual budget process works. |
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Cancer Research in Your CommunityClinical trials and NCI collaborations as well as state-specific cancer information. |
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Understanding Cancer StatisticsKey facts about the human and economic cost of cancer and resources to help make the data more understandable. |
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How Cancer Research WorksA look at the process of conducting cancer research — from basic science in the laboratory to treatment in the clinic. |
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Policy HighlightsUpdates on federal cancer news and congressional testimony. |
Help us fight cancer! EU (FACE)
We hope you will join the Forum Against Cancer Europe (FACE) and we call on you to work towards implementing the European Parliament Cancer Resolution by supporting us in our campaign to:
1. Encourage and adopt national Charters for patients' rights according to European guidelines to ensure that the rights of cancer patients are upheld and enforced.
2. Urgently develop and, where existing, improve national cancer plans, setting priorities and effectively allocating resources for improving cancer control and research across the European Union, paying attention to rare or difficult to treat cancers.
3. Ensure cancer patients are included in formulating and monitoring all research, legislation and policies that affect their health.
4. Invest in cancer prevention in Member States and implement the Council Recommendation on Cancer Screening of 2003 by setting up or improving national high quality population-based screening programmes.
5. Vigorously promote cancer awareness in the general public through the existing Europe against Cancer Code.
6. Make timely, high quality and up to date information, diagnosis, treatment and care available for all cancer patients in each European Member State..
7. Firmly tackle the socio-economic and geographic divide, which leads to inequalities in cancer control
8. Oppose discrimination in the latest cancer treatment because of age, race, gender and domicile.
The Forum Against Cancer Europe (300 patient groups/patient-governed)
The "Forum Against Cancer Europe" is an initiative by the European Cancer Patient Coalition (ECPC). ECPC is representing more than 300 cancer patient groups across 42 countries, most in the EU Member States. It is run and governed by cancer survivors, is publicly audited, and is registered as a non-profit association in the Netherlands.
Tuesday, October 05, 2010
financial news: PREVIEW-New cancer data may be tonic for sickly Roche | Reuters
"Frings said Roche would file for European regulatory approval of Avastin in ovarian cancer by the end of the year, with a U.S. submission following in 2011."
Dancing with NED - A Cancer Rock Documentary | Ovarian Cancer National Alliance
<iframe src="http://player.vimeo.com/video/13338331" width="400" height="225" frameborder="0"></iframe><p><a href="http://vimeo.com/13338331">Dancing with N.E.D. Trailer</a> from <a href="http://vimeo.com/user4027907">Spark Media</a> on <a href="http://vimeo.com">Vimeo</a>.</p>This video is a trailer produced by Washington D.C.-based Spark Media and Stone Soup Productions for a documentary about one of the year’s most talked about rock bands, No Evidence of Disease (NED). NED are a group of six GYN surgeons, scattered across the country, who create and perform original music to help raise awareness and research funding for GYN cancers, spread healing through music, and help humanity in general rock out.
(book) Commentary: The politics of precancer : The Lancet
"....The fact that most cases of cancer in this self-defined population (BRCA) was of a non-familial form and that the frequency of the mutation did not translate into a higher rate of cancer was ignored....."
Preventive strikes: women, precancer, and prophylactic surgery By Ilana Lowy
Audio/Video Insights, Implications, Questions, Answers: Report of the Investigators of Surgical and Pathology Issues at Three Essex County Hospitals
Note: this audio/video (62 minutes) refers to the investigation into this year's media reports concerning unnecessary mastectomies/pathology issues and national public exposure of the issue; quality of surgical and pathology care in Windsor/Essex counties (Ontario); notes co-operative investigation (patients??...still listening - terms of reference....)
new stats on Ovarian Cancer and Us blog
This week's stats: most views by country - U.S., France, Canada and UK
Life-Saving Developments in Ovarian Cancer Research | Reader's Digest Canada
September – ovarian cancer month – was marked with the usual high-profile events to raise funds and awareness. September 2010, however, will be remembered as particularly significant for this most deadly of women’s cancers.
Increased cancer risks for relatives of very early-onset breast cancer cases with and without BRCA1 and BRCA2 mutations - abstract
CONCLUSION: First-degree relatives of women with very early-onset breast cancer are at increased risk of cancers not explained by BRCA1 and BRCA2 mutations.
media: U.S. New health care changes are only the beginning - CNN.com
"....Patient advocates say Thursday's changes are only the beginning. "The big resolutions will come in 2014 when you will start to see tens of millions of people getting coverage," says Avram Goldstein, communication director for the Health Care for America Now, a liberal grass roots health advocacy organization. It offers a detailed timeline of what changes consumers can expect over the next few years..." cont'd
Ovarian cancer care for the underserved: Are surgical patterns of care different in a public hospital setting? abstract
CONCLUSIONS:
Ovarian cancer patients treated in public hospitals are less likely to have gynecologic oncologists and high-volume surgeons involved in their care. This is a preliminary finding that warrants further investigation.OpenNotes Project "levels the playing field" between doctors and patients -- Canadian Medical Association Journal
"....The OpenNotes Project aims to improve communication and transparency between doctors and patients, many of whom don’t even realize notes are being taken, says Dr. Tom Delbanco, a lead investigator of the study. "We share these notes with consultants, insurers and people who evaluate quality of care, but almost never with the patient. I think providers feel these are their own records, rather than their patients’, so in quiet ways, perhaps unconsciously, they build up obstacles to patients gaining access to them." As in Canada, American patients have a legal right to review their doctors’ notes as part of their medical records. However, those who wish to gain access to the files often face prohibitive printing or copying fees, lengthy processes and delays, as well as all manner of bureaucratic red tape, says Delbanco. "At the same time, it’s been shown patients remember very little of what goes on in the examining room."...cont'd
Monday, October 04, 2010
Chemobrain ... Is It Real?
