Monday, January 02, 2012
Getting Doctors And Patients On The Same Team: A Basketball Metaphor For Health Care - Better Health
....But for the business of medicine, it’s all about the zone.... But what happens when the patients change tactics?.....What if the patient’s psyche or medical issues don’t follow the typical playbook?....So the players become confused.....
Loss of ARID1A protein expression occurs as an early event in ovarian clear-cell carcinoma development and frequently coexists with PIK3CA mutations : Modern Pathology
ARID1A is a recently identified tumor suppressor gene that is mutated in ~50% of ovarian clear-cell carcinomas. This mutation is associated with loss of ARID1A protein expression as assessed by immunohistochemistry. The present study aimed at determining the timing of the loss of ARID1A protein expression during the development of ovarian clear-cell carcinoma and assessing its relevance in correlation to PIK3CA gene mutations......
A Prospective Study of Serum 25-Hydroxyvitamin D (vitamin D) Levels, Blood Pressure, and Incident Hypertension in Postmenopausal Women
authors.....for the Women’s Health Initiative Investigators
In postmenopausal women in this study, serum levels of 25(OH)D were not related to changes in blood pressure, and evidence for an association with lower risk of incident hypertension was weak.
Women of Teal: 4 Years of Blogging -
Thanks to the statistics the Blogger software started keeping in May 2009, I know that my blog has reached far from the Garden State. I have also been read in Germany, Great Britain, Russia, Canada, South Korea, France , the Netherlands, Iran and Australia and I have between 1,500 and 2,200 page views a month.....
Serum HE4 levels are less frequently elevated than CA125 in women with benign gynecologic disorders
Introduction
HE4 is a novel biomarker for ovarian cancer. This study measured HE4 and CA125 levels in women with benign gynecologic disorders.
Serum Levels of the Ovarian Cancer Biomarker HE4 are decreased in Pregnancy and Increase with Age
Objectives:
To establish normal ranges for HE4 serum levels in healthy women.
2013 results to show if bevacizumab (Avastin) prolongs life in ovarian cancer - - media
NEW YORK (Reuters Health) - The coauthor of a study that helped convince the European Commission on Friday to approve bevacizumab (Avastin) as an initial post-surgical treatment for advanced ovarian cancer predicted that some doctors may be reluctant to use the drug until mortality data become available in 2013.......
Sunday, January 01, 2012
Amazon.com: Methods of Cancer Diagnosis, Therapy, and Prognosis: Ovarian Cancer..... (published 2010)
Blogger's Note: available on kindle; new, used
Book Description
Follow-up with CA125 after primary therapy of adva... [Ann Oncol. 2011] - PubMed - NCBI
CONCLUSIONS:
Women should be advised not to have routine CA125 measurements, providing they are well and have no symptoms suggesting relapse. In asymptomatic patients with a rising CA125 level, chemotherapy can be delayed. Earlier stopping of maintenance therapy just because of rising CA125 might deny patients continuing benefit from that therapy. Use of CA125 to define progression could result in platinum-sensitive patients being falsely classified as platinum resistant.
Table of Contents — Dec 2011 - 8th International Symposium on Advanced Ovarian Cancer: Optimal Therapy 4 Mar 2011, Valencia Spain
Blogger's Note: abstracts - subscription req'd ($$$) to access full view symposium articles
- R. C. Bast, Jr Molecular approaches to personalizing management of ovarian cancer Ann Oncol (2011) 22(Suppl 8): viii5-viii15 doi:10.1093/annonc/mdr516
- N. Urban Designing early detection programs for ovarian cancer Ann Oncol (2011) 22(Suppl 8): viii6-viii18 doi:10.1093/annonc/mdr472
- N. F. Hacker Quality control in ovarian cancer surgery Ann Oncol (2011) 22(Suppl 8): viii19-viii22 doi:10.1093/annonc/mdr517 S.
