Sunday, February 26, 2012
WebMD - Future Fertility Fix? Egg-Producing Stem Cells Found in Human Ovaries
"....Scientists say they have found a way to use ovarian stem cells to perhaps one day help infertile women get pregnant -- or add years to a woman’s reproductive cycle.
In a study published in Nature Medicine, researchers report finding egg-producing stem cells in human ovaries. They also report being able to make some of those ovarian stem cells grow into immature eggs that may someday be useful for reproduction.
At this point, such “seed” eggs can’t be fertilized by sperm. But if scientists are able to entice them to mature and can prove they can be fertilized and grow into embryos -- a feat that has been reported in mice -- it would overturn a long-held scientific belief that women can’t make new eggs as they get older.
“What it does is really open a door into human reproduction that 10 years ago didn’t even exist,” says researcher Jonathan L. Tilly, PhD, director of the Vincent Center for Reproductive Biology at Massachusetts General Hospital, in Boston....."
Humoral response to catumaxomab correlates with clinical outcome: Results of the pivotal phase II/III study in patients with malignant ascites. (compared to paracentesis)
Humoral response to catumaxomab correlates with clinical outcome: Results of the pivotal phase II/III study in patients with malignant ascites.
The trifunctional antibody catumaxomab is a targeted immunotherapy for the intraperitoneal treatment of malignant ascites.
In a Phase II/III trial in cancer patients (n = 258) with malignant ascites, catumaxomab showed a clear clinical benefit vs. paracentesis and had an acceptable safety profile. Human antimouse antibodies (HAMAs), which could be associated with beneficial humoral effects and prolonged survival, may develop against catumaxomab as it is a mouse/rat antibody. This post hoc analysis investigated whether there was a correlation between the detection of HAMAs 8 days after the fourth catumaxomab infusion and clinical outcome. HAMA-positive and HAMA-negative patients in the catumaxomab group and patients in the control group were analyzed separately for all three clinical outcome measures (puncture-free survival, time to next puncture and overall survival) and compared to each other. There was a strong correlation between humoral response and clinical outcome: patients who developed HAMAs after catumaxomab showed significant improvement in all three clinical outcome measures vs. HAMA-negative patients. In the overall population in HAMA-positive vs. HAMA-negative patients, median puncture-free survival was 64 vs. 27 days (p < 0.0001; HR 0.330), median time to next therapeutic puncture was 104 vs. 46 days (p = 0.0002; HR 0.307) and median overall survival was 129 vs. 64 days (p = 0.0003; HR 0.433).
Similar differences between HAMA-positive and HAMA-negative patients were seen in the ovarian, nonovarian and gastric cancer subgroups.
In conclusion, HAMA development may be a biomarker for catumaxomab response and patients who developed HAMAs sooner derived greater benefit from catumaxomab treatment.
Cigarette smoking and risk of histological subtypes of epithelial ovarian cancer in the EPIC... - Abstract - UK PubMed Central
"The results from the EPIC study add further evidence that smoking increases risk of mucinous ovarian cancer and support the notion that the effect of smoking varies according to histological subtype."
Ovarian Stem Cells Edge Closer to Reality (CME/CE)
Ovarian Stem Cells Edge Closer to Reality (CME/CE)
(MedPage Today) -- Primitive germline stem cells isolated from human ovaries produced oocytes in vitro, supporting the concept that women continue to produce eggs throughout their reproductive years, investigators reported.....
Medicare's Hospital Web Site Reeks Of The DMV - Forbes
"....You’d like to know the answer to a simple question. “If I ever have a heart attack where should I tell the ambulance to take me?”....
The Language of He’s ('Cancer-Dancer')
http://www.cancer-dancer.org/blog-post/2747/the-language-of-hes/
The Language of He’s:
Him: So, uh, how are you. You know?
He: Pretty good.
Him: So, good?
He: Yeah. I guess. You know.
Him: Considering. Yeah…..And she?
He: Well…that’s. You know how it is.
Him: Hanging in there?
He: Yeah. I guess. Hard to say. What can you do?
Him: Right. You know. We can talk. About it. If you want.
He: Good. Yeah, that’s good.
Him: Yeah. Good. OK. It’s a bitch, right?
He: Yeah. Not much fun, really.
Him: Sucks.
He: That’s for sure.
Him: But what can you do?
He: Right.
Him: So. You handling it?
He: Yeah. I can handle it. Right now I’m handling it.
Him: Alright….Want another?
He: Sure. Why not? I mean….why not?
Some time later, back at the ranch:
Her: So…how is He?
abstract: Controlling angiogenesis in breast cancer: A systematic review of anti-angiogenic trials
Controlling angiogenesis in breast cancer: A systematic review of anti-angiogenic trials
Source: Cancer Treatment Reviews
Purpose
Angiogenesis is critical for tumor growth and a promising therapeutic target. This review will summarize and analyze data from clinical trials of anti-angiogenic agents in the treatment of breast cancer (BC).
Design
A systematic search of PubMed and conference databases was performed to identify reports of randomized clinical trials investigating specific anti-angiogenic agents in the treatment of BC.
Results and discussion
Phase III trials in advanced BC have demonstrated a reduction in the risk of disease progression (22–52%), improved response rates and net improvements in progression-free survival of 1.2 to 5.5 months, but no significant improvements in overall survival with the addition of bevacizumab to chemotherapy. Results of phase III trials in early breast cancer have been inconsistent. Bevacizumab-containing regimens have also been associated with higher overall adverse event rates compared to chemotherapy alone. Phase III trials of the tyrosine kinase inhibitor sunitinib were negative, while randomized phase II trials of sorafenib and pazopanib have improved some outcomes when combined with chemotherapy or targeted therapy compared to controls. In addition to expected vascular class safety signals, tyrosine kinase inhibitors show “off-target” side effects. Ongoing clinical trials evaluating combinatorial strategies based on biological synergies and translational studies identifying biological predictors of response will be crucial to establish meaningful clinical benefits in selected BC populations.
Conclusion
Most trials of anti-angiogenic agents in BC have reported improved response rate and progression-free survival but no increase in overall survival compared to chemotherapy alone. Optimizing the therapeutic indices of these agents is a focus of ongoing research and will be critical to their future development.
Seth's Blog: Stick to what you (don't) know
Stick to what you (don't) know
One of the dumbest forms of criticism is to shout down an expert
in one field who speaks up about something else. The actor with a
political point of view, or the physicist who talks about philosophy.
The theory is that people should stick to what they know and quietly sit
by in all other situations.
Of course, at one point, we all knew nothing. The only way you ever know anything, in fact, is to speak up about it. Outline your argument, support it, listen, revise.
The byproduct of speaking up about what you don't know is that you soon know more. And maybe, just maybe, the experts learn something from you and your process.
No one knows more about the way you think than you do. Applying that approach, combining your experience, taking a risk--this is what we need from you.
Of course, at one point, we all knew nothing. The only way you ever know anything, in fact, is to speak up about it. Outline your argument, support it, listen, revise.
The byproduct of speaking up about what you don't know is that you soon know more. And maybe, just maybe, the experts learn something from you and your process.
No one knows more about the way you think than you do. Applying that approach, combining your experience, taking a risk--this is what we need from you.
Saturday, February 25, 2012
UPDATE: Additional Web sites Selling MMS Sodium Chlorite Solution Not Authorized for Oral Consumption by Humans - Health Canada Advisory 2012-02-23
......Health Canada would also like to remind Canadians that there are no therapeutic products containing sodium chlorite authorized for oral consumption by humans. MMS may cause serious health problems that include poisoning, kidney failure and harm to red blood cells that reduces the ability of the blood to carry oxygen. Additional health problems may also include abdominal pain, nausea, vomiting, and diarrhoea.
Consumers should consult their health care practitioner if they have used or are using MMS products and report any adverse reaction to Health Canada.
Health Canada has notified distributors identified to date that the sale of sodium chlorite for human consumption is in contravention of the Food and Drugs Act. We have also requested that identified distributors remove product from the Canadian market. As such, the websites (www.miracle-mineral-supplement.com and www.mms1.ca) may or may not be operational. (Blogger's Note: the first website is still operational, the second website 'not found' - updated 11:14pm Feb 25th)
Advancing personalized medicine: Tailoring drugs to fit a patient's genetic predisposition
Drug effectiveness on common diseases Not all drugs are equally effective in all patients. Some types of drugs, such as analgesics,
are effective on almost all patients, whereas other types, such as anticancer agents, are effective only on 25% of patients. In working
towards the realization of personalized medicine, it is important to develop ways of using genetic information to prescribe to
patients the most suitable drugs in light of their genetic risk to side effects.
abstract: Incidence of metachronous second primary cancers in Osaka, Japan: update of analyses using population-based cancer registry data
Incidence of metachronous second primary cancers in Osaka, Japan: update of analyses using population-based cancer registry data:
(define: metachronous - Two or more cancers appearing at different points in time.)