Cancer Newsline -
09/20/2010
Chemobrain, or difficulty in efficiently processing information, is
a legitimate, diagnosable condition that may be caused by chemotherapy
treatment, the cancer itself, or secondary medical conditions such as
anemia. Christina Meyers, Ph.D., Professor of Neuro-Oncology at MD
Anderson Cancer Center, discusses chemobrain and how it can affect
cancer patients.Guest(s): Christina Meyers, Ph.D.
- Listen to Chemobrain ... Is It Real?
- Download Chemobrain ... Is It Real? on iTunes
U.S. webinar Oct 7th - Upcoming Webinar: Pre-Existing Condition Insurance Plans Created by the Affordable Care Act - The Commonwealth Fund
The Commonwealth Fund invites you to join a free webinar on pre-existing condition insurance plans, part of a series of webinars on realizing health reform's potential. This one-hour webinar, to be held Thursday, Oct. 7, at 2 p.m., E.T., will address the Affordable Care Act provision on establishing temporary high-risk pools, also called preexisting condition insurance plans (PCIP), which are designed to quickly make health insurance available to uninsured individuals with preexisting conditions, many of whom previously had been denied coverage. Speakers will examine eligibility, benefits, premiums and cost-sharing, enrollment and outreach, and oversight of the PCIP programs, as well as plan variability.
What: 'Realizing Health Reform's Potential' Webinar: Pre-Existing Condition Insurance Plans Created by the Affordable Care Act
When: Thursday, Oct. 7, at 2 p.m., E.T.
Speakers: Jean P. Hall, Ph.D., associate research professor at the University of Kansas and author of a new Commonwealth Fund report on PCIPs, and Amie Goldman, CEO, the Health Insurance Risk-Sharing Plan Authority in Wisconsin and chair of the National Association of State Comprehensive Health Insurance Plans; and Deborah Armstrong, executive director, New Mexico Medical Insurance Pool
Moderator: Sara R. Collins. Ph.D., vice president, Affordable Health Insurance, The Commonwealth Fund
To register, go to: https://cc.readytalk.com/r/8ctspn2599j0
The effect of age on the tolerability of intraperitoneal chemotherapy, complication rate, and survival in patients with ovarian cancer
Sunday, October 03, 2010
Incidentally… avoiding the problem of incidental findings (Practical Ethics)
"A new study from the Mayo clinic
in the United States points to a frequent problem in certain types of
medical research. When healthy volunteers or patients with a given
condition take part in research studies they may have brain scans, CAT
scans, blood tests or genetic tests that they wouldn’t otherwise have
had. These tests are not done for the benefit of the individual, they
are designed to answer a research question. But sometimes, quite often
according to the authors of this new study, researchers may spot
something on the scan that shouldn’t be there, and that could indicate a
previously undiagnosed health condition. These ‘incidental findings’ generate an ethical dilemma for researchers....."cont'dIncreased risk of other cancers for relatives of women with early onset breast cancer | e! Science News
Published: Wednesday, September 29, 2010 - 18:23
in Health & Medicine
"The results suggest there could possibly be undiscovered genes causing breast cancer in these young women, and perhaps other cancers in their families," Professor Hopper said.
Every year in Australia, more than 300 women are diagnosed with breast cancer before the age of 35 years. This is approximately one in 40 of all breast cancers.
In the largest population based study of its kind, scientists studied 2200 parents and siblings of 500 women diagnosed with breast cancer before the age of 35 from across three countries, Australia, Canada and the United States.
After excluding families with mutations in BRCA1 and BRCA2, the two known major breast cancer susceptibility genes, they found that close relatives were at increased risk of not only breast cancer, but also of cancers of the prostate, lung, brain and urinary tract.
The results showed:
- Fathers and brothers had a 5-fold increased risk of prostate cancer.
- Mothers and sisters had a 2-fold increased risk of ovarian cancer as well as a 4-fold increased risk of breast cancer
- Close relatives also had a 3-fold increased risk for brain cancer, an 8-fold increased risk for lung cancer, and a 4-fold increased risk for urinary tract cancers.
"The results of this study could help scientists discover new cancer susceptibility genes that explain the risk of early-onset and other cancers within some families," he said.
"Our next step is to conduct larger studies to further clarify these results."
full free access: New developments in treatment of ovarian carcinoma: focus on Trabectedin
Note: click on 'pdf' for full free access to paper
abstract: Pancreatic Cancer Screening in a Prospective Cohort of High-Risk Patients: A Comprehensive Strategy of Imaging and Genetics — Clinical Cancer Research
Results:
Fifty-one patients in 43 families were enrolled, with mean age of 52 years, 35% of whom were male. Of these patients, 31 underwent EUS and 33 MRI. EUS revealed two patients with pancreatic cancer (one resectable, one metastatic), five with intraductal papillary mucinous neoplasms (IPMN), seven with cysts, and six with parenchymal changes. Five had pancreatic surgery (one total pancreatectomy for pancreatic cancer, three distal and one central pancreatectomy for pancreatic intraepithelial neoplasia 2 and IPMN).
A total of 24 (47%) had genetic testing (19 for BRCA1/2 mutations, 4 for CDKN2A, 1 for MLH1/MSH2) and 7 were positive for BRCA1/2 mutations. Four extrapancreatic neoplasms were found: two ovarian cancers on prophylactic total abdominal hysterectomy and bilateral salpingo-oophorectomy, one carcinoid, and one papillary thyroid carcinoma. Overall, 6 (12%) of the 51 patients had neoplastic lesions in the pancreas and 9 (18%) had neoplasms in any location. All were on the initial round of screening. All patients remain alive and without complications of screening.