- Kang and S.-Y. Park To predict or not to predict? The dilemma of predicting the risk of suboptimal cytoreduction in ovarian cancer Ann Oncol (2011) 22(Suppl 8): viii23-viii28 doi:10.1093/annonc/mdr530
- N. Katsumata Dose-dense therapy is of benefit in primary treatment of ovarian cancer? In favor Ann Oncol (2011) 22(Suppl 8): viii29-viii32 doi:10.1093/annonc/mdr468
- M. E. L. van der Burg, I. A. Boere, and P. M. J. J. Berns Dose-dense therapy is of benefit in primary treatment of ovarian cancer: contra Ann Oncol (2011) 22(Suppl 8): viii33-viii39 doi:10.1093/annonc/mdr514
- S. Pignata, L. Cannella, D. Leopardo, G. S. Bruni, G. Facchini, and C. Pisano Follow-up with CA125 after primary therapy of advanced ovarian cancer: in favor of continuing to prescribe CA125 during follow-up Ann Oncol (2011) 22(Suppl 8): viii40-viii44 doi:10.1093/annonc/mdr470
- G. J. S. Rustin Follow-up with CA125 after primary therapy of advanced ovarian cancer has major implications for treatment outcome and trial performances and should not be routinely performed Ann Oncol (2011) 22(Suppl 8): viii45-viii48 doi:10.1093/annonc/mdr471
- E. A. Eisenhauer Optimal assessment of response in ovarian cancer Ann Oncol (2011) 22(Suppl 8): viii49-viii51 doi:10.1093/annonc/mdr467
- Michael A. Bookman Update of randomized trials in first-line treatment Ann Oncol (2011) 22(Suppl 8): Viii52-viii60 doi:10.1093/annonc/mdr466
- E. Pujade-Lauraine and J. Alexandre Update of randomized trials in recurrent disease Ann Oncol (2011) 22(Suppl 8): viii61-viii64 doi:10.1093/annonc/mdr518
- R. A. Burger Antiangiogenic agents should be integrated into the standard treatment for patients with ovarian cancer Ann Oncol (2011) 22(Suppl 8): viii65-viii68 doi:10.1093/annonc/mdr529
- M. Markman The use of bevacizumab in the management of ovarian cancer: an argument for single-agent rather than combination therapy Ann Oncol (2011) 22(Suppl 8): viii69-viii71 doi:10.1093/annonc/mdr469
- C. Sessa Update on PARP1 inhibitors in ovarian cancer Ann Oncol (2011) 22(Suppl 8): viii72-viii76 doi:10.1093/annonc/mdr528 K.
- Bell-McGuinn, J. Konner, W. Tew, and D. R. Spriggs New drugs for ovarian cancer Ann Oncol (2011) 22(Suppl 8): viii77-viii82 doi:10.1093/annonc/mdr531
Saturday, December 31, 2011
Gynecologic Oncology : Withdrawal from familial ovarian cancer screening for surgery: Findings from a psychological evaluation study (PsyFOCS)
Highlights
► Previous negative experiences of OC screening might lead women to opt for surgery.
► OC screening may be an interim risk management strategy before opting for surgery.
Gynecologic Oncology : The association between endometriosis and ovarian cancer: A review of histological, genetic and molecular alterations
.... PTEN play a part in the malignant transformation of endometriosis, some studies have revealed TP53 mutations in endometriotic lesions, and mutation of ARID1A (clear cell)
Highlights
► Atypical endometriosis is a transition from benign endometriosis to carcinoma.
► Endometriosis is characterized by genetic instability.
► Oxidative stress, inflammation and hyperestrogenism link endometriosis with cancer.
Gynecologic Oncology : There is no decision to make: Experiences and attitudes toward treatment-focused genetic testing among women diagnosed with ovarian cancer
Highlights
► Women's views regarding genetic testing at diagnosis of ovarian
cancer
► This ‘treatment-focused’ genetic testing is highly acceptable
► Advantages of genetic testing at diagnosis outweigh the disadvantages
► This ‘treatment-focused’ genetic testing is highly acceptable
► Advantages of genetic testing at diagnosis outweigh the disadvantages
Androgen receptor expression is a biological marker for androgen sensitivity in high grade serous epithelial ovarian cancer
Highlights
► Androgen receptor expression correlates with androgen sensitivity in 
ovarian
cancer.
► Androgen receptor expression decreases with chemotherapy.
► Androgen receptor expression is a biomarker for androgen therapy inovarian cancer.
ovarian cancer.► Androgen receptor expression decreases with chemotherapy.