Summary
Cancer survivors are at excess risk of developing second primary cancers, but the level of risk is uncertain in Japan.
To investigate the risk of survivors developing second primary cancers, we conducted a retrospective cohort study using data from the Osaka Cancer Registry. Study subjects were all reported cases aged 0-79, who were first diagnosed with cancer between 1985 and 2004 in Osaka and survived for at least 3 months, followed up through December 2005.
A metachronous second primary cancer was defined as any invasive second cancer which was diagnosed between 3 months and 10 years after the first cancer diagnosis.
The main outcome measures were incidence rates per 100,000 person-years, cumulative risk and standardized incidence ratios (SIRs) of second primary cancer. Metachronous second primary cancers developed in 13,385 (3.8%) out of 355,966 survivors after a median follow-up of 2.5 years. Sex-specific incidence rates of metachronous second primary cancer per 100,000 person-years increased with age, and were higher among males than females (except for age 0-49), but these rates did not differ over the study period. The 10-year cumulative risk was estimated as 13.0% for those who first developed cancer in their sixties (16.2% for men, 8.6% for women). The SIRs among those with first cancer at 0-39 years old and 40-49 years old were 2.13 and 1.52, respectively, in both sexes, while the SIRs among cancers of the mouth/pharynx, esophagus and larynx were much higher than one as for site relationships.
We showed that cancer survivors in Osaka, Japan, were at higher risk of second primary cancers compared to the general population. Our findings indicated that second primary cancers should be considered as a commonly encountered, major medical problem. Further study is required to advance our understanding for effective measures against multiple primary cancers.
To investigate the risk of survivors developing second primary cancers, we conducted a retrospective cohort study using data from the Osaka Cancer Registry. Study subjects were all reported cases aged 0-79, who were first diagnosed with cancer between 1985 and 2004 in Osaka and survived for at least 3 months, followed up through December 2005.
A metachronous second primary cancer was defined as any invasive second cancer which was diagnosed between 3 months and 10 years after the first cancer diagnosis.
The main outcome measures were incidence rates per 100,000 person-years, cumulative risk and standardized incidence ratios (SIRs) of second primary cancer. Metachronous second primary cancers developed in 13,385 (3.8%) out of 355,966 survivors after a median follow-up of 2.5 years. Sex-specific incidence rates of metachronous second primary cancer per 100,000 person-years increased with age, and were higher among males than females (except for age 0-49), but these rates did not differ over the study period. The 10-year cumulative risk was estimated as 13.0% for those who first developed cancer in their sixties (16.2% for men, 8.6% for women). The SIRs among those with first cancer at 0-39 years old and 40-49 years old were 2.13 and 1.52, respectively, in both sexes, while the SIRs among cancers of the mouth/pharynx, esophagus and larynx were much higher than one as for site relationships.
We showed that cancer survivors in Osaka, Japan, were at higher risk of second primary cancers compared to the general population. Our findings indicated that second primary cancers should be considered as a commonly encountered, major medical problem. Further study is required to advance our understanding for effective measures against multiple primary cancers.
© 2012 Japanese Cancer Association
abstract: Different Levels of Sialyl-Tn Antigen Expressed on MUC16 in Patients With Endometriosis and Ovarian Cancer
Different Levels of Sialyl-Tn Antigen Expressed on MUC16 in Patients With Endometriosis and Ovarian Cancer
Abstract:
Objective:
Although CA125 antigen is a useful marker for ovarian cancer, its expression is also elevated in endometriosis. The purpose of this study was to develop an assay method for evaluating differentially glycosylated MUC16 (CA125 core protein) in patients with endometriosis and ovarian cancer.
Materials and Methods:
We prepared MUC16-enriched fractions from peritoneal fluid of patients with endometriosis and conditioned medium of ovarian carcinoma-3 cells by gel filtration, and evaluated the expression of sialyl-Lea, Tn, and sialyl-Tn antigens by dot blot analysis. A sandwich enzyme-linked immunosorbent assay was developed to measure the level of sialyl-Tn antigen expressed on MUC16 (sTn/MUC16). The level of sTn/MUC16 was compared between patients with endometriosis (n = 21) and ovarian cancer (n = 36) and in ovarian cancers with different clinical diagnostic criteria. Furthermore, distribution of MUC16 and sialyl-Tn antigen in ovarian cancer tissues was observed immunohistochemically.
Results:
Sialyl-Tn antigen was markedly detectable in the MUC16-enriched fractions from conditioned medium of ovarian carcinoma-3 cells but negligible in those from the peritoneal fluid of the patients with endometriosis. The level of sTn/MUC16 determined by a sandwich enzyme-linked immunosorbent assay was significantly higher in the patients with ovarian cancer than that in the patients with endometriosis (P < 0.001).
An elevated level of sTn/MUC16 was detected in 44% of the patients with ovarian cancer but not all the patients with endometriosis. This level increased more prominently in the patients with ovarian cancer than that of MUC16 as both the clinical stage and cytological grade advanced. An elevated level of sTn/MUC16 was frequently found in the patients with serous and endometrioid carcinomas. Consistent with this, sialyl-Tn antigen was colocalized with MUC16 in serous and endometrioid ovarian cancer tissues.
Conclusions:
Estimation of the sTn/MUC16 level may be useful for discriminating endometriosis from ovarian cancer and for evaluating the clinical stage, cytological grade, and histological type of ovarian cancer.
abstract: Evolution of surgical treatment paradigms for advanced-stage ovarian cancer: Redefining ‘optimal’ residual disease
Evolution of surgical treatment paradigms for advanced-stage ovarian cancer: Redefining ‘optimal’ residual disease
Abstract:
Over the past 40 years, the survival of patients with advanced ovarian cancer has greatly improved due to the introduction of combination chemotherapy with platinum and paclitaxel as standard front-line treatment and the progressive incorporation of increasing degrees of maximal cytoreductive surgery. The designation of “optimal” surgical cytoreduction has evolved from residual disease ≤ 1 cm to no gross residual disease. There is a growing body of evidence that patients with no gross residual disease have better survival than those with optimal but visible residual disease. In order to achieve this, more radical cytoreductive procedures such as radical pelvic resection and extensive upper abdominal procedures are increasingly performed. However, some investigators still suggest that tumor biology is a major determinant in survival and that optimal surgery cannot fully compensate for tumor biology.
The aim of this review is to outline the theoretical rationale and historical evolution of primary cytoreductive surgery, to re-evaluate the preferred surgical objective and procedures commonly required to achieve optimal cytoreduction in the platinum/taxane era based on contemporary evidence, and to redefine the concept of “optimal” residual disease within the context of future surgical developments and analysis of treatment outcomes.
Highlights
► No gross residual disease is associated with superior survival outcomes for patients with advanced-stage epithelial ovarian cancer.► Complete cytoreduction should be the preferred surgical objective at the time of initial surgery for advanced-stage epithelial ovarian cancer.
Outcomes of Patients with Gynecologic Malignancies Undergoing Video-Assisted Thoracoscopic Surgery (VATS) and Pleurodesis for Malignant Pleural Effusion
Outcomes of Patients with Gynecologic Malignancies Undergoing Video-Assisted Thoracoscopic Surgery (VATS) and Pleurodesis for Malignant Pleural Effusion
Background
We evaluated the indications and outcomes of patients with known gynecologic malignancies that underwent video-assisted thoracoscopic surgery (VATS) and pleurodesis for malignant pleural effusion.
Methods
After IRB approval was obtained, a retrospective study of patients with gynecologic malignancies who underwent planned VATS/pleurodesis between 1/2000 and 7/2010 was performed. Abstracted data included demographics, diagnosis, disease status, treatment history, indication for VATS, complications, and outcomes
Results
42 patients (University of Alabama) with a gynecologic malignancy underwent VATS/pleurodesis. Median age was 63 years. 29 patients (69%) had ovarian cancer. 57% had recurrent disease at the time of VATS and 57% were undergoing chemotherapy at the time of VATS. 8 patients (19%) underwent perioperative VATS to improve pulmonary status. 7 patients (17%) underwent a palliative VATS. The median length of stay was 7 days (range 1–53). 62% had gross disease noted at the time of VATS. A mean of 1650 cc of fluid was drained at time of surgery (range 300–4500), and the majority (88%) of patients had a talc pleurodesis performed. 7 patients (17%) were readmitted within 30 days; 6 were for complications unrelated to their VATS............. Patients who underwent a perioperative VATS had the longest survival (845 days).