Saturday, October 02, 2010
abstract: Managing menopausal symptoms and depression in tamoxifen users: Implications of drug and medicinal interactions
OBJECTIVE: Tamoxifen, a medication used in the treatment of breast cancer, often induces menopausal symptoms. Certain medications and natural supplements taken or prescribed to alleviate tamoxifen-induced hot flashes and depressive states in women with breast cancer interact with tamoxifen. This paper reviews potentially problematic interactions and offers treatment recommendations.
CONCLUSIONS: Clinicians should remain cautious about using strong inhibitors and/or inducers of cytochrome 2D6 and 3A4 concomitantly with tamoxifen. Use of natural menopausal supplements and diets rich in isoflavones should not be encouraged in tamoxifen users until more data is available. There are however safe treatments for hot flashes and depression in tamoxifen users.
abstract: Treatment of bevacizumab-induced hypertension by Amlodipine
Also reference:
NORVASC® (amlodipine besylate) Tablets for Oral Administration
http://www.rxlist.com/norvasc-drug.htm
full free access: Rustin et al: Early versus delayed treatment of relapsed ovarian cancer (MRC OV05/EORTC 55955): a randomised trial : The Lancet
Note: full free access is available/registration (free) is required to view
abstract: Does Neoadjuvant (Avastin) Bevacizumab Increase Surgical Complications in Breast Surgery?
Conclusions Cisplatin/bevacizumab and cisplatin alone neoadjuvant therapy resulted in a significant number of postoperative complications. Specifically, use of expanders/implants may be problematic for patients treated with bev. However, this was a single-arm trial; randomized controlled studies will be needed to determine the optimal use of bevacizumab in the timing of breast cancer surgery.
Memory Impairment Common in People with a History of Cancer « AACR News
"He calls the condition “cancer related cognitive dysfunction,” suggesting that it goes beyond the “chemobrain” label that has been attached primarily to women treated with chemotherapy for their breast cancer who reported problems in cognitive function (e.g., attention and memory). “These memory issues can be related to treatment, such as chemotherapy, radiation, and hormone therapies, or to the tumor biology itself, which could change brain chemistry and neurobehavioral function,” said Jean-Pierre."
Friday, October 01, 2010
full free access: Ovarian cancer: relevant therapy, not timing, is paramount : The Lancet
Note: registration required to view (free)
The impact of systematic para-aortic and pelvic lymphadenectomy on survival in patients with optimally debulked ovarian cancer
Abstract Aim: The objective of this study was to verify the impact of systematic retroperitoneal lymphadenectomy on survival in patients with ovarian cancer.
Medscape: No Benefit for Early Tx of Ovarian Cancer Relapse
Note: article discusses the concerns/issues/study etc
media item: New Clues to Treating Ovarian Cancer Relapse
New Clues to Treating Ovarian Cancer Relapse
Starting chemotherapy when first signs reappear not especially effective, study finds "This paper, the first randomized trial to look at the timing of chemo in women with recurring ovarian cancer, appears in the Oct. 2 issue of The Lancet, a special themed issue on cancer...."
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)61268-8/abstract
SOURCES: Andrew Berchuck, M.D., director, division of gynecologic oncology, Duke University Medical Center, Durham, N.C.; Robert A. Burger, M.D., professor of surgical oncology, section of gynecologic oncology and director, Women's Cancer Center, Fox Chase Cancer Center, Philadelphia; Oct. 2, 2010, The Lancet
Wednesday, September 29, 2010
free full access: Sept 2010 Pegylated liposomal doxorubicin in the management of ovarian cancer
"This review aims at summarizing the available evidence and the new perspectives for the clinical role of PLD in the management of patients with epithelial ovarian cancer."
(U.S.) S. 1674: Improving Access to Clinical Trials Act of 2010 (GovTrack.us)
Text:
Summary
Status:
Occurred: Introduced Sep 15, 2009
Occurred: Referred to Committee View Committee Assignments
Occurred: Passed Senate Aug 5, 2010
Occurred: Passed House Sep 23, 2010
Not Yet Occurred: Signed by President ...
Having passed in identical form in both the House and Senate, this bill now awaits the signature of the President before becoming law. [Last Updated: Sep 29, 2010 9:33PM]
Last Action:
Sep 24, 2010: Presented to President.
Related:
See the Related Legislation page for other bills related to this one and a list of subject terms that have been applied to this bill. Sometimes the text of one bill or resolution is incorporated into another, and in those cases the original bill or resolution, as it would appear here, would seem to be abandoned.
Votes:
Aug 5, 2010: This bill passed in the Senate by Unanimous Consent. A record of each senator’s position was not kept.
Sep 23, 2010: This bill passed in the House of Representatives by voice vote. A record of each representative’s position was not kept.
free full access: Integrating Supportive and Palliative Care in the Trajectory of Cancer: Establishing Goals and Models of Care — JCO
"......One of the key barriers to early referral is the misunderstanding that palliative care is only provided at the end of life once patients have exhausted all cancer treatment options. Some oncologists have expressed the concern that a referral to palliative care would destroy a patient's hope. It is important to recognize that patients do not need to choose between cancer treatments and supportive/palliative care. Rather, they can take advantage of the expertise of both the oncology and the palliative care teams in optimizing quantity and quality of life under a simultaneous care model......"
Tuesday, September 28, 2010
Mayo Collaboration Finds Source of Breast Drug Side Effect - Drugs.com MedNews (aromatase inhibitors/arthritis/bone pain)
Mayo Collaboration Finds Source of Breast Drug Side Effect
Pharmacogenomic discovery allows for improved cancer therapy
ROCHESTER, Minn. — Mayo Clinic researchers and their international colleagues have discovered genetic variants that lead to severe arthritis for a subset of women when taking aromatase inhibitors to treat their breast cancer. This serious side effect is so painful that many women halt their lifesaving medication. The findings appear today in the online issue of Journal of Clinical Oncology.