► Androgen receptor expression is a biomarker for androgen therapy in
ovarian cancer.Second Malignancies Among Elderly Survivors of Cancer
Blogger's note: selected text referencing ovarian cancer:
Ovarian Cancer Survivors
Most ovarian cancer patients present with relatively late stage disease, and thus the overall 5-year survival rate is only 46% [1]. However, in women who survive ≥5 years following ovarian cancer, the risk for developing a second malignancy is high, with a 31% higher risk than in the general population [54]. The cancers most often seen after ovarian cancer are breast, colorectal, and bladder cancer and leukemia [55]. Breast and colon cancer are most often seen after ovarian cancer in younger women, largely because of the prevalence of genetic syndromes, such as BRCA mutation and hereditary nonpolyposis colorectal cancer (Lynch Syndrome), that predispose to these tumors and ovarian cancer [27, 29, 55]. Some rare tumors have also been associated with ovarian cancer, including biliary tract cancer and both the ocular and skin variants of malignant melanoma, and are also thought to be a result of genetic syndromes such as BRCA-2 mutation [26, 54, 56].
However, an excess risk for second malignancies has been seen in women diagnosed with primary cancer of the ovary at age 50–69 years as well, and these second cancers appear more likely to be a result of treatment. In particular, the risks for bladder, soft tissue, and bone cancers are substantially higher in women who received radiation, and these risks become most apparent ≥10 years following the initial radiation therapy [54, 57].
The risk with chemotherapy in the development of second cancers is also apparent across all age groups. The risk for the subsequent development of both AML and acute lymphocytic leukemia have been shown to be significantly higher in women following a primary diagnosis of ovarian cancer, even in women aged ≥70 years at the time of their primary diagnosis and in women who did not receive radiation [54]. Historically, this greater risk was attributed to alkylating chemotherapeutic agents, such as melphalan and chlorambucil [32], but these agents have largely fallen out of use in the treatment of ovarian cancer. More recently, platinum-based chemotherapy, which is routinely used in ovarian cancer treatment, has also been associated with a higher late risk for leukemia. This was demonstrated in a large registry case–control study of women who developed leukemia after ovarian cancer. Of note, 71% of patients who developed leukemia were aged ≥60 years at the time of their ovarian cancer diagnosis, whereas 29% were aged ≥70 years [31]......
......Further evidence-based guidelines are needed for early detection and treatment of second malignancies in older adults, and physicians caring for this population should integrate age, health status, projected life expectancy, and patient preferences when deciding upon screening and prevention measures.
......Further evidence-based guidelines are needed for early detection and treatment of second malignancies in older adults, and physicians caring for this population should integrate age, health status, projected life expectancy, and patient preferences when deciding upon screening and prevention measures.
Revisiting the Role of Antiandrogen Strategies in Ovarian Cancer
link to abstract
selected excerpts (in efforts to understand the issues):
Epidemiological Data on Androgens and the Risk for EOC
In women, androgens are mainly synthesized in the adrenal glands, the ovaries, and adipose tissue, and they have an important physiological significance for bone and muscle growth and maintenance as well as cognitive function [1, 5]. There is a growing body of evidence supporting the notion that androgens influence proliferation of the normal ovarian epithelium and are a risk factor for EOC......First, most clinical trials evaluating the use of androgen blockade for the treatment of EOC have been small, nonrandomized studies involving patients with platinum-resistant disease......
Third, most clinical trials assessing anti-AR strategies in EOC have not measured AR expression. The trials that did measure it used IHC, the results of which may not always reflect AR activity in EOC.
Friday, December 30, 2011
Research Papers What Patients Tell Us about Primary Healthcare Evaluation Instruments: Response Form, Bad Questions and Missing Pieces
Blogger's Note: there is a bias in this report (demographics of participants), however, an interesting read and in particular the integrity of the participants as per one quote below
sample:
Bad questions
When asked about questions they did not like, respondents consistently stated they did not like assessing processes occurring in the provider's mind or that they did not directly observe or experience. Almost all questionnaires contained such questions.....Obstetrics/Gynecology articles: The New England Journal of Medicine (2 articles)
SpecialtyObstetrics/Gynecology
original article
December 29, 2011 | R.A. Burger
and Others
and Others
Incorporating bevacizumab in a chemotherapy regimen (7.5 mg/kg every 3 weeks for five or six cycles) and then continuing bevacizumab alone for a total of 12 months of treatment extended progression-free survival in advanced and high-risk earlystage ovarian cancer.
