PLoS ONE: Increased Expression of PITX2 Transcription Factor Contributes to Ovarian Cancer Progression (clear cell ovarian/high grade)

PLoS ONE: Increased Expression of PITX2 Transcription Factor Contributes to Ovarian Cancer Progression

"....According to FIGO grading classification, high-grade ovarian tumor cells are usually poorly histological differentiated [20], grow faster and highly metastatic [7]. In addition, prognosis of high-grade ovarian tumor is poor thereafter it often associates with poor survival rate [21], [22].The clear cell subtype ovarian cancer accounts for approximately 6% of all epithelial ovarian tumors and most cases of this subtype are high-grade tumor exhibiting an aggressive phenotype [3], [22], [23]. Our study showed that both mRNA and protein levels of PITX2 was frequently upregulated in ovarian cancer particularly in the high-grade and clear cell subtypes, indicating that PITX2may play an important role in driving aggressive phenotypes in ovarian cancer.....

see blogger's note: Medical News: More Good Data for PARP Blocker (Olaparib) in Ovarian Ca - in Meeting Coverage, ASCO from MedPage Today

Blogger's Note: see blog postings 'olaparib' (searchable) of March 27th and March 8th and others; also use NEJM search for more information on ovarian cancer/Olaparib

Medical News: More Good Data for PARP Blocker in Ovarian Ca - in Meeting Coverage, ASCO from MedPage Today

not yet recruiting: Cyclophosphamide and Vaccine Therapy in Treating Patients With Stage II-III Breast, Ovarian, Primary Peritoneal, or Fallopian Tube Cancer - Full Text View - ClinicalTrials.gov

Cyclophosphamide and Vaccine Therapy in Treating Patients With Stage II-III Breast, Ovarian, Primary Peritoneal, or Fallopian Tube Cancer - Full Text View - ClinicalTrials.gov

This study is not yet open for participant recruitment.

Verified May 2012 by Mayo Clinic

First Received on May 23, 2012.   Last Updated on May 24, 2012   History of Changes

Sponsor:	Mayo Clinic
Information provided by (Responsible Party):	Keith Knutson, Ph.D., Mayo Clinic
ClinicalTrials.gov Identifier:	NCT01606241

Massachusetts Moves to Require End-of-Life Talks

Mass. Moves to Require End-of-Life Talks:
WBUR radio and Kaiser Health News report that the Massachusetts Senate has quietly approved a measure requiring doctors and nurses to discuss end of life options with patients who have a terminal illness. The Palliative Care Awareness bill was included as part of a sweeping health reform measure and, remarkably, was not controversial. It was supported by both Republicans and Democrats and by a wide range of advocacy groups, including leading right-to-life organizations.

pdf: Family perspectives in lynch syndrome becoming a family at risk, patterns of communication and influence on relations

pdf:  Family perspectives in lynch syndrome becoming afamily at risk, patterns of communication andinfluence on relations 

Family perspectives in lynch syndrome becoming a family at risk, patterns of communication and influence on relations

Family perspectives in lynch syndrome becoming a family at risk, patterns of communication and influence on relations

The complete article is available as a provisional PDF. The fully formatted PDF and HTML versions are in production.

 Abstract:
Background: A growing number of individuals are diagnosed with hereditary cancer. Though increased levels of anxiety and depression have been demonstrated around the time of genetic counselling, most individuals handle life at increased risk well. Data have, however, been collected on individual basis, which led us to focus on family perspectives of hereditary cancer.

Methods: Lynch syndrome represents a major type of hereditary colorectal and gynaecological cancer. We preformed open-ended interviews with 27 informants from 9 Lynch syndrome families. Inductive content analysis revealed three major themes: transition to a risk family, patterns of communication and influence on family relations and individual roles.

Results: Family members described how learning about Lynch syndrome shifted focus from daily issues to concerns about cancer. Changes in communication related to difficulties in talking to children about heredity and informing new family members and distant relatives about an increased risk of cancer. Influence on relations was exemplified by family members taking on different roles, e.g. females often being responsible for coordinating information about heredity and providing support. Families in which members had experienced cancer at young age typically informed children soon after learning about heredity and at young age, whereas families with experience of cancer at higher age postponed information and thereby also genetic counselling.

Conclusions: Three major family perspectives are described in Lynch syndrome families; becoming a risk family, patterns of communication and influence on family relations. Since these issues are central, our findings suggests that such family perspectives should be considered during genetic counselling in order to contribute to information spread, help family members cope with the increased risk, and motivate family members at risk to undergo surveillance.

What's Hot at ASCO This Year? (Brentuximab/ovarian cancer/CD30)

What's Hot at ASCO This Year?

".... Another study that builds on a previous breakthrough screened more than 1000 patients with nonlymphoma malignancies for high CD30 expression (Abstract 3069). A drug targeting this molecular defect, brentuximab (Adcetris, Seattle Genetics), has recently been approved for Hodgkin's lymphoma, but the new study found the CD30 defect in patients with mesothelioma and in those with testicular and ovarian cancer. The next step will be to see if these patients respond to the drug, Dr. Vogelzang explained.....

Physician Group Says No to Kittens in Medical Training

Physician Group Says No to Kittens in Medical Training

 The group, the Physicians Committee for Responsible Medicine (PCRM), asked a branch of the US Department of Agriculture (USDA) yesterday to investigate the use of kittens in the center's pediatric residency program. The PCRM said that the medical center is violating the Animal Welfare Act, which governs healthcare facilities that use live animals for research, testing, or training.

Squamous Cell Carcinoma of the Oral Cavity in Nonsmoking Women: A New and Unusual Complication of Chemotherapy for Recurrent Ovarian Cancer? PLD (pegylated liposomal doxorubicin)

Squamous Cell Carcinoma of the Oral Cavity in Non smokingWomen: A New and Unusual Complication of Chemotherapy for Recurrent Ovarian Cancer?

Abstract
Purpose.
To describe occurrences of oral squamous cell carcinoma (SCC) in patients who had received long-term pegylated liposomal doxorubicin (PLD) for ovarian cancer.

Patients and Methods.
In our cohort of patients on maintenance PLD for ovarian and related mullerian epithelial malignancies, we encountered two patients with invasive SCC of the oral cavity (one of them multifocal) and one with high-grade squamous dysplasia. Review of patients at our institution receiving PLD for recurrent ovarian cancer identified three additional patients. The duration of treatment, cumulative PLD dose, human papillomavirus (HPV) positivity, BRCA status, stage at diagnosis, outcome, and other characteristics are reviewed.

Results.
All five cases were nonsmokers with no known risk factors for HPV and four were negative for p16 expression. Four of the patients had known BRCA mutations whereas one tested negative. Cumulative doses of PLD were >1,600 mg/m(2) given over 30-132 months. Three had SCCs staged as T1N0 oral tongue, alveolar ridge (gingival), and multifocal oral mucosa; one had a T2N0 oral tongue; and one had dysplasia. After excision, two were given radiation but recurred shortly thereafter; the others remain well and have had no further exposure to cytotoxic drugs, including PLD.

Conclusion. 
Awareness of this possible long-term complication during PLD treatment should enhance the likelihood of early detection of oral lesions in these patients. Decisions to continue maintenance PLD after complete response of the original cancer should perhaps consider the benefits of delaying ovarian cancer recurrence versus the possible risk for a secondary cancer. 