Read more: http://www.drugs.com/clinical_trials/mayo-collaboration-finds-source-breast-10214.html#ixzz10seG0Pnb
Quality of pathology reports for advanced ovarian cancer: Are we missing essential information? An audit of 479 pathology reports from the EORTC-GCG 5
Quality of pathology reports for advanced ovarian cancer: Are we missing essential information? An audit of 479 pathology reports from the EORTC-GCG 55971/NCIC-CTG OV13 neoadjuvant trial
CONCLUSION: This audit of ovarian cancer pathology reports reveals that in a substantial number of reports basic pathologic data are missing, with possible adverse consequences for the quality of cancer care. Specialisation by pathologists and the use of standardised synoptic reports can lead to improved quality of reporting. Further research is needed to better define pre- and post-operative diagnostic criteria for ovarian cancer treated with neoadjuvant chemotherapy.
Declaration: The World Cancer Declaration - A call to action from the global cancer community | Union for International Cancer Control
Targets: by 2020
- Sustainable delivery systems will be in place to ensure that effective cancer control programmes are available in all countries
- The measurement of the global cancer burden and the impact of cancer control interventions will have improved significantly
- Global tobacco consumption, obesity and alcohol intake levels will have fallen significantly
- Populations in the areas affected by HPV and HBV will be covered by universal vaccination programmes
- Public attitudes towards cancer will improve and damaging myths and misconceptions about the disease will be dispelled
- Many more cancers will be diagnosed when still localized through the provision of screening and early detection programmes and high levels of public and professional awareness about important cancer warning signs
- Access to accurate cancer diagnosis, appropriate cancer treatments, supportive care, rehabilitation services and palliative care will have improved for all patients worldwide
- Effective pain control measures will be available universally to all cancer patients in pain
- The number of training opportunities available for health professionals in different aspects of cancer control will have improved significantly
- Emigration of health workers with specialist training in cancer control will have reduced dramatically
- There will be major improvements in cancer survival rates in all countries
Monday, September 27, 2010
Prognostic value of microsatellite instability (MSI) and PTEN expression in women with endometrial cancer: results from studies of the NCIC Clinical Trials Group (NCIC CTG)
Abstract
AIM: The impact of PTEN status and microsatellite instability (MSI) on the prognosis of women with endometrial cancer is controversial. The aim of this study was to investigate MSI and PTEN expression in two patient populations using data from NCIC CTG studies.METHODS: Archival paraffin embedded tumour from women with endometrial cancer enrolled in NCIC CTG studies: EN5 (stage I/II) and IND 126, 148 and 160 (advanced/recurrent disease) were examined for MSI using BAT25/26 and for PTEN expression using immunohistochemistry. PTEN and MSI status were correlated with clinicopathologic variables and survival using data from NCIC CTG trial databases.
RESULTS: PTEN and MSI results were available from 128 and 163 patients, respectively. MSI+ tumours were more common in women enrolled in EN5 compared to the IND studies (p=0.01). PTEN negative tumours were associated with improved survival in both univariate (hazard ratio (HR) 0.55, 95% confidence interval (CI) 0.32-0.94; p=0.03) and multivariate (adjusted HR 0.54, 95% CI 0.30-0.96; p=0.03) analyses in women enrolled in IND studies. Microsatellite stable tumours were associated with an improved prognosis in univariate (HR 0.18, 95% CI 0.06-0.51; p<0.0001)>
CONCLUSIONS: PTEN negative tumours in women with advanced disease are associated with improved survival. MSI+ tumours are more common in early stage disease and in this group of women are associated with a worse prognosis
abstract: Will designated patient navigators fix the problem? Oncology nursing in transition
Abstract
With increasing concern for equity and access across the cancer care system, we have seen expanding enthusiasm for various forms of designated patient "navigators" to facilitate coordination. While the intention is laudable, many of the popular implementation strategies risk accentuating strain upon the system and further complicating the coordination problem. These authors claim the motivation underlying the navigator movement can be reframed as an emerging recognition of the value of nursing work when it is optimally positioned to support patients, as they experience the cancer care system. This paper calls on Canadian oncology nurses to critically challenge navigation strategies, and adopt only those consistent with the significant reforms required to ensure a cancer care system so effective that external navigators are no longer necessary.
abstract: Will designated patient navigators fix the problem? Oncology nursing in transition
Abstract
With increasing concern for equity and access across the cancer care system, we have seen expanding enthusiasm for various forms of designated patient "navigators" to facilitate coordination. While the intention is laudable, many of the popular implementation strategies risk accentuating strain upon the system and further complicating the coordination problem. These authors claim the motivation underlying the navigator movement can be reframed as an emerging recognition of the value of nursing work when it is optimally positioned to support patients, as they experience the cancer care system. This paper calls on Canadian oncology nurses to critically challenge navigation strategies, and adopt only those consistent with the significant reforms required to ensure a cancer care system so effective that external navigators are no longer necessary.
BRCA1 mutations and colorectal cancer in Poland
Abstract
Evidence to date that germline mutations in the tumor suppressor gene BRCA1 increase the incidence of colorectal cancer is mixed, and both positive and negative results have been reported. To establish whether or not inherited variation in BRCA1 influences the risk of colorectal cancer, we genotyped 2,398 unselected patients with colorectal cancer and 4,570 controls from Poland for three BRCA1 founder mutations (C61G, 4153delA and 5382insC). A BRCA1 mutation was present in 0.42% of unselected cases of colorectal cancer and in 0.48% of controls (OR = 0.8; P = 0.8). The mutation frequency was slightly higher (0.93%) in 321 cases who reported a family history of colon cancer in a first- or second-degree relative (OR = 1.9; P = 0.5). A BRCA1 mutation was also seen in excess (0.82%) in 851 cases who were diagnosed with colorectal cancer at age 60 or earlier (OR = 1.7; P = 0.3). The mean age at onset in carriers was 7 years younger than in non-carriers (57.0 years vs. 64.0) and the difference was significant (P = 0.05). This study suggests that BRCA1 mutations may be associated with early-onset of colorectal cancer.