Conclusion
Patients with gynecologic malignancies may require a VATS/pleurodesis for symptomatic pleural effusions. This procedure appears to be safe and effective in this patient population.
Highlights
► Many patients with gynecologic malignancies will develop pleural effusion► Few studies exclusively evaluate the role of VATS/pleurodesis in gynecologic oncology patients
► VATS/pleurodesis can safely and effectively ameliorate symptoms of recurrent malignant pleural effusion.
Trends in therapy and survival of advanced stage epithelial ovarian cancer patients in the Netherlands
Trends in therapy and survival of advanced stage epithelial ovarian cancer patients in the Netherlands
Objective
The aim of this study was to describe trends in survival and therapy in advanced stage epithelial ovarian cancer (EOC) in the Netherlands and to determine if changes in therapy affected survival.
Methods
All EOC patients diagnosed in the Netherlands during 1989–2009 were selected from the Netherlands Cancer Registry. Differences in treatment over time were tested by the Cochran-Armitage trend test. Multivariable relative survival analyses were performed to test whether changes in treatment are associated with survival.
Results
23,399 EOC patients were diagnosed, of whom 15,892 (67.9%) in advanced stage (stage ≥ 2b).
In advanced stage patients, the proportion receiving (neo-)adjuvant chemotherapy and optimal debulking (residuals < 1 cm) increased over time in all age groups. In elderly patients (≥ 75 years) a stable proportion (approximately 28%) did not receive any treatment.
Five-year relative survival in advanced stage patients increased from 18% in 1989–1993 to 28% in 2004–2009. In the multivariable model survival improved over time (relative excess risk (RER) of 2004–2009 was 0.71, 95% CI 0.67-0.75 compared to 1989–1993). This RER attenuated to 0.85 (95% CI 0.80-0.90) and 0.91 (95% CI 0.83-0.99) with inclusion of treatment variables in the model (surgery with chemotherapy or optimal surgery with chemotherapy, respectively).
This suggests that the improvement was mainly, although not entirely, caused by changes in treatment.
Conclusion
Treatment in advanced stage EOC patients in the Netherlands improved over the last two decades; more patients received (neo)adjuvant chemotherapy and underwent optimal debulking surgery. Changes in treatment led to partial improvement of survival in EOC patients.
Highlights
► Survival in epithelial ovarian cancer patients improved in the last two decades. ► More Dutch patients receive the recommended (optimal) surgery and chemotherapy. ► Changes in therapy explain most but not all of the improved survival in the Netherlands.Diagnostic value of PET/CT is similar to that of conventional MRI and even better for detecting small peritoneal implants in patients with recurrent ovarian cancer.
The present study revealed that PET/CT is similar to conventional MRI for the detection of recurrent ovarian cancer. PET/CT has greater accuracy in the detection of small-to-medium-sized (<2 cm) peritoneal implants compared with MRI. This may affect surgical decision making.
abstract: Epigenetic epidemiology for cancer risk: harnessing germline epigenetic variation (reference to Lynch Syndrome)
Abstract
Genetic epidemiology aims to use the natural variation in the genome, namely single nucleotide polymorphisms and copy number variants to look for associations between particular genotypes and disease risk or prognosis.
Recent work is now aiming to look further into the genome at the natural variation present in the epigenome, in DNA methylation as well as histone modifications, which both regulate gene expression. Epigenetic epidemiology aims to address the same questions about disease risk and prognosis using the normal epigenetic variability. Some examples of rare "epimutations" that can be detected in peripheral blood DNA have been reported in the genes MLH1, MSH2 and IGF2. Other studies have reported increased cancer risk with skewed distributions of the normal pattern in cancer cases compared to controls, showing the promise of harnessing the normal variation in the epigenome. However, some confounding factors need to be considered including the relationship between the epigenome and increasing age and tissue heterogeneity.
Future studies using genome-wide approaches will likely find many more novel epigenetic biomarkers for cancer risk and prognosis.
Recent work is now aiming to look further into the genome at the natural variation present in the epigenome, in DNA methylation as well as histone modifications, which both regulate gene expression. Epigenetic epidemiology aims to address the same questions about disease risk and prognosis using the normal epigenetic variability. Some examples of rare "epimutations" that can be detected in peripheral blood DNA have been reported in the genes MLH1, MSH2 and IGF2. Other studies have reported increased cancer risk with skewed distributions of the normal pattern in cancer cases compared to controls, showing the promise of harnessing the normal variation in the epigenome. However, some confounding factors need to be considered including the relationship between the epigenome and increasing age and tissue heterogeneity.
Future studies using genome-wide approaches will likely find many more novel epigenetic biomarkers for cancer risk and prognosis.
Drug Shortages > Daunorubicin Hydrochloride Solution for Injection (updated 2/24/2012)
"The company cannot estimate a future release date for more product."
Biomarkers in Patients With Previously Untreated Invasive Ovarian Epithelial, Fallopian Tube, or Peritoneal Cancer - Full Text View - ClinicalTrials.gov (GOG-0252)
Purpose
RATIONALE: Studying samples of tumor
tissue, peritoneal cavity fluid, and blood from patients receiving
intraperitoneal chemotherapy may help doctors learn more about the
effects of intraperitoneal chemotherapy on cells. It may also help
doctors identify and learn more about biomarkers related to cancer.
PURPOSE: This research study is studying biomarkers in patients with previously untreated invasive ovarian epithelial, fallopian tube, or peritoneal cancer.
| Condition | Intervention |
|---|---|
|
Fallopian Tube Cancer Ovarian Cancer Primary Peritoneal Cavity Cancer |
Drug: intraperitoneal chemotherapy Genetic: gene expression analysis Genetic: protein analysis Other: flow cytometry Other: immunoenzyme technique Other: immunohistochemistry staining method Other: laboratory biomarker analysis |
France: Search for Predictors of Therapeutic Response in Ovarian Carcinoma - Full Text View - ClinicalTrials.gov
Search for Predictors of Therapeutic Response in Ovarian Carcinoma (miRSa)
This study is currently recruiting participants.
Verified February 2012 by Centre Francois Baclesse
First Received on July 8, 2011. Last Updated on February 23, 2012 History of Changes
Secondary Outcome Measures:
Further study details as provided by Centre Francois Baclesse:
Primary Outcome Measures:
- search for predictors of
response to chemotherapy [ Time Frame: 12 months after beginning
treatment ] [ Designated as safety issue: No ]the search for predictors of response to chemotherapy in patients with carcinoma of the ovary, the fallopian tube or peritoneal serous-type advanced by using (i) the miRNA profile of serum before treatment with chemotherapy and (ii) the identification of polymorphisms or SNPs (Single Nucleotide polymorphism) in particular genes involved in the metabolism of chemotherapy agents
Secondary Outcome Measures:
- profiling miRNA expression [ Time Frame: 1 month ] [ Designated as safety issue: No ]- Characterization of the response to treatment with profiling miRNA expression after the first course of chemotherapy in patients with carcinoma of the ovary, the fallopian tube or peritoneal serous-type advanced
- study of changes in serum miRNA expression [ Time Frame: 6 months ] [ Designated as safety issue: No ]- The study of changes in serum miRNA expression identified as predictive of tumor response during chemotherapy treatment.
Oral Therapies and Food: To Eat or Not to Eat? - Cancer Network
"As the treatment of cancer shifts increasingly more toward oral therapies, patients are now partly responsible for when and how they take their medication. Despite the potential for increased absorption if taken with food, most oncology drug labels warn patients to take the drug while fasting.
Last fall, Dr. Mark J Ratain brought up the issue of increased utilization of oral cancer treatment in the context of patient adherence and optimal utilization in the Journal of Clinical Oncology article, "Flushing oral oncology drugs down the toilet."[1]......
open access: Impact of electronic medical record on physician practice in office settings: a systematic review
Impact of electronic medical record on physician practice in office settings: a systematic review:
The complete article is available as a provisional PDF. The fully formatted PDF and HTML versions are in production.
Background:
Increased investments are being made for electronic medical records (EMRs) in Canada. There is a need to learn from earlier EMR studies on their impact on physician practice in office settings. To address this need, we conducted a systematic review to examine the impact of EMRs in the physician office, factors that influenced their success, and the lessons learned.