December 29, 2011 | T.J. Perren
and Others
and Others
The addition of bevacizumab to chemotherapy (15 mg/kg for six cycles) followed by extended therapy with bevacizumab every 3 weeks for a total of 15 months of treatment improved progression-free survival by 4 months in incompletely resected stage III or IV ovarian cancer.
Incorporation of Bevacizumab in the Primary Treatment of Ovarian Cancer — NEJM
Blogger's Note: see also the section 'Media in This Article'
Thursday, December 29, 2011
Medical News: ECCO-ESMO: Bevacizumab Safe in 'Real World'
Action Points
- Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.
- Explain that a retrospective study showed a benefit for bevacizumab in patients with recurrent ovarian cancer, similar to benefits seen in prior clinical trials.
- Note that the greatest benefit from bevacizumab was seen in platinum-sensitive ovarian cancer and those receiving second- or third-line treatment in combination with chemotherapy.
Medical News: ECCO-ESMO: Spikes in Liver Enzymes Common in Ovarian Cancer Tx (Trabectedin / Yondelis)
Action Points
- Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.
- Explain that liver transaminase abnormalities in patients with advanced ovarian cancer who received trabectedin did not impact outcomes, including response rate.
- Note that liver transaminase abnormalities were seen in 63% of patients studied.
Medical News: SABCS: Removing Ovaries May Put Bone Health at Risk - in Meeting Coverage, SABCS (cancer prevention/BRCA)
Blogger's Note: note absence of Lynch Syndrome/female cancer prevention
MedPage Today Action Points
- This study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.
- The removal of both ovaries, which is often done as a preventive measure in women at high risk of breast cancer, may increase a younger woman's likelihood of low bone mineral density (BMD) and arthritis.
- The prevalence of arthritis was even higher in women who had their ovaries removed before age 45.
Copy Number Variation Analysis of Matched Ovarian Primary Tumors and Peritoneal Metastasis
Blogger's note: technical
Our study highlights the benefit and importance of performing paired analysis of primary tumors and their metastatic lesions in ovarian cancer. While comparison of primary and metastasis as groups provided insight into cancer development, the matched analysis allowed more specific detection of consistent differences. Indeed advanced disease allows access to not only the primary but also the different metastatic sites. It has been clearly demonstrated that the patients' prognosis relies on tumor residue; therefore it is critical to understand the biology of the metastatic lesions in order to design appropriate new therapeutic approaches. The results presented here should be a step in that direction.
Systematic Immunohistochemistry Screening for Lynch Syndrome in Early Age-of-Onset Colorectal Cancer Patients Undergoing Surgical Resection
This strategy identifies a substantial number of LS patients who would have been missed if genetic testing was based on the Amsterdam II Criteria alone.
Microsatellite Instability in Saliva from Patients with Hereditary Non-polyposis Colon Cancer (Lynch Syndrome) and Siblings Carrying Germline Mismatch Repair Gene Mutations
Saliva testing, a less-invasive procedure than PBL testing, is more sensitive and appears to be a viable alternative for identifying MSI in carriers with MMR mutations.
Two cases of ovarian metastasis of colon cancer
Ovarian tumors were diagnosed as metastasis from colon cancer. Ovarian metastasis of colon cancer is a relatively rare event, but a long-term survival case has been reported by multimodality therapy including surgery.
Patient-Reported Outcomes in Oncology - Center for Medical Technology Policy - survey feedback deadline Jan 30rh, 2012
On May 24, 2011, the project team presented their recommendations at the ISPOR16th Annual International Meeting.
The EGD is available for public comment. Click the following link to download, PRO EGD Final (35), and visit this survey by January 30, 2012 to provide feedback.