The finding of oral SCC in patients on long-term PLD
maintenance should alert oncologists to have a high index of
suspicion with any oral complaints that arise, and suggests a
possible need for regular oral examinations in this treatment
population. How long to continue maintenance with PLD after
a CR has been achieved is an unanswered question. The possible
risks to patients receiving maintenance PLD beyond CR
must be weighed against the presumed benefits of delaying
ovarian cancer recurrence on an individual basis.

paywalled: Early Postoperative CT as a Prognostic Biomarker in Patients With Advanced Ovarian, Tubal, and Primary Peritoneal Cancer Deemed Optimally Debulked at Primary Cytoreductive Surgery

Early Postoperative CT as a Prognostic Biomarker in Patients With Advanced Ovarian, Tubal, and Primary Peritoneal Cancer Deemed Optimally Debulked at Primary Cytoreductive Surgery

CONCLUSION:

Our study showed that residual disease larger than 1 cm was present on early postoperative CT in almost half of the patients deemed to have optimally debulked disease at primary cytoreduction.

[Biomarker for colorectal cancer] - Lynch Syndrome/MSI/KRAS/BRAF

[Biomarker for colorectal cancer]

Abstract
Discovery of usable molecular biomarkers is the step closer to a realization of personalized therapy for patients with colorectal cancer(CRC). Herein we present an update of the most recent data on promising biological prognostic and/or predictive markers, including microsatellite instability(MSI) and KRAS/BRAF mutations. Additionally, we propose a new genetic classification for CRC based on MSI and KRAS/BRAF mutation status (a 2 x 3 matrix). The 2 x 3 matrix is constructed of 6 cells that are made by [MSI/non-MSI] x [BRAF mutant/KRAS mutant/wild type of the both genes].

All of CRC including Lynch syndrome could be classified without overlapping into the 6 cells. More interestingly, each cell has each promising biological prognostic and/or predictive feature, which will help clinicians to make personalized treatment strategy for each CRC patient.

paywalled: Management and Prognosis of Clear Cell Borderline Ovarian Tumor.

Management and Prognosis of Clear Cell Borderline Ovarian Tumor.:

Abstract
BACKGROUND: The clear cell borderline ovarian tumor (CCBOT) of the ovary is a rare tumor accounting for less than 1% of BOT. Fewer than 25 cases have been reported in the literature (including details on clinical management and outcomes). The aim of this study was to determine the prognosis of a series of CCBOTs collected in 2 reference centers.
PATIENTS AND METHODS: This was a retrospective review of patients with CCBOT treated or referred to our institutions. A centralized histological review by a reference pathologist and data on the clinical characteristics, management, and outcomes of patients were required for inclusion.
RESULTS: Twelve patients were identified between 2000 and 2010. The median age of patients was 68 years (range, 36-83 years). Two had been treated conservatively and 9 radically (data unknown in 1). The tumor was unilateral in 11 cases. All patients had stage I disease. All cases were CCBOT with an adenofibromatous pattern. Stromal microinvasion or intraepithelial carcinoma was histologically associated in 2 and 3 cases, respectively. Four of the 12 patients had synchronous endometrial disorders (but no endometrioid carcinoma). No cases were histologically associated with endometriosis. Four patients were lost to follow-up. Among 8 other patients, after a median period of 28 months (range, 2-129 months), no recurrence had occurred (1 patient had died of another disease).
CONCLUSION: Clear cell borderline ovarian tumor carries a good prognosis. All tumors are (blogger's note - 'were' in this study of 12 pts) stage I; therefore, surgical staging is not necessary in most of the cases. Conservative treatment could be proposed to young patients, but uterine curettage would then be required in cases of uterine preservation.

paywalled: Comparability of stage data in cancer registries in six countries: lessons from the international cancer benchmarking partnership - Walters - International Journal of Cancer - Wiley Online Library

 
Comparability of stage data in cancer registries in six countries: lessons from the international cancer benchmarking partnership 

Abstract

The International Cancer Benchmarking Partnership is investigating cancer survival differences between six high-income nations using population-based cancer registry data. Differences in overall survival are often explained by differences in the stage at diagnosis and stage-specific survival. Comparing stage at diagnosis using cancer registry data is challenging because of different regional practices in defining stage, despite the existence of international staging classifications such as TNM. This paper describes how stage data may be reconciled for international analysis. Population-based cancer registry data were collected for 2.4 million adults diagnosed with colorectal, lung, breast (women) or ovarian cancer during 1995-2007 in Australia, Canada, Denmark, Norway, Sweden and the United Kingdom. The stage data received were coded to a variety of international systems, including the TNM classification, Dukes' for colorectal cancer, FIGO for ovarian cancer, and to national 'localised, regional, distant” categorisations. To optimise comparability for analysis, a rigorous and repeatable process was defined to produce a final stage variable for each patient. An algorithm was also defined to map TNM, Dukes' and FIGO to a “localised, regional, distant” categorisation. We recommend how stage data should be recorded and processed to optimise comparability in population-based international comparisons of stage-specific cancer outcomes. The process we describe to produce comparable stage data forms a benchmark for future research. The algorithm to convert between TNM and a “localised, regional, distant” categorisation should be valuable for international studies, until global consensus is achieved to adhere to a single staging system like TNM.

Is Renal Thrombotic Angiopathy a Potential Problem in the Chronic Treatment of Ovarian Cancer?

UNC Kidney Center:  thrombotic microangiopathy
                           ~~~~~~~~~~~~~~~~~~

Is Renal Thrombotic Angiopathy a Potential Problem in the Chronic Treatment of Ovarian Cancer?

"Treatments for recurrent ovarian cancer result in clinical
benefit and prolongation of survival times. However, our findings suggest that platinums, PLD (in large cumulative doses), bevacizumab, and possibly gemcitabine may result in cumulative kidney damage. Awareness of these long-term complications should open the way for studies on treatment strategies designed to minimize renal complications."

Abstract

Abstract Background and Objective

Ovarian cancer is usually diagnosed at an advanced stage, with most patients undergoing surgery followed by platinum- and taxane-based chemotherapy. After initial clinical remission, the majority recur, leading to additional treatments, including not only platinums and taxanes but also pegylated liposomal doxorubicin (PLD), gemcitabine, topotecan, and, more recently, bevacizumab, which may extend survival times. PLD, in particular, has been extensively studied by our group, with encouraging therapeutic results. We, however, observed instances of chronic kidney disease (CKD) developing among patients who received long-term treatment for recurrent ovarian cancer. To document the frequency and contributing factors to the emergence of CKD, we initiated a retrospective review at two institutions.

(Kidney damage was defined by pathologic abnormalities
or markers of damage, including abnormalities on blood
and urine tests and radiologic studies.)

Patients and Methods. 

Fifty-six consecutive patients with recurrent ovarian cancer receiving treatment at New York University Cancer Institute were reviewed for the presence of renal disease in 1997–2010. At Shaare Zedek Medical Center, 73 consecutive patients with ovarian cancer were reviewed in 2002–2010. Patients were diagnosed with CKD if they had an estimated GFR <60 mL/minute per 1.73 m² for >3 months and were staged according to the National Kidney Foundation guidelines.

Results. 

Thirteen patients (23%) developed stage ≥3 CKD. Three patients had renal biopsies performed that showed thrombotic microangiopathy. 

Conclusions. 

CKD (chronic kidney disease) is emerging as a potential long-term consequence of current chemotherapy for recurrent ovarian cancer.