Mucosal carcinoma of the fallopian tube coexists with ovarian cancer of serous subtype only: a study of Japanese cases
Abstract
Previous studies in Western countries have revealed that mucosal carcinoma of the fallopian tube frequently coexists with pelvic (ovarian, tubal, and peritoneal) serous carcinomas, and early tubal carcinoma is now regarded as a possible origin of these tumors. However, the relationship between early tubal carcinoma and non-serous ovarian cancer, such as clear cell adenocarcinoma, has not been studied in detail. In this study, we sought to examine the coexistence of mucosal carcinoma of the fallopian tube in Japanese ovarian cancer cases. We submitted the fallopian tubes in toto for histological examination in 52 ovarian carcinoma cases and three peritoneal serous carcinoma cases. The ovarian tumors included 12 serous adenocarcinomas, 23 clear cell adenocarcinomas, nine endometrioid adenocarcinomas, three mucinous adenocarcinomas, and four mixed epithelial carcinomas. Mucosal carcinoma of the fallopian tube did not coexist with non-serous adenocarcinoma (n = 40). In contrast, mucosal carcinoma of the fallopian tube was observed in six cases of ovarian serous adenocarcinoma and one case of peritoneal serous adenocarcinoma. In these cases, the p53 immunophenotypes were similar in tubal lesions and invasive ovarian or peritoneal carcinomas. Tumors were negative for p53 in four of seven cases, and one of the p53-negative serous adenocarcinomas showed low-grade morphology. We believe that some ovarian and peritoneal serous adenocarcinomas develop from early tubal carcinomas. However, it should be noted that early tubal carcinomas are not always p53-positive immunohistochemically. Finally, it is unlikely that early tubal lesions are involved in the carcinogenesis of clear cell adenocarcinoma and other non-serous adenocarcinomas.
Overview of Neuroendocrine Tumors: Focus on Carcinoid Tumors and Syndrome
Overview of Neuroendocrine Tumors: Focus on Carcinoid Tumors and Syndrome
Neuroendocrine tumors (NETs)
NETs: A common and heterogenous group of solid malignant tumors »
Carcinoid tumors: A frequently occurring GI malignancy »
NETs: Survival rates are correlated with extent of disease and tumor differentiation »
The rising incidence of carcinoid tumors »
Sept 27th: Lots of Epogen and Procrit Recalled Due to Glass Flakes in Vials
"According to the manufacturer, the lamellae result from the interaction of the formulation with glass vials during the shelf life of the product. However, the company states that it has found that the lamellae have a low potential to affect patients who may have received the recalled product. "To date, there have been no complaints or adverse events reported which can be directly attributed to the presence of glass lamellae," the company notes."
(full free access) Decisions, Decisions: Family Doctors as Gatekeepers to Prescription Drugs and Diagnostic Imaging in Canada
Decisions, Decisions: Family Doctors as Gatekeepers to Prescription Drugs and Diagnostic Imaging in Canada
O U R F I N D I N G S:
The Health Council of Canada is unable to conclusively determine if the use of family physician services has increased, decreased or remained stable over the past decade, despite a rise in the number of practising family physicians in Canada. This is due to the growing variety of physician practice models across the country and the way data are collected,(or not) to reflect the services provided.
Editorial :: Cochrane in the United States of America - The Cochrane Collaboration (background/2010 Keystone, Colorado conference)
Note: The Gynecologic Cancer Review Group section of the Cochrane is based out of the UK. Consumer reviewers may participate irrespective of geographic location as the Cochrane is primarily internet-based.
"On 18 October 2010, the first joint Colloquium between the Campbell and Cochrane Collaborations opens in Keystone, Colorado, USA. The USA last hosted the Cochrane Collaboration Colloquium and annual meeting in 1998 in Baltimore, Maryland. The Colloquium's return to the USA comes on the heels of President Obama's signing of historic health care reform legislation. As reported, "the reforms, which will cost an estimated USD 940 billion over 10 years, will expand the provision of care to 32 million more people, predominantly the poorest, and will result in the country achieving 95% coverage" (MacAskill 2010). At the same time The American Recovery and Reinvestment Act of 2009 has provided USD 1.1 billion for Comparative Effectiveness Research (CER), and established the Patient-Centered Outcomes Research Institute (PCORI). PCORI will make a major annual investment in CER, through the National Institutes of Health (NIH) and the Agency for Healthcare Research and Quality (AHRQ).
The US contribution to the development of The Cochrane Collaboration has been considerable. US-based researchers represented 7/84 (8.3%) of the pioneers attending the first Cochrane Colloquium in October 1993........."cont'd
Sunday, September 26, 2010
part 111: International patient charters are often nonbinding or feature fuzzy metrics -- Canadian Medical Association Journal (patient charter of rights)
Last of a three-part series on patient charters
Part I: Patients charters: the provincial experience (www.cmaj.ca/cgi/doi/10.1503/cmaj.109-3339)
Part II: Patient charters all buzz and no bite, advocates say (www.cmaj.ca/cgi/doi/10.1503/cmaj.109-3340)
(repeat) abstract: SGO White Paper on ovarian cancer: etiology, screening and surveillance
Abstract: Ovarian cancer is a heterogeneous, rapidly progressive, highly lethal disease of low prevalence. The etiology remains poorly understood. Numerous risk factors have been identified, the most prominent involving an inherited predisposition in 10% of cases. Women with germline mutations associated with Hereditary Breast/Ovarian Cancer and Lynch syndromes have dramatically elevated risks (up to 46% and 12%, respectively). Risk-reducing salpingo-oophorectomy is the best method to prevent ovarian cancer in these high-risk women. Significant risk reduction is also seen in the general population who use oral contraceptives. Since up to 89% patients with early-stage disease have symptoms prior to diagnosis, increased awareness of the medical community may facilitate further workup in patients who otherwise would have had a delay. Despite enormous effort, there is no proof that routine screening for ovarian cancer in either the high-risk or general populations with serum markers, sonograms, or pelvic examinations decreases mortality. Further evaluation is needed to determine whether any novel biomarkers, or panels of markers, have clinical utility in early detection. Prospective clinical trials have to be designed and completed prior to offering of any of these new diagnostic tests. CA125 is currently the only biomarker recommended for monitoring of therapy as well as detection of recurrence. This commentary provides an overview on the background, screening and surveillance of ovarian cancer.