Results:
For this review we included publications cited in Medline and CINAHL between 2000 and 2009 on physician office EMRs. Studies were included if they evaluated the impact of EMR on physician practice in office settings. The Clinical Adoption Framework provided a conceptual scheme to make sense of the findings and allow for future comparison/alignment to other Canadian eHealth initiatives.In the final selection, we included 27 controlled and 16 descriptive studies. We examined six areas: prescribing support, disease management, clinical documentation, work practice, preventive care, and patient-physician interaction. Overall, 22/43 studies (51.2%) and 50/109 individual measures (45.9%) showed positive impacts, 18.6% studies and 18.3% measures had negative impacts, while the remaining had no effect. Forty-eight distinct factors were identified that influenced EMR success.
Several lessons learned were repeated across studies:
(a) having robust EMR features that support clinical use;
(b) redesigning EMR-supported work practices for optimal fit;
(c) demonstrating value for money;
(d) having realistic expectations on implementation; and
(e) engaging patients in the process.
Conclusions:
Currently there is limited positive EMR impact in the physician office. To improve EMR success one needs to draw on the lessons from previous studies such as those in this review.
abstract: A Binary Histologic Grading System for Ovarian Serous Carcinoma is an Independent Prognostic Factor: A Population-based Study of 4,317 Women diagnosed in Denmark 1978–2006
A Binary Histologic Grading System for Ovarian Serous Carcinoma is an Independent Prognostic Factor: A Population-based Study of 4,317 Women diagnosed in Denmark 1978–2006
Objective
To evaluate the prognostic significance of histologic grade on survival of ovarian serous cancer in Denmark during nearly 30 years.
Methods
Using the nationwide Danish Pathology Data Bank, we evaluated 4,317 women with ovarian serous carcinoma in 1978–2006. All pathology reports were scrutinized and tumors classified as either low-grade serous carcinomas (LGSC) or high-grade serous carcinomas (HGSC). Tumors in which the original pathology reports were described as well-differentiated were classified as LGSC, and those that were described as moderately or poorly differentiated were classified as HGSC. We obtained histologic slides from the pathology departments for women with a diagnosis of well-differentiated serous carcinoma during 1997–2006, which were then reviewed by expert gynecologic pathologists. Data were analyzed using Kaplan-Meier methods and Cox proportional hazards regression analysis with follow-up through June 2009.
Results
Women with HGSC had a significantly increased risk of dying (HR = 1.9; 95% CI: 1.6–2.3) compared with women with LGSC while adjusting for age and stage. Expert review of 171 women originally classified as well-differentiated in 1997–2006 were interpreted as LGSC in 30% of cases, whereas 12% were interpreted as HGSC and 50% as serous borderline ovarian tumors (SBT). Compared with women with confirmed LGSC, women with SBT at review had a significantly lower risk of dying (HR = 0.5; 95% CI: 0.22–0.99), and women with HGSC at review had a non-significantly increased risk of dying (HR = 1.6; 95% CI: 0.7–3.4).
Conclusions
A binary grading system is a significant predictor of survival for ovarian serous carcinoma.
Highlights
► The histologic diagnosis based on a binary grading system is an independent predictor of survival following ovarian serous carcinoma.► Expert gynecologic pathologists’ review of the histologic diagnosis further confirms the utility of the binary grading system.
abstract: Incidence of and Risk Factors for Postoperative Ileus in Women Undergoing Primary Staging and Debulking for Epithelial Ovarian Carcinoma
Incidence of and Risk Factors for Postoperative Ileus in Women Undergoing Primary Staging and Debulking for Epithelial Ovarian Carcinoma
Objective
Thorough primary cytoreduction for epithelial ovarian carcinoma (EOC) improves survival. The incidence of postoperative ileus (POI) in these patients may be underreported because of varying POI definitions and the evolving, increasingly complex contemporary surgical approach to EOC. We sought to determine the current incidence of POI and its risk factors in women undergoing debulking and staging for EOC.
Methods
We retrospectively identified the records of women who underwent primary staging and cytoreduction for EOC between 2003 and 2008. POI was defined as a surgeon's diagnosis of POI, return to nothing-by-mouth status, or reinsertion of a nasogastric tube. Perioperative patient characteristics and process-of-care variables were analyzed. Univariate analyses were used to identify POI risk factors; variables withP≤.20 were included in multivariate analysis.
Results
Among 587 women identified, the overall incidence of POI was 30.3% (25.9% without bowel resection, 38.5% with bowel resection;P = .002). Preoperative thrombocytosis, involvement of bowel mesentery with carcinoma, and perioperative red blood cell transfusion were independently associated with increased POI. Postoperative ibuprofen use was associated with decreased POI risk. Women with POI had a longer length of stay (median, 11 vs 6 days) and increased time to recovery of the upper (7.5 vs 4 days) and lower (4 vs 3 days) gastrointestinal tract (P < .001 for each).
Conclusions
The rate of POI is substantial among women undergoing staging and cytoreduction for EOC and is associated with increased length of stay. Modifiable risk factors may include transfusion and postoperative ibuprofen use. Alternative interventions to decrease POI are needed.
Highlights
► In this study, 30% of women undergoing EOC debulking had postoperative ileus (POI).► Transfusion was associated with increased POI in a dose–response fashion.
► Postoperative use of ibuprofen decreased the incidence of POI.
abstract: Does vitamin D protect against DNA damage?
Does vitamin D protect against DNA damage?
Source: Mutation Research/Fundamental and Molecular Mechanisms of Mutagenesis
Vitamin D is a secosteroid best known for its role in maintaining bone and muscle health. Adequate levels of vitamin D may also be beneficial in maintaining DNA integrity. This role of vitamin D can be divided into a primary function that prevents damage from DNA and a secondary function that regulates the growth rate of cells. The potential for vitamin D to reduce oxidative damage to DNA in a human has been suggested by clinical trial where vitamin D supplementation reduced 8-hydroxy-2′-deoxyguanosine, a marker of oxidative damage, in colorectal epithelial crypt cells.
Studies in animal models and in different cell types have also shown marked reduction in oxidative stress damage and chromosomal aberrations, prevention of telomere shortening and inhibition of telomerase activity following treatment with vitamin D.
The secondary function of Vitamin D in preventing DNA damage includes regulation of the poly-ADP-ribose polymerase activity in the DNA damage response pathway involved in the detection of DNA lesions. It is also able to regulate the cell cycle to prevent the propagation of damaged DNA, and to regulate apoptosis to promote cell death. Vitamin D may contribute to prevention of human colorectal cancer, though there is little evidence to suggest that prevention of DNA damage mediates this effect, if real.
Very limited human data mean that the intake of vitamin D required to minimise DNA damage remains uncertain.
Postoperative lymphocysts after lymphadenectomy for gynaecological malignancies: preventive techniques and prospects
Postoperative lymphocysts after lymphadenectomy for gynaecological malignancies: preventive techniques and prospects
Postoperative lymphocyst formation is an insufficiently recognised complication of lymphadenectomy for gynaecological malignancies. Lymphocysts are collections of lymph organised into cysts that develop in contact with lymphadenectomy compartments.There has been considerable debate about the relevance of lymphocyst prevention using surgical (eg. surgical mesh/complications.....) or pharmacotherapeutic methods. Here, we review the available studies about the impact of these methods on the incidence of lymphocysts. This review suggests that several techniques may decrease the incidence of lymphocysts when used in combination. On a literature basis, the peritoneum should be left open over the lymphadenectomy sites at the end of the procedure and drains should not be placed at the end of the procedure (infection rates?) . Omentoplasty should be encouraged and further studies are needed to assess the potential benefits of new energies. Postoperative octreotide therapy seems beneficial but the role of this drug in pelvic oncological surgery remains to be determined.
Omentoplasty - o·men·to·plas·ty (
-m
n
t
-pl
s
t
) n.
A surgical procedure in which a portion of the greater omentum is used to cover or fill a defect, augment arterial or portal venous circulation, absorb effusions, or increase lymphatic drainage.
abstract: Prognostic value of elevated preoperative serum CA125 in ovarian tumors of low malignant potential: A multinational collaborative study. (ANZGOG0801)
Prognostic value of elevated preoperative serum CA125 in ovarian tumors of low malignant potential: A multinational collaborative study. (ANZGOG0801)
Objective
Previous studies on prognostic factors in ovarian tumors of low malignant potential (LMP) were too small for robust conclusions. We examined the prognostic impact of preoperative serum CA125 ≥ 50 U/ML levels in patients diagnosed with ovarian LMP tumors in a large multinational cohort.