• Chronic kidney disease
• Ovarian cancer
• Pegylated liposomal doxorubicin
• Renal thrombotic microangiopathy

PLoS ONE: The KRAS-Variant Is Associated with Risk of Developing Double Primary Breast and Ovarian Cancer (study of pts with both ovarian and breast cancers)

Blogger's Note: the other cancers (KRAS mutations) referred to beyond ovarian and breast cancers include references to lung and melanoma cancers; KRAS mutations have been established in colorectal cancers, however, there are no references on this particular subject within this research article regarding Lynch Syndrome -
an ongoing area of specific research (re: KRAS/Lynch Syndrome/blog posting of May 16, 2012 Jnl ASCP)
                                      ~~~~~~~~~~~~~~~~~~~
PLoS ONE: The KRAS-Variant Is Associated with Risk of Developing Double Primary Breast and Ovarian Cancer


Table 1. The KRAS-variant is significantly associated with uninformative breast and ovarian cancer patients.
doi:10.1371/journal.pone.0037891.t001

Purpose

A germline microRNA binding site-disrupting variant, the KRAS-variant (rs61764370), is associated with an increased risk of developing several cancers. Because this variant is most strongly associated with ovarian cancer risk in patients from hereditary breast and ovarian families (HBOC), and with the risk of premenopausal triple negative breast cancer, we evaluated the association of the KRAS-variant with women with personal histories of both breast and ovarian cancer, referred to as double primary patients.

Conclusions

These findings further validate the importance of the KRAS-variant in breast and ovarian cancer risk, and support the association of this variant as a genetic marker for HBOC families previously considered uninformative.

Introduction 

Hereditary breast and ovarian cancer (HBOC) syndrome is an inherited cancer-susceptibility syndrome marked by an increased risk of developing both ovarian cancer and breast cancer [1]. Families generally considered as having HBOC syndrome are those with multiple family members that have one of these cancers, especially at young ages, or an individual with a cancer in both organs, a “double primary” patient. While this is a relatively rare presentation, a substantial number of women develop both breast and ovarian primaries over their lifetime. While BRCA1 and BRCA2 are strongly associated with HBOC syndrome [2], a large number of HBOC families and women with double primary cancer do not have detectable genetic mutations (herein referred to as “uninformative” patients).
The chances of identifying a mutation causative for HBOC increase when testing individuals diagnosed with double breast/ovarian primaries [3]–[5]. However, a recent report suggests that the rates of BRCA mutations are not higher in a patient with a double primary without a family history than that for isolated first degree relative pairs with single primaries (14% versus 17% with mutations, respectively) [4]. This supports the importance of family history even in patients with double primary cancers. Although BRCA mutations were found in 49% of double primary patients in this recent analysis, it should be noted that this indicates that over half of double primary patients do not have a known genetic cause for their disease. This is consistent with other reports of these patients [3], [5].............The goal of this study was to determine the association of the KRAS-variant with women with double primary breast and ovarian cancer, to further validate the association of this variant with HBOC families. Findings here support the importance of the KRAS-variant in uninformative HBOC families as well as in predicting the risk of multiple primary cancers in women.......

Association of the KRAS-variant with Multiple Cancers in All Patients

Because the KRAS-variant has been found to be associated with an increased risk for other cancers besides breast and ovarian cancer [11], [15] we tested the hypothesis that the KRAS-variant would predict for an increased risk of developing additional cancers in this double primary cohort, regardless of BRCA mutation status. For 183 of the patients in our study where this information was available, 79.2% (n = 145) had reported just the two cancers (breast and ovarian), 12.0% (n = 22) had two separate primary breast cancers and also ovarian cancer, and 8.7% (n = 16) had cancer in an additional organ outside of the breast and ovary (triple primary).

Full-Exon Pyrosequencing Screening of BRCA Germline Mutations in Mexican Women with Inherited Breast and Ovarian Cancer

Full-Exon Pyrosequencing Screening of BRCA Germline Mutations in Mexican Women with Inherited Breast and Ovarian Cancer:


Hereditary breast cancer comprises 10% of all breast cancers. The most prevalent genes causing this pathology are BRCA1 and BRCA2 (breast cancer early onset 1 and 2), which also predispose to other cancers. Despite the outstanding relevance of genetic screening of BRCA deleterious variants in patients with a history of familial cancer, this practice is not common in Latin American public institutions. In this work we assessed mutations in the entire exonic and splice-site regions of BRCA in 39 patients with breast and ovarian cancer and with familial history of breast cancer or with clinical features suggestive for BRCA mutations by massive parallel pyrosequencing. First we evaluated the method with controls and found 41–485 reads per sequence in BRCA pathogenic mutations. Negative controls did not show deleterious variants, confirming the suitability of the approach. In patients diagnosed with cancer we found 4 novel deleterious mutations (c.2805_2808delAGAT and c.3124_3133delAGCAATATTA in BRCA1; c.2639_2640delTG and c.5114_5117delTAAA in BRCA2). The prevalence of BRCA mutations in these patients was 10.2%. Moreover, we discovered 16 variants with unknown clinical significance (11 in exons and 5 in introns); 4 were predicted as possibly pathogenic by in silico analyses, and 3 have not been described previously. This study illustrates how massive pyrosequencing technology can be applied to screen for BRCA mutations in the whole exonic and splice regions in patients with suspected BRCA-related cancers. This is the first effort to analyse the mutational status of BRCA genes on a Mexican-mestizo population by means of pyrosequencing.

How Much Weight Should Anecdotes Really Have In Health Policy?

How Much Weight Should Anecdotes Really Have In Health Policy?:
By D. Brad Wright

There’s something compelling about the personal narrative that vast mountains of quantitative data cannot rival. Anecdotes are, quite simply, powerful. They tap into our shared humanity, making something seem somehow more real by putting a face on it. This is why, if you follow politics for very long, you will find numerous cases of policymakers championing issues that have touched their own lives in some way. For example, Senator X doesn’t care about issue Y, until they discover that their son or daughter is affected by it. Then, almost overnight, they seem to care more about issue Y than almost anything else. Such a shift is completely understandable, but often out of proportion to the true scale of the issue in society.

In health policy, the personal narrative can also be very powerful. In fact, the journal Health Affairs routinely runs a “Narrative Matters” section that puts a face on the health care issues of the day. It is absolutely critical that health policymakers, health services researchers, and others, not lose sight of the fact that their work and the subsequent decisions it informs, are based on real people. However, it is equally critical for objectivity to be maintained, and narrative can threaten our work in this regard.......

Surgical site infection prevention: a survey to identify the gap between evidence and practice in University of Toronto teaching hospitals - Can J Surg. 2012 Jun 1

Blogger's Note: surgical site infections safety checklist: WHO (World Health Organization) program in patient safety

Surgical site infection prevention: a survey to identifythe gap between evidence and practice in University of Toronto teaching hospitals

 "Surgical site infections (SSIs) are the most common
complication following surgery, with reported rates
ranging from 5% to 30%.1 The attributable morbidity
and mortality is significant, with patients who experience
SSIs being 60% more likely to spend time in the
intensive care unit, 5 times more likely to be readmitted to
hospital and twice as likely to die than patients without
SSIs.2 Whereas many risk factors for the development of
SSIs are related to patient characteristics that cannot be easily
modified, there are a variety of system or hospital factors
that can be manipulated. These include improper selection
and administration of antibiotic prophylaxis, intraoperative
hypothermia and intraoperative hyperglycemia.3
Despite clear evidence and guidelines to direct SSI prevention
strategies, compliance is uniformly poor......

paywalled: The risk of metachronous cancers in patients with small-intestinal carcinoid tumors: a US population-based study

 Blogger's Note: while rare, and there is no specific reference in this abstract, carcinoid ovarian cancer tumors do exist so this research will be of interest for those diagnosed, this blog has some research on ovarian carcinoid tumors

The risk of metachronous cancers in patients with small-intestinal carcinoid tumors: a US population-based study