media - NICE issues first GP ovarian cancer guidance highlighting four red flags
Detecting ovarian cancer in primary care
• Refer urgently if physical examination identifies a pelvic or abdominal mass and/or ascites.
• Investigate if a woman reports any of the following more than 12 times a month: abdominal distension, difficulty eating and/or feeling full, pelvic or abdominal pain or increased urinary urgency and/or frequency
• Also consider testing woman with abnormal vaginal bleeding, unexplained weight loss, abdominal distension, fatigue or changes in bowel habit.
• Send women with a serum CA125 35 IU/ml for an ultrasound scan and refer with a positive scan urgently for further investigation.
• Advise any woman who has normal serum CA125, or a normal ultrasound, to return to her GP for re-assessment if her symptoms persist or become more frequent.
Source: The recognition and initial management of ovarian cancer, draft NICE guideline, September 2010
Saturday, September 25, 2010
U.S. - Stanford study of program for cancer survivors needs participants
Now, researchers at the Stanford University School of Medicine are looking for participants for a study on the program, which was designed to help people get the most out of life while living with cancer. This study is specifically for patients who have had cancer more than once.
Participants are needed who have had at least two bouts of cancer and have completed major treatment in the past five years. Participants can live anywhere in the United States but need access to a computer with an Internet connection and an e-mail account.
Those who are interested in participating should visit http://cancersurvivors.stanford.edu or e-mail cancersurvivors@stanford.edu.
“Cancer: Thriving and Surviving” is a six-week, Internet-based workshop intended to help people living with cancer deal with their unique problems and concerns, which can include fear of reoccurrence, depression, fatigue and a sense of isolation. Each workshop brings together online about 25 people and is facilitated by two trained moderators — at least one of whom is a cancer survivor, like Gaynor Watson.
The study will assess the workshop’s effectiveness.
The workshop is an adaptation of a chronic-disease-management program developed by Kate Lorig, DrPH, professor emeritus of immunology and rheumatology, that has been shown to be effective at improving health and well-being for participants.
To evaluate this new program, Lorig and colleagues at the University of Hawaii previously enrolled 400 first-time cancer survivors in the cancer course; now the study has been expanded to include patients with a recurring or second cancer.
Gaynor Watson said past participants have benefited from the sense of camaraderie with their online peers and from the ability to communicate with others who relate to what they’re doing. Her hope, she said, is that they also walk away with “a sense of self-empowerment and the skills to live a quality life.”
During the study, survivors will be randomly assigned to participate in a workshop, or to wait six months to take the workshop. Those enrolled in the online program will have access to a Web-based learning center and online discussion boards to address such topics as healthy eating, physical activity, stress and fatigue management, communication and emotional strategies. They’ll be asked to log on two or three times for a total of about two hours each week over the six-week period; all participants will complete two online questionnaires about their health over a six-month period.
The study, which is being conducted in the Stanford Patient Education Research Center, is funded by the Stanford Cancer Center.
Australian women's awareness of ovarian cancer symptoms, risk and protective factors and estimates of own risk - abstract
Blogger's Note: similar studies and public polls over the past few years, irrespective of country, have noted the same results. As in the past, the conclusion/s beg many questions regarding not only funding/donations but the reality of existing campaigns.
Australian women's awareness of ovarian cancer symptoms, risk and protective factors, and estimates of own risk.
Centre for Health Initiatives, University of Wollongong, Wollongong, 2522, Australia, sandraj@uow.edu.au.
Abstract
OBJECTIVE: To examine Australian women's perceived risk of ovarian cancer, reasons for perceived risk levels, and knowledge of ovarian cancer symptoms at two timepoints (2003 and 2007).METHODS: A computer-assisted telephone (CATI) survey of 2,954 Australian women with no history of ovarian cancer was conducted.
RESULTS: Approximately 60% of women perceived their risk of ovarian cancer was similar to other women of their age; 10% indicated an increased risk, and 30% indicated a lower risk. These figures were similar in 2003 and 2007. Logistic regression found that lower income, increased age, being born overseas, and being retired were significantly associated with lower perceived risk (accounted for only 7.5% of the variance). Common reasons for higher perceived risk included family history of ovarian/other cancers, increasing age, and having had other types of cancer or health problems. Reasons for lower than average risk included absence of family history, having a hysterectomy, and having regular Pap smears (indicating confusion between ovarian and cervical cancer). There appeared to be substantial confusion in women's understanding of ovarian cancer symptoms; this was similar in 2003 and 2007.
CONCLUSION: The observed misperceptions and confusion regarding ovarian cancer symptoms and risk factors suggest ongoing public education campaigns are needed to improve knowledge and awareness.