Methods
This retrospective study included 940 patients with ovarian LMP tumors diagnosed between 1985 and 2008 at six gynecologic cancer centers. Patients either had radical treatment (bilateral salpingo-oophorectomy with or without hysterectomy) or conservative, fertility-sparing treatment. Multivariate Cox proportional hazard models were used to determine independent prognostic factors for disease-free (DFS) and overall survival (OS). Based on receiver operating characteristic curve (ROC), a preoperative serum CA125 level ≥ 50 U/ml was considered “elevated”.
Results
CA125 was more often elevated in serous than in mucinous tumors and in advanced FIGO stages (2 to 4) compared to stage1. DFS at 5 years was 89% and 95% in patients with elevated and normal CA125 levels. Similarly, the 5-year OS was 90% among patients with elevated CA125 compared to 95% among patients with normal levels. For both DFS and OS elevated CA125 levels and advanced stages of the disease were independent prognostic factors. Analysis of subgroups revealed that CA125 was only prognostic in serous LMP tumors.
Conclusions
In the context of serous ovarian LMP tumors, elevated preoperative serum CA125 represents a biomarker independently associated with impaired disease-free and overall survival. CA125 is available in most centers and could inform surgeons about the risk of treatment failure.
Highlights
► CA125 is a known prognostic marker in invasive epithelial ovarian cancer.► Elevated levels are also prognostic in serous borderline ovarian cancers.
Friday, February 24, 2012
abstract: Palliative Care Consultation Service and Palliative Care Unit: Why Do We Need Both?
Background. Palliative care (PC) infrastructure has developed differently around the globe. Whereas some institutions consider the palliative care unit (PCU) a valuable component, others report that the sole provision of a state-of-the art palliative care consultation service (PCCS) suffices to adequately care for the severely ill and dying.
Objective. To aid institutional planning, this study aimed at gathering patient data to distinguish assignments of a concomitantly run PCU and PCCS at a large hospital and academic medical center.
Conclusion. This study presents a direct comparison between patients in a PCU and a PCCS. Results strongly support the hypothesis that the coexistence of both institutions in one hospital contributes to the goal of ensuring optimal high-quality PC for patients in complex and challenging clinical situations."Limitations
Though this is the first study providing the information discussed
above, some limitations have to be considered.
1. Satisfaction of the PC team with patient care is a surrogate
measure. We were unable to provide patient-reported outcomes,
which should be the gold standard when assessing
the quality of PC services [41]. Moreover, the validity of a
one-item five-point grading scale is considerably restricted,
and the findings may be influenced by other circumstances
such as a lack of confidence in the PCCS team outside their
own institution. ....."
abstract: The Stool DNA Test Is More Accurate Than the Plasma Septin 9 Test in Detecting Colorectal Neoplasia (n=30 pts)
Background & Aims
Several noninvasive tests have been developed for colorectal cancer (CRC) screening. We compared the sensitivities of a multimarker test for stool DNA (sDNA) and a plasma test for methylated septin 9 (SEPT9) in identifying patients with large adenomas or CRC.Conclusions
Based on analyses of paired samples, the sDNA test detects nonmetastatic CRC and large adenomas with significantly greater levels of sensitivity than the SEPT9 test. These findings might be used to modify approaches for CRC prevention and early detection.
open access publisher: Hindawi Publishing Corporation
Hindawi Publishing Corporation Hindawi is a rapidly growing academic publisher with more than 300 Open Access journals covering a wide range of academic disciplines.
open access: Review - Fertility-Sparing Surgery in Early Epithelial Ovarian Cancer: A Viable Option?
Epithelial ovarian cancer (EOC) continues to represent one of the most lethal conditions in women in the western countries. With the shifting of childbearing towards higher age, EOC increasingly affects women with active childbearing wish, resulting in major impacts on treatment management.......
According to the 2007 guidelines of the American College of Obstetrics and Gynecology (ACOG), fertility-sparing surgery for reproductive-age patients with invasive EOC is recommended for highly or moderately differentiated stage IA disease with non-clear-cell histology [14]. In an equivalent manner, the European Society for Medical Oncology (ESMO) referring in 2008 to fertility-sparing techniques in EOC identified patients with unilateral stage I tumor without dense adhesions showing favorable histology (i.e., high or moderate differentiated, non-clear-cell histology) as being the optimal candidates for this procedure [15]. However, the number of published studies concerning fertility-sparing surgery in young EOC patients is rather limited and the evaluated patient’s samples too small to allow unanimous consensus regarding the definition of the selection criteria of the optimal candidate for fertility-sparing surgery in stage I EOC. That leads to a broad variety of national guidelines regarding FSS worldwide, especially in respect to Ic (iatrogenic versus not) and/or poorly differentiated disease and to clear cell histologic subtype [16]. Moreover, under additional consideration of the relatively recently emerging dualistic model theory of EOC pathogenesis, which divides EOC in type I and type II disease [17], patients selection for FSS could theoretically be performed under this perspective and hence indicated for early-stage, type I tumors, even though there is currently no evidence that would support such an approach. Open questions remain if there should be differentiation between iatrogenic Ic disease due to intraoperative tumor rupture versus Ic due to tumor on ovarian surface or malignant cells in peritoneal cytology, whether patients with G3 tumors with no evidence of further metastatic disease in adequate staging are eligible of FSS and whether nonserous or non-endometrioid histologic subtypes should be a priori excluded from any organ-preserving technique.......
Table 1:
Relevant case series reports in the literature concerning fertility-sparing surgery in epithelial ovarian cancer: oncologic outcome.
Total patients: 580
Age Ranges: 26–35.9
Cell Type/#'s:
300 (52%) mucinous
51 (9%) serous
128 (22%) clear cell
65 (11%) endometriod
Mean PFS (mo) or 5 y DFS: 33.3–100%
5 y OS: 66.7–100%
Death: 18 (3.1%)
Table 2:
Relevant case series reports in the literature concerning fertility-sparing surgery in epithelial ovarian cancer: reproductive outcome.
Conclusion
After thorough insight of the current literature, FSS in early-stage EOC appears an absolutely viable and safe option for women younger than 40 years who wish to preserve their childbearing potential after careful consideration of histologic subtypes. The optimal indication is referring to stage Ia G1/G2 disease, as well as stage Ic with favorable, that is, non-clear-cell histology. Here there has to be differentiated between iatrogenic—due to intraoperative tumor rupture—versus biologic Ic disease—due to surface involvement or positive Douglas cytology—since the latter is associated with less favorable outcomes after FSS. In case of stage Ic disease and clear cell histology, there is increasing evidence of a poorer relapse-free survival compared to non-clear-cell histology.
For that reason a fertility-sparing approach in this special patients collective should be indicated only after thorough discussion and informed consent of the affected patients with careful balancing of the risks and benefits.
In any case, the treating gynecologic oncologist should be fully aware of his double role in treating the malignant disease as well as in providing oncofertility care to young EOC patients, by considering offering fertility-sparing alternatives when allowed so by tumor stage and histologic differentiation.
NCI Cancer - Clinical Trials Network Aims to Strengthen Cancer Immunotherapy Pipeline
"Later this year, the first clinical trials will be launched under a new NCI-funded initiative to spur the development of cancer treatments that work by revving up the immune system's response to tumors. The Cancer Immunotherapy Trials Network
(CITN) includes the foremost researchers in cancer immunotherapy from 27 top U.S. cancer centers and universities who are working collectively to identify promising agents and to formulate and run the trials in which they will be tested....."
Thursday, February 23, 2012
abstract: Improving Psychological Adjustment Among Late-Stage Ovarian Cancer Patients: Examining the Role of Avoidance in Treatment
Improving Psychological Adjustment Among Late-Stage Ovarian Cancer Patients: Examining the Role of Avoidance in Treatment
Improving Psychological Adjustment Among Late-Stage Ovarian Cancer Patients: Examining the Role of Avoidance in Treatment
Abstract
Data suggest that individuals dealing with a cancer diagnosis are less likely to suffer from depression, anxiety, and psychological distress when they cope with their condition from a stance of emotional and cognitive acceptance (e.g. Dunkel, et al., 1992; Stanton, et al., 2000). Although traditional CBT often includes some acceptance-oriented elements, recent variants of CBT, such as Acceptance and Commitment Therapy (ACT), have acceptance as a central focus. ACT targets emotional distress directly through acceptance of difficult thoughts and emotions.
The current study is a preliminary comparison of ACT and treatment as usual (TAU) in the treatment of emotional distress among women with late-stage ovarian cancer.