"In conclusion, almost one-third of patients with SICs have an associated metachronous primary tumor. When these primaries occur prior to (but not after) the SIC diagnosis, the prognosis is worse than with an initial SIC. The type of malignancies associated with SICs may guide future screening efforts.."

paywalled: Evolutionary Pathways in BRCAl-Associated Breast Tumors

Evolutionary Pathways in BRCAl-Associated Breast Tumors

Abstract

BRCAl-associated breast tumors display loss of BRCA1 and frequent somatic mutations of PTEN and TP53. Here we describe the analysis of BRCA1, PTEN, and p53 at the single cell level in 55 BRCA1-associated breast tumors and computational methods to predict the relative temporal order of somatic events, on the basis of the frequency of cells with single or combined alterations. Although there is no obligatory order of events, we found that loss of PTEN is the most common first event and is associated with basal-like subtype, whereas in the majority of luminal tumors, mutation of TP53 occurs first and mutant PIK3CA is rarely detected. We also observed intratumor heterogeneity for the loss of wild-type BRCA1 and increased cell proliferation and centrosome amplification in the normal breast epithelium of BRCA1 mutation carriers. Our results have important implications for the design of chemopreventive and therapeutic interventions in this high-risk patient population.

SIGNIFICANCE: Defining the temporal order of tumor-driving somatic events is critical for early detection, risk stratification, and the design of chemopreventive therapies. Our combined experimental and computational approach reveal that the loss of wild-type BRCA1 may not be the first event in the majority of BRCA1-associated breast tumors and may not be present in all cancer cells within tumors.  

Cancer Discov; 2(6); 1–9. ©2012 AACR.

Bionomics launches ovarian cancer trial - BNC105 Australia/U.S. (134 women/18 locations)

Bionomics launches ovarian cancer trial - clinical trials, cancer, Bionomics, Biotechnology - Australian Life Scientist

Bionomics (ASX:BNO) has launched a clinical trial of its BNC105 cancer treatment candidate in women with ovarian cancer.

The Phase I/II trial will involve up to 134 women across 18 sites in Australia, New Zealand and the US.

In Australia, the trial be conducted by the Australian and New Zealand Gynaecological Oncology Group in conjunction with the National Health and Medical Research Council Clinical Trials Centre.

Patients will receive BNC105 in conjunction with standard chemotherapy drugs carboplatin and gemcitabine......

Interval colon cancer in a Lynch syndrome patient under annual colonoscopic surveillance: a case for advanced imaging techniques? (including Lynch Syndrome background information/research)

 Blogger's Note: worth reading even for those without colorectal cancer but with a familial interest in Lynch Syndrome cancers, discusses research on surveillance timing, discordance in mutation carriers, risk variances (% risk) etc...

Background
Lynch syndrome confers increased risk for various malignancies, including colorectal cancer.
Colonoscopic surveillance programs have led to reduced incidence of colorectal cancer and reduced mortality from colorectal cancer. Colonoscopy every 1–2 years beginning at age 20– 25, or 10 years earlier than the first diagnosis of colorectal cancer in a family, with annual colonoscopy after age 40, is the recommended management for mutation carriers. Screening programs have reduced colon cancer mortality, but interval cancers may occur.

Lynch syndrome is defined as the presence of a germline mutation in a DNA mismatch repair gene [1]. Mutation carriers have increased risk for various malignancies, including carcinomas of the colorectum (CRC), endometrium, ovary, small bowel, stomach, biliary tract, bladder, ureter and renal pelvis [2].

Interval colon cancer in a Lynch syndrome patient under annual colonoscopic surveillance: a case for advanced imaging techniques?

"This report highlights several features of Lynch syndrome. First, individuals carrying deleterious mutations in a DNA mismatch repair gene (MLH1, MSH2, MSH6, PMS2) deserve annual colonoscopic examinations with a careful search for, and removal of, all mucosal lesions. Second, adenoma is the precursor lesion for CRC in Lynch syndrome.....

CancerGEM KB|Home - searchable database/online resource

Blogger's Note: see the results of the search using 'Lynch Syndrome' as a test per example below:

CancerGEM KB|Home


About CancerGEM KB
CancerGEM KB is a continuously updated searchable online resource that provides access to scientific information on the use of genomic information in cancer care and prevention. more

---

Search CancerGEM KB




162 abstracts in HuGE published Literature

No GWAS/meta-analysis entry

1 evidence review/recommendation entries

1 genomic tests in transition to practice 

Office of Public Health Genomics/CDC launches the CancerGEM KB : CDC Office of Public Health Genomics in collaboration with NCI Division of Cancer Control and Population Sciences launches the CancerGEM KB: CancerGEM KB is an online resource for researchers, public health professionals, policy makers, and health care providers interested in the use of genomic information in cancer care and prevention. CancerGEM KB provides objective synthesis and timely dissemination of information on cancer human genome epidemiology (genetic associations, gene-environment interactions and gene prevalence information) and aggregated evidence on cancer genomic tests in transition to clinical and public health practice. CancerGEM KB also offers summary information on Genomic Tests through PLoS Currents Evidence on Genomic Tests, an open-access journal for systematic reviews and structured short summaries of evidence for the validity and utility of genetic tests. Read more about CancerGEM KB

 

Changing Roles and Responsibilities for Caregivers - free telephone workshop NCI June 19th

 The  Tenth Annual Cancer Survivorship Series:
Living With, Through & Beyond Cancer 

On Tuesday, June 19th, CancerCare, in collaboration with the National Cancer Institute: Office of Cancer Survivorship and Office of Communications and Education, LIVESTRONG, American Cancer Society, Intercultural Cancer Council, Living Beyond Breast Cancer and National Coalition for Cancer Survivorship, will present a free, telephone workshop entitled: Changing Roles and Responsibilities for Caregivers. You can listen to this program on the telephone or via live streaming through the internet.

This workshop is the third of a four-part series.  This free series is made possible by support from the National Cancer Institute and LIVESTRONG and offers cancer survivors, their families, friends and health care professionals practical information to help them cope with concerns that arise after treatment ends.   

The faculty for this program includes:

• Suzanne Martz-Dones, RN, MA, CCRN, NE-BC, Caregiver Perspective, Administrative Nurse Manager, Mount Sinai Hospital

• Barbara A. Given, PhD, RN, FAAN, University Distinguished Professor, Associate Dean for Research and Doctoral Program, College of Nursing, Michigan State University

• Stewart B. Fleishman, MD, Founding Director, Cancer Supportive Services, Continuum Cancer Centers of New York: Beth Israel & St. Luke's-Roosevelt

The fourth and final workshop of the series - Managing Post-Treatment Neuropathy - will take place on July 17th.  

These workshops are free – no phone charges apply.  However, pre-registration is required.  To register, and for more information, simply go to the CancerCare website, www.cancercare.org/connect.
If you missed Parts I or II of the series, they are available as podcasts, 24 hours a day, 7 days a week: 

Part I: Using Mind/Body Techniques to Cope with the Stress of Survivorship

Part II: Recapturing Joy and Finding Meaning
We are very excited to offer this telephone workshop series to you. We hope that you will join us and that you will share this information with your patients and colleagues.  

Old drug (Thioridazine) could have new use as cancer stem cell destroyer | CTV News

Old drug could have new use as cancer stem cell destroyer | CTV News

.....Thioridazine is known to work as a psychiatric and Parkinson's medication by targeting receptors in the brain for dopamine, which is a neurotransmitter that plays a variety of roles in the brain.
It turns out that leukemia cells (and other cancer types including ovarian) have a dopamine receptor on their surfaces too — making them vulnerable to the drug. The drug doesn't kill these cancerous stem cells, but rather encourages them to become normal again.
The team's research is published in the science journal, Cell.