Friday, September 24, 2010
Wednesday, September 22, 2010
Search of: msh2 - List Results - ClinicalTrials.gov
| Found 4 studies with search of: | msh2 |
| 1 | Recruiting | Methotrexate in Metastatic Colorectal Cancer With MSH2 Deficiency
| ||||
| 2 | Recruiting | Study of Genes and the Environment in Patients With Endometrial Cancer in the East Anglia, Oxford, Trent, or West Midlands Regions of the United Kingdom
| ||||
| 3 | Recruiting | Study of Genes and the Environment in Patients With Colorectal Cancer in the East Anglia Region of the United Kingdom
| ||||
| 4 | Recruiting | Anonymous Testing of Pathology Specimens for BRCA Mutations in Ashkenazi Jewish Individuals Who Have Cancer
|
carcinoma vs adenocarcinoma - definitions
Definitions of carcinoma on the Web:
- any malignant tumor derived from epithelial tissue; one of the four major types of cancer
wordnetweb.princeton.edu/perl/webwn - A
carcinoma is any cancer that arises from epithelial cells. Carcinomas
invade surrounding tissues and organs and may metastasize, or spread, to
lymph nodes and other sites.
en.wikipedia.org/wiki/Carcinoma
pathology2.jhu.edu/PANCREAS/agloss.cfm - A
malignancy arising from a tissue that lines a body cavity. Skin, gut,
breasts, prostate are epithelial lining cell cancers and constitute the
most common form of cancers in the human body.
www.sharedexperience.org/Glossary.lasso - A
subtype of cancer that develops from tissues covering or lining organs
or glands of the body, such as skin, colon, lung, or breast. Most of the
cancers are carcinomas. Some cancers that arise from connective tissues
like bone are called sarcomas. ...
medicineworld.org/cancer/descriptions.html - A malignant tumor that begins in the lining layer (epithelial cells) of organs. At least 80% of all cancers are carcinomas.
www.americanbrachytherapy.org/aboutBrachytherapy/glossary.cfm - This term refers to cancer of cells that line various organs. This category is the largest and the most common type of cancer.
www.oncothyreon.com/about/glossary.html
Definitions of adenocarcinoma on the Web:
- malignant tumor originating in glandular epithelium
wordnetweb.princeton.edu/perl/webwn - Any of several forms of carcinoma that originate in glandular tissue
en.wiktionary.org/wiki/adenocarcinoma - The form of cancer that most people are talking about when they
refer to "cancer of the pancreas." These tumors account for 75% of all
pancreas cancers. Microscopically, adenocarcinomas form glands. These
tumors can grow large enough to invade nerves which can cause back pain.
...
pathology2.jhu.edu/PANCREAS/agloss.cfm - Cancerous
cell growth in a glandular or glandlike pattern. This cancer can occur
in various organs and is the most common cancer of the pancreas (also
referred to as adenocarcinoma of the pancreas).
www.gemzar.com/pat/pat930_glossary.jsp
CBC.ca News - Charities paid $762M to private fundraisers
Note: also see blog "BSB4uD", this article focuses on external fundraisers but the focus should be fundraising costs irrespective of source
"If a charity's not going to be transparent with you on how it's spent money in the past, why would you give it a donation?" she asked.
Money paid by charities spending more than 50% of their revenues on external fundraisers, by province, in 2008:
| Province | # of charities | Amount raised ($) | Amount paid to fundraisers ($) | Net revenue for charity ($) |
| B.C. | 38 | 4,976,236 | 3,436,926 | 1,539,310 |
| Alta. | 27 | 19,529,677 | 16,434,884 | 3,094,793 |
| Sask. | 4 | 537,703 | 384,954 | 152,749 |
| Man. | 3 | 561,674 | 307,378 | 254,296 |
| Ont. | 100 | 38,223,556 | 25,024,532 | 13,199,024 |
| Que. | 28 | 8,477,161 | 7,113,096 | 1,364,065 |
| N.B. | 5 | 750,874 | 588,702 | 162,172 |
| N.S. | 2 | 406,617 | 322,806 | 83,811 |
| N.L. | 3 | 118,969 | 88,337 | 30,632 |
| P.E.I. | 4 | 346,448 | 264,157 | 82,291 |
full free access: PLoS Medicine: Seventy-Five Trials and Eleven Systematic Reviews a Day: How Will We Ever Keep Up? Cochrane Collaboration
"To meet the needs of patients, clinicians, and policymakers, unnecessary trials need to be reduced, and systematic reviews need to be prioritised. Streamlining and innovation in methods of systematic reviewing are necessary to enable valid answers to be found for most patient questions. Finally, clinicians and patients require open access to these important resources."
Women with Cancer: Talking Teal with Cancer Advocate Rebecca Esparza
Note: Rebecca can also be found on FB
abstract: Resident Participation Does Not Affect Surgical Outcomes, Despite Introduction of New Techniques
Abstract
BACKGROUND: Surgical operations at academic medical centers typically involve a resident physician performing cases together with, and/or under the supervision of, an attending physician. Although this is a widely accepted practice, recent emphasis on patient safety has led to scrutiny about this educational model. There are few studies evaluating whether complication rates, independent of patient risk factors, are affected by resident participation in operations.STUDY DESIGN: We identified 295 patients (590 breasts) who had undergone bilateral reduction mammoplasty led by a single attending surgeon between October 1, 1997 and September 30, 2008 at the University of Michigan Health System. In all cases, the attending operated on the right breast and the resident operated on the left breast under the supervision of the attending, allowing each patient to act as their own control. Their charts were retrospectively reviewed and major complications were defined as those requiring either an operation or hospitalization to treat.
RESULTS: Twenty-three patients (7.8%) had a major complication after their breast reduction. Ten of these complications occurred in the left breast, 9 in the right breast, and 4 in both breasts. Statistical analysis revealed no differences in major complication rates between the side operated on with the primary surgeon being the resident versus the attending (4.7% versus 4.4%; p = 1.00).