Forty-seven women diagnosed with Stage III or IV ovarian cancer were randomly assigned to one of two treatment conditions. Treatment consisted of 12 face-to-face meetings with a therapist, each following a TAU or ACT protocol. Results indicate that both groups showed improved mood and quality of life following the intervention. The ACT group showed significantly greater improvements compared to the TAU group. Furthermore, mediation analyses indicate that the effects of treatment were mediated by cognitive avoidance.
Although the study is limited by the implementation of treatment in both conditions by a single therapist, the TAU group showed improvements that were consistent with effect sizes available in the literature, suggesting that the intervention was a credible and effective control treatment.
These findings provide preliminary support for the use of ACT (Acceptance and Commitment Therapy) in ovarian cancer populations. Further work is needed to investigate the effectiveness in other oncology populations as well as investigate potential patient characteristics which may interact with these interventions.
(BRCA's) Cancer cure hopes as genetic code hereditary breast disease is mapped for first time - media
Cancer cure hopes as genetic code hereditary breast disease is mapped for first time
"....The study also included teams from the Institut Curie in France, the University Medical Centre Utrecht in the Netherlands, The Cancer Research UK London Research Institute in London and the University of Nottingham.
Last week the ICR, writing in the British Journal of Cancer, said all women under 50 who are diagnosed with triple-negative (TN) breast cancer should be screened for the BRCA1 gene fault, which also carries with it an additional high risk of developing ovarian cancer....."
media: 'Cinderella cancers' that doctors miss: Multiple visits to the GP needed for proper diagnosis (re: Lancet Oncology)
'Cinderella cancers' that doctors miss: Multiple visits to the GP needed for proper diagnosis | Mail Online
"...But the study, published in The Lancet Oncology journal, said there were ‘wide variations’ depending on the type of cancer and patient......
The study, which looked at 24 different cancers, comes amid concerns that some patients are not given the best chance of beating the disease because of delays in diagnosis.
The study shows patients with breast, melanoma, testicular and endometrial cancers were more likely to be referred to a specialist after just one or two consultations.
However, those with some less common cancers such as multiple myeloma, pancreatic, stomach and ovarian, as well as those with lung and colon cancers and lymphomas, were more likely to require three or more GP visits....."
Counterfeit drugs: a growing global threat : The Lancet
"The fight against counterfeit drugs must be strengthened without further delay. It needs consensus among all countries and interested parties, and requires wise and bold leadership from WHO. An indispensable goal of the campaign is ensuring the availability of genuine and affordable essential medicines in developing countries."
New Meaningful-Use Rules Stress Online Contact With Patients
New Meaningful-Use Rules Stress Online Contact With Patients:
The proposed rules, which would not take effect until 2014, would require physicians to begin receiving secure messages from patients to earn an EHR bonus — and avoid a Medicare penalty.
Medscape Medical News
National Foundation for Cancer Research Funds Novel Approach to Early Stage Ovarian Cancer - MarketWatch (press release)
National Foundation for Cancer Research Funds Novel Approach to Early ... - MarketWatch (press release):
National Foundation for Cancer Research Funds Novel Approach to Early ...
MarketWatch (press release) The new grant, entitled "SQUID Imaging for Detection of Early Stage Ovarian Cancer," will augment Dr. Bast's ongoing program at The University of Texas MD Anderson Cancer Center with this emerging technology. Dr. Bast is a world leader in the early ... and more » |
Cepmed Launches Online Personalized Medicine Portal for Canadians - media release
Cepmed Launches Online Personalized Medicine Portal: Media Release, Montreal
The Centre of Excellence in Personalized Medicine (Cepmed), announced today that they have launched a web-based Personalized Medicine Portal for Canadians and joined DNA Direct by Medco's Genomic Medicine Network (GMN).
Cepmed's Personalized Medicine Portal (Portal) provides information and decision making tools that will help patients understand how genetic testing can be used to inform treatment decisions and enable better communication between patients and providers. The Portal, available at www.cepmed.com, provides information about access to specific genetic tests in each Province. "Many of the stakeholders have told us that there is a dearth of reliable, evidence based information concerning personalized medicine tests. A centralized source of information about which tests exist, who should take them and how they should be interpreted is what we are offering through our partnership with DNA Direct by Medco. We believe this resource will contribute to improved patient outcomes and savings to the health care system." - Dr. Clarissa Desjardins - CEO, Cepmed.
According to the Personalized Medicine Coalition, there are more than 50 genetic tests currently available that can inform treatment decisions and drug therapy for a wide range of diseases.(i) With the availability of these tests, support and demand for personalized medicine is growing internationally. However, effective integration of personalized medicine into clinical care is challenging. It is widely thought that effective adoption of personalized medicine will require the participation of informed and engaged patients and healthcare providers.
Cepmed plans to use the Portal as a key element of implementation studies in personalized medicine, collaborating with healthcare providers, patient organizations and the public to define how personalized medicine is best applied within the Canadian health care system. These studies will be informed by Cepmed's participation in DNA Direct by Medco's GMN. The GMN brings together leaders in personalized medicine and offers opportunities to establish multi-site studies in genomics, with a particular focus on real-world or implementation studies.
"We are excited about this opportunity to expand our Genomic Medicine Network to include a premier personalized medicine organization in Canada," said Joan Kennedy, President of DNA Direct by Medco. "Cepmed will add a unique perspective and new types of collaboration opportunities across the network."
About DNA Direct
DNA Direct, a wholly owned subsidiary of Medco Health Solutions, Inc. (NYSE:MHS), delivers guidance and decision support for genomic medicine to patients, providers and payers. The company's comprehensive clinical programs are unique to genomic medicine and combine proprietary technology with genetic expertise; including a national call center of genetic experts, web-based applications, and educational resources and training. DNA Direct is based in San Francisco. For more information, visit www.dnadirect.com.About Cepmed
Cepmed is a non-profit organization dedicated to promoting personalized medicine through research, commercialization, and education. Cepmed participates in several public-private partnerships that have funded studies in translational medicine and pharmacogenomics. Cepmed has established expert physician panels in cardiology, oncology, and a multi-disciplinary Strategic Advisory Panel. Cepmed is working with these panels to ensure that personalised medicine is effectively incorporated into routine medical practice, resulting in improved health care in Canada.
Founded by Dr. Jean Claude Tardif at the Montreal Heart Institute, Cepmed makes use of the Beaulieu-Saucier Pharmacogenomics Centre, the Montreal Heart Institute Coordinating Centre (MHICC) and the Montreal Heart Institute Biobank in its projects. It is a Centre of Excellence for Commercialization and Research (CECR) and supported by the Canadian Government and Genome Quebec as well as private partners including Merck, Pfizer, AstraZeneca and Novartis.
(i) "The Case for Personalized Medicine, 3rd Edition", published by the Personalized Medicine Coalition in 2011
Katherine Bonter
Director of Advocacy and Promotion
Centre of Excellence in Personalised Medicine
(514) 670-7658
kbonter@cepmed.com
Whole genome sequencing in health services
Whole genome sequencing in health services:
The rapid development of fast, affordable whole genome sequencing (WGS) technologies is set to bring major changes to clinical and public health practice. The potential benefits within the next few years are significant: improved diagnosis and management of inherited diseases and cancer, and more personalised use of treatments and therapies.
The potential benefits of the new technologies are significant: improved diagnosis and management of inherited diseases and cancer, and more personalised use of treatments and therapies. However,successful delivery of a more efficient and effective system of healthcare using genomics requires:
- Creation of new biomedical informatics expertise within the NHS and building databases that will drive better understanding of which genomic variants affect health.
- Use of targeted forms of genome analysis that minimise unexpected (incidental) findings and telling patients only about medically important information that arises.
- Better understanding of genomic data interpretation among health professionals
The full report is available as a free electronic download at Next steps in the sequence.
Whole genome sequencing overview is also available.
Genetic Information Non-Discrimination Act Charges
Genetic Information Non-Discrimination Act Charges:
The following chart represents the total number of charge receipts filed and resolved under Genetic Information Non-Discrimination. The data are compiled by the Office of Research, Information and Planning from data compiled from EEOC's Integrated Mission System.
Clinical Oncology News - Revamping the NCI Clinical Trials Cooperative Groups
Blogger's Note: to view, register (free)
Clinical Oncology News - Revamping the NCI Clinical Trials Cooperative Groups
Line-up of the NCI Cooperative Groups After Consolidation
- The Cancer and Leukemia Group B Cooperative Group (CALGB), the North Central Cancer Treatment Group (NCCTG) and the American College of Surgeons Oncology Group (ACOSOG) have merged to form The Alliance for Clinical Trials in Oncology.