.....The next step is to test thioridazine in clinical trials on cancer patients. The first study will focus on 30 patients with acute myeloid leukemia, or AML, whose disease has relapsed after chemotherapy.....

"By targeting the rare population of cells that seed, that drive the cancer, what we are hoping with the drug is to eliminate those cells and prevent patients from getting sick again," he says.

While researchers are excited, there are some concerns about side effects. Thioridazine was once widely used as a psychiatric medication, but its use has been curtailed after studies showed it can lead to heart and eye problems in patients taking it long term.
Health Canada took thioridazine off the market in Canada in 2005 after reports it could boost the risk of rare but potentially fatal changes in heart rhythm. Those problems happened only in patients who took the drug daily for more than two years. Bhatia says that for the cancer study, the drug would be used in low doses for about 20 to 30 days, much like standard chemotherapy.

A note of caution – many drugs that show effects in the lab may not work in people, so this is an exciting but very preliminary finding, say doctors.

Read more: http://www.ctv.ca/CTVNews/TopStories/20120524/thioridazine-cancer-drug-stem-cell-120524/#ixzz1vrcRskoW

Cancer Resources | OncoLink - The Web's First Cancer Resource

Cancer Resources | OncoLink - The Web's First Cancer Resource
 

 You may have come to OncoLink searching for information for your friend or family member who has a diagnosis of cancer. At the same time you may be wondering about your own risk of cancer. Why them? Could it be me? What can I do differently to lower my risk of developing cancer?

What's My Risk? is a comprehensive program designed to help the user learn about factors that determine their personal risk of many types of cancer and what they can do to decrease that risk.

We collect the answers people provide to be used in future development of the program and research related to use of such a program. Your use of the program is completely voluntary. We will not ask you for any personally identifiable information. We collect internet protocol (IP) addresses (a numerical label assigned to each device (e.g., computer, printer) in a computer network using the Internet) in order to remove duplicate entries from our data analysis. However, the IP address is removed from the data after duplicates are removed and is not linked to the responses of a user. If you choose to email your report to yourself, be advised that we do not store your email address or use it for anything other than delivering the report. Because of this, we cannot respond to any questions submitted in the user satisfaction survey at the end of the program. If you require assistance, please:

• visit our contact page or
• send us your comment or question.

Due to the sensitive nature of the medical information provided in this tool, this program is meant for use only by persons over the age of 18.

 What's My Risk? Questionnaire

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Ovarian reserve and response to IVF and in vitro maturation treatment following chemotherapy.

Ovarian reserve and response to IVF and in vitro maturation treatment following chemotherapy.

Hum Reprod. 2012 May 22;


Abstract
BACKGROUND
Chemotherapy and radiotherapy can result in ovarian failure and premature menopause. However, there is still a paucity of information on the ovarian reserve and efficacy of assisted reproduction treatment (ART) procedures in patients with cancer previously exposed to chemotherapy or radiotherapy. The aim of our study was to evaluate the ovarian reserve and ovarian response to IVF or in vitro maturation (IVM) treatment in women who had previously been treated with chemotherapy.

METHODSI
In this retrospective cohort study, we compared 23 women with cancer who had undergone chemotherapy and subsequently underwent fertility treatment with IVF (n= 14) or IVM (n= 9). In the IVF group, patients mostly had hematologic, gynecologic, gastro-intestinal, bone and soft tissue cancers, whereas in the IVM group patients had estrogen-receptor positive breast cancer, hematologic and brain cancers. The control (unexposed) group consisted of 70 age-matched women with male factor infertility undergoing the same treatment protocol (IVF n= 42 and IVM n= 28). All women were aged <42 years and undergoing their first cycle of ART.

RESULTS
There were no differences in age and FSH levels between the cancer and the control groups. However, the antral follicle count (AFC) was lower in the cancer-IVF group (median: 5, range: 3-12) than in the control group (median: 15, range: 12-18; P = 0.0009). Women with cancer treated with IVF had lower peak estradiol levels on the day of hCG administration than controls (P = 0.006) and lower number of oocytes retrieved [median: 4.5, range: 2-7; versus 12 (8-16) in controls; P < 0.0001]. In patients with cancer treated with IVM, the AFC was lower than in the control group (median: 14, range: 9.5-17; versus median: 20.5 range: 16-23, respectively; P = 0.0007). Likewise, the number of oocytes retrieved was lower in the cancer-IVM group (median: 6, range: 4-10) than that in the control group (median 10.5, range: 7.5-17; P = 0.01). The percentage of mature metaphase II oocytes was comparable in the cancer and control groups.

CONCLUSIONS
The ovarian reserve, response to gonadotrophins and number of oocytes retrieved are adversely affected by previous chemotherapy. This study reports the first series of IVM outcomes in cancer patients with a prior history of chemotherapy. In women with estrogen-receptor positive breast cancer, IVM of oocytes with cryopreservation of oocytes or embryos is a viable option. Since the efficacy of ART is significantly reduced after chemotherapy, early referral for fertility preservation before gonadotoxic treatment will give these young women the best chance to conceive.

Utility of Closed Suction Pelvic Drains at Time of Large Bowel Resection for Ovarian Cancer.

Utility of Closed Suction Pelvic Drains at Time of Large Bowel Resection for Ovarian Cancer

Abstract
OBJECTIVE:
To test the hypothesis that the use of closed suction pelvic drains placed at time of large bowel resection (LBR) for ovarian cancer (OC) decrease morbidity following anastomotic leak (AL).

METHODS: 
Consecutive cases of LBR for OC between 01/01/1994 and 06/20/2011 were retrospectively identified. Drains were routinely used until bowel movement. AL was defined as: 1) feculent fluid from drains/wound/vagina, 2) radiographic evidence of AL, or 3) AL found at reoperation. Descriptive statistics, Wilcoxon rank-sum, Pearson's chi-square and Fisher's exact test were used.

Eribulin: A Novel Cytotoxic Chemotherapy Agent (June).

Eribulin: A Novel Cytotoxic Chemotherapy Agent (June)

Ann Pharmacother. 2012 May 22;

Abstract
OBJECTIVE:To review the chemistry, pharmacology, pharmacokinetics, safety, and efficacy of eribulin (Halaven).

....Eribulin has also shown activity in Phase 2 studies in other types of cancers, such as non-small cell lung cancer, prostate cancer, urothelial cancer, soft tissue sarcomas, and platinum-susceptible ovarian, fallopian tube, or peritoneal cancers........

Effects of Funding Policy Changes and Health Warnings on the Use of Erythropoiesis-Stimulating Agents [Original Contributions]

Effects of Funding Policy Changes and Health Warnings on the Use of Erythropoiesis-Stimulating Agents [Original Contributions]

Purpose:
To characterize the effects of formulary changes and governmental safety warnings on use of erythropoiesis-stimulating agents (ESAs) in patients with cancer.

Patients and Methods:
We conducted a cross-sectional time-series analysis using health administrative data from Ontario, Canada. From January 1997 to December 2009 we identified all ESA initiations among patients diagnosed with cancer. We explored the effects of two formulary changes that progressively liberalized coverage for ESAs, first by rescinding the requirement for blood transfusion in 2003 and then by removing all restrictions in 2007. We also explored the effect of US Food and Drug Administration and Health Canada warnings issued in the second quarter of 2007. To assess regional variability in ESA use, we determined prescription rates for each of Ontario's 14 regional cancer centers.