CONCLUSIONS: In the context of this single surgical operation, resident participation does not substantially affect major complication rates. The common residency training paradigm provides clinical experience and supervision without necessarily impacting patient safety. Analysis of additional operations in different settings will be necessary.
ICR (UK) - Lynch Syndrome mutation MSH2 - 60-Year-Old Drug Shows New Promise for Inherited Cancer
"....Methotrexate is similar to a normal molecule called folinic acid, which is required for copying DNA. The drug prevents cells from making and repairing DNA - a process needed for cancer growth. It was one of the first chemotherapy drugs to be invented in the 1940s and is still used to treat a number of cancers today. But until now, it has not commonly been used to treat people with HNPCC.
Professor Alan Ashworth, who led this Cancer Research UK-funded study at the ICR, said: "The MSH2 gene plays a vital role in repairing DNA damage but if it is faulty, mistakes accumulate in cells and increase the risk of cancer developing.
"What's exciting about methotrexate is that it selectively destroys the cells lacking the MSH2 function. This indicates that it may make an excellent treatment for patients with the genetic alteration. With our colleagues at The Royal Marsden Hospital, we have set up clinical trials to test this."...cont'd
A whisper-game perspective on the family communication of DNA-test results: a retrospective study on the communication process of BRCA1/2-test results
"...Unclassified-variants were most frequently misinterpreted by probands and relatives, and had the largest differences between probands' and relatives' perceptions...."
What I wish I'd known before surgery: BRCA carriers' perspectives after bilateral salipingo-oophorectomy (abstract)
"This study illustrates that while health care providers are discussing selected side effects of PBSO, women undergoing this surgery have other concerns that should be addressed..."
Microbubble-enhanced US in Body Imaging: What Role? (abstract)
Note: CE US = contrast enhanced ultrasound
Abstract
Contrast agents for ultrasonography (US) comprise microscopic bubbles of gas in an encapsulating shell. They are unique in that they interact with the imaging process, oscillating in response to a low-intensity ultrasound field and disrupting in response to a high-intensity field. New contrast-specific imaging modes allow US to show exquisite vascularity and tissue perfusion in real time and with excellent spatial resolution. In Europe, Asia, and Canada, to name only the most obvious, characterization of focal liver masses is the first and best established use of contrast-enhanced (CE) US, allowing for the noninvasive diagnosis of commonly encountered liver masses with comparable accuracy to that of computed tomography and magnetic resonance studies. CE US is a preferred modality for the difficult task of diagnosis of liver nodules detected on surveillance scans in those at risk for hepatocellular carcinoma. Newer body applications include the guidance of ablative intervention, monitoring activity of bowel inflammation in Crohn disease, characterization of kidney masses, especially cystic renal cell carcinoma, diagnosis of prostate cancer, and monitoring the response of tumors to antivascular drug therapies. Microbubble contrast agents are easy to use and robust; their use poses no risk of nephrotoxicity and requires no ionizing radiation. CE US plays a vital and expanding role that improves management and patient care.
Home : Nature Genetics re: BRCA 1/breast cancer/ polymorphisms (SNP's - international genome study)
Latest highlights
Advance Online Publication
Genetics of breast cancer
Letter by Antonius AntoniouFergus Couch and colleagues report a genome-wide association study for modifiers of breast cancer susceptibility in BRCA1 mutation carriers with breast cancer and BRCA1 mutation carriers without breast cancer. They identify a locus at 19p13 associated with breast cancer risk in BRCA1 mutation carriers, and replication studies show that this locus associates with estrogen receptor-negative breast cancer in the general population.
Advance Online Publication
Simon Gayther and colleagues report a genome wide association study for ovarian cancer. They identify two new susceptibility loci at 2q31 and 8q24. Separately, Paul Pharoah and colleagues report a genome-wide association study for survival time after diagnosis of epithelial ovarian cancer. They identify a locus at 19p13 associated with susceptibility to the serous subtype of epithelial ovarian cancer.
health media: BRCA1 Breast Cancer Risk Linked To Other Genes
"...People who carry certain mutations of the BRCA1 gene are known to have a higher risk of developing breast cancer.
Couch told the media that their findings should be "useful in helping determine individual risk for breast cancer in BRCA1 carriers".
"It also provides insights into hormone-receptor-negative breast cancer in the general population," he added.
For the study, Couch and colleagues conducted four phases of genome-wide association studies (GWAS) that altogether involved 20 research centers in 10 North American and European countries and Israel.
For the first phase, to identify candidate gene variants, they scanned the genomes of 1,193 carriers of BRCA1 mutations who were under 40 and had invasive breast cancer and compared them to scans of about the same number of controls: BRCA1 carriers of similar age who did not have breast cancer.
In comparing the genomes from the two populations the researchers examined over half a million genetic alterations. They found 96 pieces of DNA called SNPs, or "snips", short for single nucleotide polymorphisms, that they thought would be likely candidates because they differed between the two populations...."cont'd
full free access: eMJA: Pathways to the diagnosis of epithelial ovarian cancer in Australia
Note: excerpts below, the tables included in the paper provide interesting information including patients with borderline tumours, 24% of patients in this study had a prior hysterectomy etc...
Objective:
To describe the diagnostic pathways experienced by a large,
representative group of Australian women with ovarian cancer, and to
document the time between first presentation to a medical professional
and clinical diagnosis.
Conclusions:
Despite anecdotal suggestions to the contrary, most women with ovarian
cancer in Australia are investigated and diagnosed promptly. The
diagnostic process is more protracted for a minority of women, and the
factors we found to be associated with diagnostic delay warrant further
investigation.
"........The numbers of symptoms reported, doctors seen and total doctor visits were all highly skewed. These variables were therefore summarised....."
"........The numbers of symptoms reported, doctors seen and total doctor visits were all highly skewed. These variables were therefore summarised....."
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