- The Eastern Cooperative Group (ECOG) and the American College of Radiology Imaging Network (ACRIN) have announced a merger.
- The Southwest Oncology Group (SWOG) will remain independent.
- The National Surgical Adjuvant Breast and Bowel Project (NSABP), the Radiation Therapy Oncology Group (RTOG) and the Gynecologic Oncology Group (GOG) are reportedly forming a confederation, although details are pending.
- The Children’s Oncology Group (COG) is exempt from the consolidation.
Thalomid (Thalidomide) - updated on RxList
Thalomid (Thalidomide) - updated on RxList: Thalomid (Thalidomide) drug description - FDA approved labeling for prescription drugs and medications at RxList
The Medicare Advantage Success Story — Looking beyond the Cost Difference
The Medicare Advantage Success Story — Looking beyond the Cost Difference: New England Journal of Medicine Ahead of Print.
U.S. Medicare - Study calls CMS' CT scan measure inaccurate - Healthcare business news and research | Modern Healthcare
A study in the Annals of Emergency Medicine concludes that a new imaging efficiency measure from the CMS known as OP-15 is not accurate in determining which hospitals perform CT scans under appropriate circumstances.
Editorial: Realizing Genomic Medicine — NEJM
"Although patience is said to be a virtue, it is a commodity that many patients cannot afford, since there is much demand for an immediate clinical return on investment in genomics research. However, biology and health care systems are complex, and it is unrealistic to expect that the march of clinical progress will accelerate at the same rate as technological advances. That said, the advances described in the second Genomic Medicine review series show that genomics has made great strides toward improving human health."
Patients’ experiences and views of an emergency and urgent care system - Knowles - 2011 - Health Expectations
Abstract
Background Surveys of patients’ experiences and views of health care usually focus on single services. During an unexpected episode of ill health, patients may make contact with different services and therefore experience care within an emergency and urgent care system. We developed the Urgent Care System Questionnaire and used it to describe patients’ experiences and views of an emergency and urgent care system in England.
Methods A market research company used quota sampling and random digit dialling to undertake a telephone survey of 1000 members of the general population in July 2007.
Results 15% (151/1000) of the population reported using the emergency and urgent care system in the previous 3 months. Two thirds of users (68%, 98/145) contacted more than one service for their most recent event, with a mean of 2.0 services per event. Users entered the system through a range of services: the majority contacted a daytime GP in the first instance (59%, 85/145), and 12% (18/145) contacted either a 999 emergency ambulance or an emergency department. Satisfaction with all aspects of care diminished when four or more services had been contacted.
Conclusions This is the first study to describe patients’ experiences and views of the emergency and urgent care system. The majority of patients experienced a system of care rather than single service care. There was an indication that longer pathways resulted in lower levels of patient satisfaction. Health care organisations can undertake similar surveys to identify problems with their system or to assess the impact of changes made to their system.
A Rational Approach to the Management of Recurrent or Persis... : Clinical Obstetrics and Gynecology
A Rational Approach to the Management of Recurrent or Persistent Ovarian Carcinoma
THIGPEN, TATE MD
Abstract
Evidence supports the current paradigm for the management of patients with recurrent or persistent ovarian carcinoma. The paradigm requires that patients be classified as platinum-sensitive or platinum-resistant. Patients who achieve a complete response with platinum-based therapy and experience at least 6 months free from recurrence should be categorized as having chemosensitive disease and should be retreated with carboplatin-based doublets. Patients who progress while receiving treatment, whose best response is stable disease, or who experience a complete response of <6 months duration should be categorized as having chemoresistant disease and should be treated with a nonplatinum single agent.
Wednesday, February 22, 2012
Concepts of metastasis in flux: The stromal progression model
Wiki:
In cell biology, stromal cells are connective tissue cells of any organ, for example in the uterine mucosa (endometrium), prostate, bone marrow, and the ovary. They are cells that support the function of the parenchymal cells of that organ. Fibroblasts, immune cells, pericytes, and inflammatory cells are the most common types of stromal cells.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Concepts of metastasis in flux: The stromal progression model: Publication year: 2012
Source: Seminars in Cancer Biology, Available online 21 February 2012
Abstract:
The ability of tumor cells to leave a primary tumor, to disseminate through the body, and to ultimately seed new secondary tumors is universally agreed to be the basis for metastasis formation. An accurate description of the cellular and molecular mechanisms that underlie this multistep process would greatly facilitate the rational development of therapies that effectively allow metastatic disease to be controlled and treated.
A number of disparate and sometimes conflicting hypotheses and models have been suggested to explain various aspects of the process, and no single concept explains the mechanism of metastasis in its entirety or encompasses all observations and experimental findings.
The exciting progress made in metastasis research in recent years has refined existing ideas, as well as giving rise to new ones. In this review we survey some of the main theories that currently exist in the field, and show that significant convergence is emerging, allowing a synthesis of several models to give a more comprehensive overview of the process of metastasis.
As a result we postulate a stromal progression model of metastasis. In this model, progressive modification of the tumor microenvironment is equally as important as genetic and epigenetic changes in tumor cells during primary tumor progression. Mutual regulatory interactions between stroma and tumor cells modify the stemness of the cells that drive tumor growth, in a manner that involves epithelial-mesenchymal and mesenchymal-epithelial-like transitions. Similar interactions need to be recapitulated at secondary sites for metastases to grow. Early disseminating tumor cells can progress at the secondary site in parallel to the primary tumor, both in terms of genetic changes, as well as progressive development of a metastatic stroma.
Although this model brings together many ideas in the field, there remain nevertheless a number of major open questions, underscoring the need for further research to fully understand metastasis, and thereby identify new and effective ways of treating metastatic disease.
abstract: Public attitudes toward cancer and cancer patients: a national survey in Korea
Blogger's Note: very sad findings
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Public attitudes toward cancer and cancer patients: a national survey in Korea.
Psychooncology. 2012 Feb 16;
Abstract
BACKGROUND: Regardless of improved survival rate, negative images and myths about cancer still abound. Cancer stigma may reduce patients' life opportunities resulting in social isolation, decreased level of emotional well-being, and poor health outcomes. This study was aimed to evaluate public attitudes toward cancer and cancer patients and people's willingness to disclose cancer diagnosis in South Korea.
METHODS: A cross-sectional survey was conducted in August and September 2009. A nationally representative sample of 1011 men and women with no history of cancer was recruited. A set of 12 questions grouped into three domains (impossibility of recovery, cancer stereotypes, and discrimination) was used to assess public attitudes toward cancer.
RESULTS: It was found 58.5% of study participants agreed that it is impossible to treat cancer regardless of highly developed medical science, 71.8% agreed that cancer patients would not be able to make contributions to society, and 23.5% agreed that they would avoid working with persons who have cancer. The proportions of people who said that that they would not disclose a cancer diagnosis to family, friends or neighbors, or coworkers were 30.2%, 47.0%, and 50.7%, respectively. Negative attitudes toward cancer were strongly associated with lower willingness to disclose a cancer diagnosis.
CONCLUSIONS: Negative attitudes, stereotypes, and discriminating attitudes toward cancer and people affected by the disease were very common in spite of clinical progress and improved survivorship.
IMPACT: Our findings emphasize the need for health policy and social changes to provide a more supportive environment for cancer survivors.
U.S. FDA - Drug Shortages (sign up for drug shortage email noticiations)
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Drug Shortages
FDA takes great efforts, within its legal authority, to address and prevent drug shortages, which can occur for many reasons, including manufacturing and quality problems, delays, and discontinuations. The agency works closely with manufacturers of drugs in short supply to communicate the issue and to help restore availability. FDA also works with other firms who manufacturer the same drug, asking them to increase production, if possible, in order to prevent or reduce the impact of a shortage.Manufacturers are not required to report information, such as reasons for shortages or the expected duration of shortages. However, many companies voluntarily provide shortage information that FDA posts on its website. FDA encourages and appreciates all reporting of shortages by manufacturers. Shortage notifications and updates may be reported to FDA at drugshortages@fda.hhs.gov.
open access: Cancer in older patients: an analysis of elderly oncology - Is it even possible to define when someone is elderly?