Results:
After the first formulary change, the ESA initiation rate increased to 1.66 new users per 1,000 patients with cancer, 374% more than predicted (P < .001). After the second formulary change, the initiation rate increased to 3.97 new users per 1,000 patients with cancer, 73% more than predicted (P < .001). After the safety warnings, this rate declined 81% by study end (P < .001). We found significant regional variation in ESA use.

Conclusion:
Formulary access and safety warnings had significant impacts on the new use of ESA drugs in patients with cancer. This suggests that both are effective means of influencing the use of these drugs. Variable ESA prescription rates across our region may reflect a lack of consensus regarding their utility.

Stage IV Cancer(s) Often Not Treated - in Meeting Coverage, ASCO from MedPage Today

Medical News: Stage IV Cancer Often Not Treated - in Meeting Coverage, ASCO from MedPage Today

2012 NICE publishes new ovarian cancer quality standard (UK OC incidence 6,500 deaths 4,500)

NICE publishes new ovarian cancer quality standard

The new quality standard is available on the NICE website from 00:01 hrs on Wednesday 23 May at: http://www.nice.org.uk/aboutnice/qualitystandards/qualitystandards.jsp


NICE has today (23 May) published a new quality standard for ovarian cancer, which states that an integrated approach to the diagnosis and management of the disease is fundamental to the delivery of high quality care to women.

Every year in the UK, there are around 6,500 women diagnosed with ovarian cancer, and about 4,400 deaths from the disease. It is more common in women over the age of 50ⁱ. Some of the symptoms of ovarian cancer are similar to those seen in more common conditions, like irritable bowel syndrome (IBS) so it can be hard to diagnose. Other symptoms include:

• Persistent pelvic or abdominal pain
• Increased abdominal size/persistent bloating
• Difficulty eating or feeling full quickly
• Needing to pass urine more urgently or more often than usual

The new quality standard for ovarian cancer consists of eight quality statements that describe high-quality, cost-effective care that should contribute to improving the effectiveness, safety and experience of care for women with ovarian cancer. The standard states that women aged 50 years or over reporting one or more symptoms occurring persistently or frequently suggesting ovarian cancer should be offered a CA125 testⁱⁱ. It also states that women with raised CA125 should have an ultrasound of their abdomen and pelvis within 2 weeks of receiving the CA125 test results. Women with a mass, growth or lump next to their uterus, which usually arises from the ovary or fallopian tube, (called an adnexal mass), and found by ultrasound should be offered magnetic resonance imaging (MRI) to help determine if the lesion is benign or malignant.

Dr Gillian Leng, Deputy Chief Executive and Director of Health and Social Care at NICE said: "We know that the poor survival rates of ovarian cancer may be linked to late diagnosis, which is often because of a lack of awareness of the early symptoms, which include abdominal bloating or pain and difficulty eating. The disease is more prevalent in women over 50, who often mistake its symptoms for the menopause. Therefore, it is important that there are clear, measureable standards that can help drive improvements in the diagnosis, care and treatment of this disease. Quality standards also help to achieve the goals set out in the NHS Outcomes Frameworkⁱⁱⁱ, as well as informing new Quality and Outcomes Framework (QOF)^iv indicators."

The new quality standard is available on the NICE website from 00:01 hrs on Wednesday 23 May at: http://www.nice.org.uk/aboutnice/qualitystandards/qualitystandards.jsp

Does journal endorsement of reporting guidelines influence the completeness of reporting of health research? A systematic review protocol

Does journal endorsement of reporting guidelines influence the completeness of reporting of health research? A systematic review protocol

Background: Reporting of health research is often inadequate and incomplete. Complete and transparent reporting is imperative to enable readers to assess the validity of research findings for use in healthcare and policy decision-making. To this end, many guidelines, aimed at improving the quality of health research reports, have been developed for reporting a variety of research types. Despite efforts, many reporting guidelines are underused. In order to increase their uptake, evidence of their effectiveness is important and will provide authors, peer reviewers and editors with an important resource for use and implementation of pertinent guidance.....

Clinical Care Options - OCEANS: PFS Improvement of 4 Months With the Addition of Bevacizumab to Carboplatin/Gemcitabine in Patients With Platinum-Sensitive Recurrent Ovarian Cancer ASCO 2011

 Blogger's Note: requires registration (free) to view

Clinical Care Options - Oncology CME - OCEANS: PFS Improvement of 4 Months With the Addition of Bevacizumab to Carboplatin/Gemcitabine in Patients With Platinum-Sensitive Recurrent Ovarian Cancer

CCO Independent Conference Coverage of the 2011 American Society of Clinical Oncology Annual Meeting*

*CCO is an independent medical education company that provides state-of-the-art medical information to healthcare professionals through conference coverage and other educational programs.

OCEANS: PFS Improvement of 4 Months With the Addition of Bevacizumab to Carboplatin/Gemcitabine in Patients With Platinum-Sensitive Recurrent Ovarian Cancer

Posting Date: June 15, 2011

• OCEANS: randomized, double-blind, placebo-controlled phase III trial^[1]

Summary of Key Conclusions

• Addition of bevacizumab to carboplatin/gemcitabine yielded significant benefits vs carboplatin/gemcitabine alone in patients with platinum-sensitive recurrent ovarian cancer
  • Median PFS improved by 4 months
  • Objective response improved by 21%
  • Median duration of response improved by 3 months
  • Trend toward improved OS
    • Data not yet mature
• Safety profile of bevacizumab plus carboplatin/gemcitabine consistent with previous reports
  • No new safety signals observed
  • No gastrointestinal (GI) perforations reported

Background

• Carboplatin/gemcitabine US Food and Drug Administration approved in 2006 for treatment of platinum-sensitive recurrent ovarian cancer based on improvement in PFS vs carboplatin alone in phase III clinical trial^[2]
• Bevacizumab: humanized anti-VEGF monoclonal antibody
  • Demonstrated single-agent activity in recurrent ovarian cancer^[3,4]
• Current study assessed carboplatin/gemcitabine chemotherapy with or without bevacizumab in patients with platinum-sensitive recurrent ovarian cancer...............cont'd

Comment on “Accentuation of Tumor Growth Secondary to Morphine Administration: The Proneoplastic Role of Morphine besides Its Role in Pain Management”

Comment on “Accentuation of Tumor Growth Secondary to Morphine Administration: The Proneoplastic Role of Morphine besides Its Role in Pain Management”

References:

• K. Luk, S. Boatman, and K. N. Johnson, “Influence of morphine on pericyte-endothelial interaction:implications for antiangiogenic therapy,” Journal of Oncology, vol. 2012, Article ID 458385, 10 pages, 2012. 