For more information, contact Merianne (Tiglao) Spencer.
link to the document - pdf file:
Recommendations for Incorporating Patient-Reported Outcomes into the Design of Clinical Trials in Adult OncologyClinical Care Options - Oncology CME - The Right Care for the Younger Patient: Meeting the Needs of Adolescents and Young Adults With Cancer
Blogger's Note: access is free after registering, slideshow (powerpoint) discusses genetics (eg. BRCA/Lynch Syndrome genes/implications)
Use of Complementary and Alternative Medicine by Cancer Patients at a Montreal Hospital
Conclusion:
Whereas disclosure of natural health products use is occurring, informative CAM discussion is not.
Dec 2011: Journal of Ovarian Research Gene Expression and Pathway Analysis of Ovarian Cancer Cells Selected for Resistance to Cisplatin, Paclitaxel, or Doxorubicin
Background
Resistance to current chemotherapeutic agents is a major cause of therapy failure in ovarian cancer patients, but the exact mechanisms leading to the development of drug resistance remain unclear.Results
A total of 845 genes (p<0.01) were found altered in at least one drug resistance phenotype when compared to the parental, drug sensitive cell line.......Conclusions
Ovarian cancer cells develop drug resistance through different pathways depending on the drug used in the generation of chemoresistance. A better understanding of these mechanisms may lead to the development of novel strategies to circumvent the problem of drug resistance.The complete article is available as a provisional PDF. The fully formatted PDF and HTML versions are in production.
Mucinous Tumors of the Ovary: Diagnostic Challenges at Frozen Section and Clinical Implications
Conclusions
Our study showed a 34% rate of discordance between FS and final diagnosis. Given that 5 cases (7%) were of GI origin, intraoperative assessment of the appendix should be performed in all mucinous ovarian tumors.
Highlights
► We examined 73 consecutive cases of mucinous ovarian tumors that had frozen section (FS) at the time of surgery.
► The rate of discordance between FS and final diagnosis was 34%.
► Consideration of appendiceal tumors is important as 7% of all cancers were found to be gastrointestinal in origin.
► The rate of discordance between FS and final diagnosis was 34%.
► Consideration of appendiceal tumors is important as 7% of all cancers were found to be gastrointestinal in origin.
A phase I study with an expanded cohort to assess the feasibility of intravenous paclitaxel, intraperitoneal carboplatin and intraperitoneal paclitaxel in patients with untreated ovarian, fallopian tube or primary peritoneal carcinoma: A Gynecologic Oncology Group study
Highlights
► The maximum tolerated dose and feasibility of IV and IP chemotherapy was assessed.
► The dose limiting toxicity rate for Paclitaxel 175 mg/m2 IV, carboplatin AUC 6 IP and paclitaxel IP was 35%.
► The dose limiting toxicity rate for Paclitaxel 175 mg/m2 IV, carboplatin AUC 6 IP and paclitaxel IP was 35%.
A randomized phase III clinical trial of a combined treatment for cachexia in patients with gynecological cancers: Evaluating the impact on metabolic and inflammatory profiles and quality of life
Objectives
Gynecological neoplastic disease progression is characterized by specific energy metabolism alterations and by symptoms including fatigue, anorexia, nausea, anemia, and immunodepression, which result in a cachexia syndrome and a marked decrease in patient quality of life (QoL). Therapeutic protocols associated with appropriate and effective psychological and social support systems are essential to counteract the symptoms of neoplastic disease in incurable patients.
Highlights
► Progression of gynecological cancers is characterized by specific alterations of energy metabolism and symptoms that impact quality of life.
► We compared a combined versus a single-agent approach for the treatment of advanced gynecological cancer-associated symptoms.
► Multimodal regimen was more effective in improving both immunometabolic alterations and quality of life in advanced gynecologic cancer patients.
► We compared a combined versus a single-agent approach for the treatment of advanced gynecological cancer-associated symptoms.
► Multimodal regimen was more effective in improving both immunometabolic alterations and quality of life in advanced gynecologic cancer patients.
Brain Metastases from Epithelial Ovarian Carcinoma: Evaluation of Prognosis and Managements - A Taiwanese Gynecologic Oncology Group (TGOG) Study
Conclusions
However, clinicians should keep alert to the neurological complaints of ovarian cancer patients and the patients might benefit from aggressive multimodal treatments.
Highlights
► The clinical characteristics of brain metastases from epithelial ovarian carcinoma.
► To identify prognostic factors and optimal treatment strategy in these patients.