Blogger's Note: (ie. opinion) this paper definitely has some 'language' issues, obviously (?) not patient/consumer reviewed
~~~~~~~~~~~~~~~~~~~~~
Conclusion
The field of onco-geriatrics is
vastly expanding. The demand from older patients is increasing, and is
predicted to continue to expand for the foreseeable future. Life
expectancy has increased, and in turn has patient expectations regarding
the quality of their lives in the latter decades of age. The burden of
oncology in the elderly will need to take a modern approach regarding
the management of these patients. The use of screening and predictive
tools can help make better decisions for these patients. Continued
collaboration between organisations has also helped to develop the
management of these patients; the International Society of Geriatric
Oncology (SIOG) was founded in 2000 with a purpose to advance the art,
science and practice of oncology in elderly patients and maintain a high
common standard of healthcare in elderly patients with cancer [16].
This and other similar steps forward will hopefully bring a more
tailored and higher standard of care to older oncology patients.
abstract: Multivariate analysis of immunohistochemical evaluation of protein expression in pancreatic ductal adenocarcinoma reveals prognostic significance for persistent Smad4 expression only (p53, Smad4, Axl, ALDH, MSH2, MSH6, MLH1 and PMS2)
Abstract
BACKGROUND:
Pancreatic ductal adenocarcinoma (PDAC) has a dismal prognosis with a 5-year survival rate of <5% and an average survival of only 6 months. Although advances have been made in understanding the pathogenesis of PDAC in the last decades, overall survival has not changed. Various clinicopathological and immunohistological variables have been associated with survival time but the exact role that these variables play in relation to survival is not clear.METHODS AND RESULTS:
To examine how the variables affected survival independently, multivariate analysis was conducted in a study group of 78 pancreatic ductal adenocarcinomas. The analysis included clinicopathological parameters and protein expression examined by immunohistochemistry of p53, Smad4, Axl, ALDH, MSH2, MSH6, MLH1 and PMS2. Lymph node ratio <0.2 (p = 0.004), tumor free resection margins (p = 0.044) and Smad4 expression (p = 0.004) were the only independent prognostic variables in the multivariate analysis. Expression of the other proteins examined was not significantly related to survival.CONCLUSIONS:
Discrepancies with other studies in this regard are likely due to differences in quantification of immunohistochemical staining and the lack of multivariate analysis. It underscores the importance to standardize the methods used for the application of immunohistochemistry in prognostic studies.abstract: Use of complementary medications among older adults with cancer - ages 65-91 yrs
The use of
herbal/complementary medications is observed in up to 17% of older
adults with cancer who are receiving chemotherapy. The types of these
agents used in this population may be distinct from those encountered
among older adults in general.
CONCLUSIONS:
Complementary
medication use was reported by 17% of older adults with cancer and was
more common among those who had less advanced disease (i.e., those
receiving adjuvant, potentially curative treatment) and higher
functional status. Further studies are needed to determine the
association between complementary medication use and cancer outcomes
among older adults. Cancer 2012;. © 2012 American Cancer Society.
Search of: ovarian cancer | Open Studies | Exclude Unknown | Interventional Studies - List Results - ClinicalTrials.gov
Found 336 studies with search of: ovarian cancer | Open Studies | Exclude Unknown | Interventional Studies
NCI Cancer Bulletin - Routine Lynch Syndrome Screening Varies at U.S. Cancer Centers
Routine Lynch Syndrome Screening Varies at U.S. Cancer Centers
An enzyme encircles the double helix to repair a broken strand of DNA. Without molecules that can mend such breaks, cells can become cancerous. Mutations in genes that regulate this DNA repair system are a hallmark of Lynch syndrome.(Illustration by Tom Ellenberger, Washington University School of Medicine)
Clinical guidelines developed by several different groups recommend routinely screening tumor samples from patients newly diagnosed with colorectal cancer for genetic markers of Lynch syndrome, although they differ with respect to exactly which patients should be screened (see Table). In the study—published online February 20 in the Journal of Clinical Oncology, and the first to attempt to assess current screening practices for the condition—only 42 percent of the responding centers reported that they conducted any routine screening for Lynch syndrome. Another 16 percent reported that they planned to do so.
NCI-designated comprehensive cancer centers—most of which are large academic medical centers that provide clinical cancer care and perform basic and clinical research—were far more likely than smaller hospitals and community cancer programs to perform this testing, the study showed.
In conducting the NCI-supported study, researchers from the City of Hope Cancer Center and Ohio State University Comprehensive Cancer Center surveyed all 39 NCI-designated comprehensive cancer centers that provide adult oncology care, a random selection of hospital-based cancer centers accredited by the American College of Surgeons, and a randon selection of community-based cancer programs. Of the 24 NCI-designated comprehensive cancer centers that responded to the survey, 71 percent reported that they routinely screened tumor samples from colorectal cancer patients, known as reflex testing. By comparison, only 15 percent of smaller community-based cancer programs reported doing so.
"Like any new practice, routine screening for Lynch syndrome will take time to be widely adopted," said the study's senior author, Dr. Deborah MacDonald of the Division of Clinical Cancer Genetics at City of Hope. "I think it's becoming more common, but it's clearly something that providers and institutions need to become more educated about."
Identifying All at Risk
Also known as hereditary non-polyposis colon cancer, Lynch syndrome is caused by mutations in several genes involved in a DNA repair process called mismatch repair (MMR, see video
). The familial syndrome accounts for 2 to 4 percent of colorectal cancer cases; these and other Lynch syndrome-related cancers typically occur in people aged 50 and younger. (See the related article in this issue.)Identifying Lynch syndrome-related cancers is important for multiple reasons, said Drs. MacDonald and Laura Beamer, the study's lead author. A diagnosis of Lynch syndrome can influence how much of the colon is removed during surgery, and women may opt for a hysterectomy, as well as removal of the ovaries, to reduce the risk of Lynch syndrome-related endometrial and ovarian cancers.
The larger impact, said Dr. Michael Hall, director of the Gastrointestinal Risk Assessment Program at Fox Chase Cancer Center in Philadelphia, may be on post-treatment surveillance for Lynch syndrome-related cancers, and on patients' close family members, who have up to a 50 percent chance of having the condition and may require more intense cancer screening than the general population.
"That's a critical point," said Dr. Hall. "This screening process allows us to identify many more people with an increased cancer risk."
A Complex Undertaking
Testing typically involves one or two different methods—DNA microsatellite instability (MSI) testing and immunohistochemistry (IHC) testing—to identify molecular changes that suggest MMR gene mutations. If these tests detect abnormalities, DNA mutational analyses are typically done to determine whether MMR gene mutations are present.
Just as clinical guidelines differ with respect to exactly which patients should be screened for Lynch syndrome, cancer centers—even the largest centers—differ in how they approach screening, the study found.
Some responding comprehensive cancer centers used the IHC test only, others used the MSI test only, and some used both. At City of Hope, tumor samples from all newly diagnosed patients younger than 60 are screened using the IHC test, with MSI testing performed as well in certain circumstances. At Ohio State, which has been at the forefront of Lynch syndrome screening, all newly diagnosed cases of colorectal cancer, regardless of the patient's age, have been screened using the IHC test since 2006.
"I do anticipate that things will become more uniform in the future as additional studies help elucidate the best, most cost-effective screening protocol," said study co-author Heather Hampel of the Clinical Cancer Genetics Program at Ohio State.
Regardless of a center's size, establishing a process for Lynch syndrome reflex testing is a complicated undertaking, and the process may take a year or longer, noted Dr. Hall. Decisions must be made about how samples will be tested and how positive screening results are communicated to patients. Not surprisingly, smaller centers, which often have fewer resources for laboratory testing or genetic counseling, can have more difficulty establishing a screening program.
And even when reflex testing is performed, there is no guarantee that the intended result, identifying people with Lynch syndrome, will be achieved, Dr. Hall stressed. "A big part of it is how many patients actually come in and get genetic counseling and have the genetic test performed," he said. In a 2009 Ohio State study, for instance, only about one-quarter of patients with suspected Lynch syndrome based on IHC testing made an appointment with a genetic counselor to follow up on the findings.
In an effort to improve the study and establishment of universal screening programs, Ms. Hampel and representatives from three other institutions recently launched the Lynch Syndrome Screening Network
. Network leaders have developed a database to anonymously track screening outcomes, as well as educational materials for cancer programs trying to initiate universal screening, Ms. Hampel said.
Clinical Guidelines on Screening for Lynch Syndrome
| Guidelines | Date | Notes |
|---|---|---|
| Revised Bethesda Guidelines | 2004 | Developed as a result of NCI-sponsored workshops |
| Evaluation of Genomic Applications in Practice and Prevention | 2009 | Recommendations from Centers for Disease Control and Prevention working group |
| National Comprehensive Cancer Network Guidelines on Colorectal Cancer Screening | 2011 | Free registration required |
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