• K. Gupta, S. Kshirsagar, L. Chang et al., “Morphine stimulates angiogenesis by activating proangiogenic and survival-promoting signaling and promotes breast tumor growth,” Cancer Research, vol. 62, no. 15, pp. 4491–4498, 2002. View at Scopus
• M. Farooqui, Y. Li, T. Rogers et al., “COX-2 inhibitor celecoxib prevents chronic morphine-induced promotion of angiogenesis, tumour growth, metastasis and mortality, without compromising analgesia,” British Journal of Cancer, vol. 97, no. 11, pp. 1523–1531, 2007. View at Publisher · View at Google Scholar · View at Scopus
• B. Biki, E. Mascha, D. C. Moriarty, J. M. Fitzpatrick, D. I. Sessler, and D. J. Buggy, “Anesthetic technique for radical prostatectomy surgery affects cancer recurrence: a retrospective analysis,” Anesthesiology, vol. 109, no. 2, pp. 180–187, 2008. View at Publisher · View at Google Scholar · View at Scopus
• B. Mathew, F. E. Lennon, J. Siegler et al., “The novel role of the mu opioid receptor in lung cancer progression: a laboratory investigation,” Anesthesia and Analgesia, vol. 112, no. 3, pp. 558–567, 2011. View at Publisher · View at Google Scholar · View at Scopus
• P. A. Singleton, M. W. Lingen, M. J. Fekete, J. G. N. Garcia, and J. Moss, “Methylnaltrexone inhibits opiate and VEGF-induced angiogenesis: role of receptor transactivation,” Microvascular Research, vol. 72, no. 1-2, pp. 3–11, 2006. View at Publisher · View at Google Scholar · View at Scopus
• S. Leo, R. Nuydens, and T. F. Meert, “Opioid-induced proliferation of vascular endothelial cells,” Journal of Pain Research, vol. 2, pp. 59–66, 2009. View at Scopus

Register now to receive the next Current Controlled Trials (CCT) newsletter

Register now to receive the next Current Controlled Trials (CCT) newsletter:

The first edition of the Current Controlled Trials quarterly newsletter was published in April 2012, and we hope that our users find this newsletter informative. If you missed it, you can register to receive future editions. We encourage you to share these updates with friends and colleagues and to send any feedback you may have on the current issue or on content that you would like to see in future issues.

The ISRCTN register works closely with the Department of Health and has been involved in a national initiative, ‘UK Clinical Trials Gateway (UKCTG)’, which aims to bring clinical trials to the attention of a wider audience. The key to the success of the UKCTG is providing the public with easy to understand information about clinical trials running in the UK. In June 2011, the ISRCTN register introduced a new lay summary field to include a plain English description of the trial, which is unique amongst trial registries.

To further promote transparency in clinical research and reduce reporting bias, in 2011 BioMed Central launched the initiative ‘threaded publications’, which puts trial registration – the first in a sequence of publications about a trial which might also include protocols and results – at the forefront of transparent reporting.

Finally, in 2012 we will be surveying our users on the functionality of the ISRCTN database and are eager to hear from trialists, researchers, systematic reviewers, health policy makers, patients and health professionals about how we can improve the database. To find out more please register to receive the newsletter, or submit your feedback online.

Medscape: Ovarian Cancer Survivors Experience Long-Term Distress

Ovarian Cancer Survivors Experience Long-Term Distress

 May 21, 2012 (San Diego, California) — Ovarian cancer survivors continue to have psychological distress even 5 or more years after completing their treatment and have undiagnosed anxiety about the possibility of recurrence, according to researchers here at the American Congress of Obstetricians and Gynecologists (ACOG) 60th Annual Clinical Meeting......

"Few women confided even to their family members or friends about their fears. More than 59% of survey respondents said they do not talk with others about their fears of recurrence, and only 6.3% had ever joined a support group for women with ovarian cancer."

Dual Eligible Demonstrations (U.S. Medicare/Medicaid): Resources for Advocates - The Commonwealth Fund

Dual Eligible Demonstrations: Resources for Advocates - The Commonwealth Fund

Overview

In April 2011, the Centers for Medicare and Medicaid Services (CMS) awarded $1 million grants to 15 states for the design of integrated service delivery and payment models for dual eligibles, people with high health care needs who are enrolled in both Medicare and Medicaid. CMS has emphasized that consumer stakeholders must be included in the planning processes. A new Commonwealth Fund–supported Web site, http://dualsdemoadvocacy.org/, offers educational resources for consumer groups and can serve as a platform for sharing ideas and strategies for improving care for dual eligibles.

The Problem

States are struggling to find ways to engage consumers in the development of integrated models of care for people with Medicare and Medicaid. At the same time, consumer representatives say they need resources to help them gain a better grasp of the technical design and implementation issues involved.

Audience

Health care consumers and state consumer advocates

The Intervention

The Web site http://dualsdemoadvocacy.org/ is a resource for consumers and advocates that provides background information, links to news and events, and, in the Advocate Tools section, concrete recommendations to help advocates work with state policymakers to ensure that new delivery models improve care for dual eligibles. The Advocate Tools cover such topics as the development of the appeals process if health plans or providers deny needed care; patient assessment and care planning; consumer protections; and provider payment models. The site also offers state-by-state information about the dual eligibles population and the demonstration projects that local policymakers are considering. The site also features a custom search tool to direct users to the most valuable resources on the Web about dual eligibles..

For More Information

Visit http://dualsdemoadvocacy.org/.

paywalled: Confidence in receiving medical care when seriously ill: a seven-country comparison of the impact of cost barriers - Health Expectations

Confidence in receiving medical care when seriously ill: a seven-country comparison of the impact of cost barriers - Wendt - 2011 - Health Expectations

Abstract

Objective  This paper examines how negative experiences with the health-care system create a lack of confidence in receiving medical care in seven countries: Australia, Canada, Germany, the Netherlands, New Zealand, the United Kingdom, and the United States.

Methods  The empirical analysis is based on data from the Commonwealth Fund International Health Policy Survey 2007, with nationally representative samples of adults aged 18 and over. For the analysis of the experience of cost barriers and confidence in receiving medical care, we conducted pairwise comparisons of group percentages as well as country-wise multivariate logistic regression models.

Results  Individuals who have experienced cost barriers show a significantly lower level of confidence in receiving safe and quality medical care than those who have not. This effect is most pronounced in the United States, where people who have foregone necessary treatment because of costs are four times as likely to lack confidence as individuals without the experience of cost barriers (adjusted odds ratio 4.00). In New Zealand, Germany, and Canada, individuals with the experience of cost barriers are twice as likely to report low confidence compared with those without this experience (adjusted odds ratios of 1.95, 2.19 and 2.24, respectively). In the Netherlands and UK, cost barriers are only a marginal phenomenon.

Conclusions  The fact that the experience of financial barriers considerably lowers confidence indicates that financial incentives, such as private co-payments, have a negative effect on overall public support and therefore on the legitimacy of health-care systems.

paywalled: Postrecurrent Oncologic Outcome of Patients With Ovarian Clear Cell Carcinoma

Postrecurrent Oncologic Outcome of Patients With Ovarian Cle... : International Journal of Gynecological Cancer

Abstract

Objectives: 

To estimate the long-term clinical outcome of patients with recurrent clear cell carcinoma (RCCC) of the ovary in comparison with those with recurrent serous adenocarcinoma (RSAC).

Conclusions: The long-term clinical outcome of patients with RCCC was extremely poor. We confirmed that RCCC (recurrent clear cell carcinoma) should be investigated as a different malignancy compared with RSAC.

Twitter Emerges as Health Policy Sounding Board - in Meeting Coverage, AUA

Medical News: Twitter Emerges as Health Policy Sounding Board - in Meeting Coverage, AUA from MedPage Today

"Social media, such as Twitter, are a useful way to gauge public sentiment," said Prabhu, a medical student at New York University in New York City. "Social media may also have a role in influencing public sentiment and altering policy."

PLoS ONE: Conflict of Interest Policies for Organizations Producing a Large Number of Clinical Practice Guidelines

PLoS ONE: Conflict of Interest Policies for Organizations Producing a Large Number of Clinical Practice Guidelines

"COI policies among organizations producing a large number of CPGs (clinical practice guidelines) currently do not measure up to IOM standards. Policy-makers, guideline funders, sponsors, and developers, as well as users need to address and demand improvements. Patients and populations need trustworthy CPGs, and the accurate disclosure and subsequent management of COI is essential to achieve that goal."