► To identify prognostic factors and optimal treatment strategy in these patients.
ScienceDirect - Gynecologic Oncology : Proceedings from the 9th International Conference on Ovarian Cancer
Blogger's note: requires ($$$) subscription to view
Patterns of first recurrence following adjuvant intraperitoneal chemotherapy for stage IIIC ovarian cancer
blogger's note:
Table 2. Site of first recurrence.
Table 3. Pattern of first recurrence
"In conclusion, patients treated with adjuvant IP chemotherapy appear to have a different pattern of disease recurrence than patients treated with IV chemotherapy. The locations of these recurrences reflect the ability of IP chemotherapy to successfully eradicate disease within the anatomic regions of drug distribution.
Recurrent disease outside the abdominal cavity can be anticipated to occur more frequently in the current era of primary IP chemotherapy.
Further efforts should be aimed at improving IP distribution of chemotherapy to areas that may become disease sanctuaries."
Editorial: Advances in ovarian cancer disease control
"Overall, when one considers the relative mortality to incidence annually, ovarian cancer is the second most lethal among women in the United States. It is estimated that in 2011, there will have been 21,990 new cases diagnosed and 15,460 ovarian cancer deaths [1]. Epithelial ovarian cancers and related malignancies, most predominantly high grade serous tumors, contribute most to this public health care burden [2], and thus will be the focus here. While it is beyond the scope to recognize all recent contributions, the purpose of this editorial is to report on several key advances in disease classification, public health, treatment, detection and prevention and to place these advances in context of pre-existing knowledge......"
A study of symptoms described by ovarian cancer survivors
"There was a marked discordance between questionnaire-reported symptoms and those recorded in hospital notes."
Wednesday, December 28, 2011
JCO Editorial/original article link: Is It Time for (Survivorship Care) Plan B?
Blogger's Note: this study (2) was a breast cancer patient study however the editorial discusses similar efforts in other cancers eg. colorectal
1) Is It Time for (Survivorship Care) Plan B?
2) Evaluating Survivorship Care Plans: Results of a Randomized, Clinical Trial of Patients With Breast Cancer
Eva Grunfeld et alAstraZeneca - AstraZeneca updates on olaparib
AstraZeneca updates on olaparib
"AstraZeneca today (December 20th, 2011) announced that its investigational compound olaparib will not progress into Phase III development for the maintenance treatment of serous ovarian cancer."
Medical News: Mixed Results With (Aflibercept) Eyelea in Ovarian Cancer - in Clinical Context, Ovarian Cancer from MedPage Today
Medical News: Mixed Results With Eyelea in Ovarian Cancer - in Clinical Context, Ovarian Cancer from MedPage Today
Action Points
- The angiogenesis inhibitor aflibercept led to a decreased need for drainage of malignant ascites in patients with advanced ovarian cancer.
- Aflibercept treatment increased the likelihood of fatal bowel perforations in patients whose disease was progressing
2008-2011 most viewed pages: Ovarian Cancer and Us blog
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Tuesday, November 01, 2011
Fiscal Sustainability and the Transformation of Canada's Healthcare System: A Shifting Gears Report
I thought you would be interested in the following page:
Fiscal Sustainability and the Transformation of Canada's Healthcare System: A Shifting Gears Report
This page was sent to you via the The Star iPhone app. Download TheStar from the App Store today, or visit http://www.thestar.com for more great stories.
Sent from my iPhone
Monday, October 03, 2011
Tuesday, September 27, 2011
ovarian cancer - (small sampling) intimate conversations of importance - many repeated over time
- please remember me - call 1-800-GOD
- my (family member) will contact you, please let the group know afterwards of my passing
- why do I have to fight the system and the cancer - it's not fair
- these are my plans for my comfort in passing on and to die on my own terms
- help me save my (family member) - do you know....can you find
- I have arranged my care - my family has been through too much trauma
- I am very scared and lost
- I cannot tell her that I love her, it is not our way - can you pass this letter to her before she dies
- looking for similar horror stories of those who have survived (for my wife)
- don't work too hard..... (in letter written before death but mailed one month later by family member)
- sending two boxes (for others) from God
- this is xxxx's daughter (son) and I regret to inform you
Tuesday, September 20, 2011
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