Seth's blog: Ranking for signal to noise ratio

Ranking for signal to noise ratio:

A whisper in a quiet room is all you need. There's so little noise, so few distractions, that the energy of the whisper is enough to make a dent.
On the other hand, it's basically impossible to have a conversation (at any volume) in a nightclub.
Signal to noise ratio is a measurement of the relationship between the stuff you want to hear and the stuff you don't. And here's the thing: Twitter and email and Facebook all have a bad ratio, and it's getting worse.........

Until you remove the noise, you're going to miss a lot of signal.

Comparative Effectiveness of Filgrastim, Pegfilgrastim, and Sargramostim as Prophylaxis Against Hospitalization for Neutropenic Complications in Patients With Cancer Receiving Chemotherapy

Comparative Effectiveness of Filgrastim, Pegfilgrastim, and... : American Journal of Clinical Oncology

Conclusions: Risk of hospitalization for neutropenic complications during cancer chemotherapy is lower with pegfilgrastim prophylaxis than with filgrastim or sargramostim prophylaxis.

HERA Announces 2012 OSB Grant Recipients | HERA Women's Cancer Foundation

HERA Announces 2012 OSB Grant Recipients | HERA Women's Cancer Foundation

Dr Curiel/Viral Genetics' P-IND Clears FDA To Commence Clinical Trials (ovarian cancer/Sorafenib) in Humans - MarketWatch

Viral Genetics' P-IND Clears FDA To Commence Clinical Trials in Humans - MarketWatch

Viral Genetics' P-IND Clears FDA To Commence Clinical Trials in Humans 

Set to Begin First Ovarian Cancer Study Test Site for Metabolic Disruption Technology (MDT) Combination Therapy

 

SAN MARINO, Calif., May 21, 2012 (BUSINESS WIRE) -- A physician-initiated Investigational New Drug (P-IND) application submitted to the FDA in late April, 2012, has cleared the FDA's screening process with the requirement for a regular IND application being waived, resulting in the company being able to begin the first of at least two proposed clinical trial sites to investigate a potential oncology treatment developed from Viral Genetics' (pinksheets:VRAL) Metabolic Disruption Technology (MDT), which is licensed exclusively to the Company. The P-IND -- part of a larger, coordinated research effort -- was submitted by the first test site at the Cancer Therapy & Research Center (CTRC) at The University of Texas Health Science Center at San Antonio, which includes patient enrollment at Scott and White Hospital (S&W) in Temple, Texas. Additional test sites may also be added in the future.

Enrollment and treatment of patients is expected to commence upon completion of internal hospital Institutional Review Boards (IRBs), which are already underway. The UT Health Science Center portion of the study will commence when all approvals are finalized.

This clinical trial -- a milestone in the Company's transition from preclinical to clinical-stage -- will be the first for the intellectual property developed by Dr. M. Karen Newell Rogers, Viral Genetics' Chief Scientist and licensed exclusively by the Company. It will examine the safety and efficacy of one of Viral Genetics licensed MDT compounds in combination with an existing cancer drug, sorafenib (marketed as Nexavar(TM)) in the treatment of patients resistant or otherwise unsuitable for standard treatments for stage III or IV ovarian cancer and related carcinomas.

The Primary Investigator on the trial is Tyler Curiel, M.D., MPH, a medical oncologist affiliated with the CTRC at the UT Health Science Center. Dr. Curiel is leading this study as he investigates the efficacy of combining two compounds in a cancer treatment that is hoped to cause the starvation of tumor cells and enhanced anti-tumor immunity, leading to the reduction of tumor size and reduced disease progression.....

paywalled - Video-assisted thoracic surgery (VATS) evaluation of intrathoracic disease in patients with FIGO III and IV stage ovarian cancer

Gynecologic Oncology - Video-assisted thoracic surgery (VATS) evaluation of intrathoracic disease in patients with FIGO III and IV stage ovarian cancer

Purchase

---

Abstract

Introduction

The aim of this study was to assess the influence of video-assisted thoracic surgery (VATS) on our treatment decisions in FIGO III and IV ovarian cancer patients.

Highlights

► Preoperative chest CTs is not an appropritate staging tool for the evaluation of intrathoracic tumorload in advanced Ovarian Cancer patients
► Video-assisted thoracic surgery can be performed quickly and safely before deciding about primary cytoreduction or neodadjuvant chemotherapy in advanced Ovarian Cancer patients

The Women's Health Initiative study and hormone therapy -- what have we learned 10 years on? (note blogger's opinion)

 Blogger's Note/Opinion: at the time of the initial publication this blogger attended numerous meetings which critically analyzed the WHI study; fear, poor communication and media hype led to many poor choices without any indepth analysis even at the time; most often the WHI/media were quoted to refer patients to their physicians;  those physicians were in the same dilemma as the patients - a mess, in fact;  to this day patients/consumers, led by fear, choose to ignore/not believe (?) post-WHI findings and analyses - more on these issues in this article as below

                               ~~~~~~~~~~~~~~~~~~~~~~~~~~~~

The Women's Health Initiative study and hormone therapy -- what have we learned 10 years on?

Public release date: 21-May-2012
International Menopause Society

The Women's Health Initiative study and hormone therapy -- what have we learned 10 years on?

In July 2002 the publication of the first Women's Health Initiative (WHI) report caused a dramatic drop in Menopausal Hormone Therapy (HT ) use throughout the world. Now a major reappraisal by international experts, published as a series of articles in the peer-reviewed journal Climacteric (the official journal of the International Menopause Society), shows how the evidence has changed over the last 10 years, and supports a return to a "rational use of HT, initiated near the menopause".

The reappraisal has been carried out by some of the world's leading experts in the field, including clinicians who worked on the original WHI study. Summarising the findings of the special issue, authors Robert Langer, JoAnn Manson, and Matthew Allison conclude that "classical use of HT" – MHT initiated near the menopause – will benefit most women who have indications including significant menopausal symptoms or osteoporosis.

Dr. Robert Langer, Principal Scientist at the Jackson Hole Center for Preventive Medicine, Jackson Wyoming, was the Principal Investigator of the WHI Clinical Center at the University of California, San Diego. He said
"With 10 years hindsight we can put the lessons learned from the WHI HT trials into perspective. In some ways we've come full circle – studies in recently menopausal women that suggested protection against major diseases led to testing whether that would carry over to older women who have even greater risks of heart attacks and fractures. That hope proved false. Unfortunately the results were wrongly generalized back to women like those who inspired the study. Information that has emerged over the last decade, shows that for most women starting treatment near the menopause, the benefits outweigh the risks, not just for relief of hot flashes, night sweats and vaginal dryness, but also for reducing the risks of heart disease and fractures".
Langer continued:
"Overgeneralizing the results from the women who were -- on average -- 12 years past menopause to all postmenopausal women has led to needless suffering and lost opportunities for many. Sadly, one of the lessons from the WHI is that starting HT 10 years or more after menopause may not be a good idea, so the women who were scared away by the WHI over this past decade may have lost the opportunity to obtain the potential benefits."

Professor JoAnn Manson (Harvard Medical School and Brigham and Women's Hospital, Boston, MA), who has been one of the WHI Principal Investigators since the study started, said:
"An important contribution of the WHI was to clarify that, for older women at high risk of cardiovascular disease, the risks of HT far outweighed the benefits. This halted the increasingly common clinical practice of prescribing HT to women who were far from the onset of menopause. Unfortunately, these findings were extrapolated to newly menopausal and healthy women who actually had a favourable benefit: risk ratio with HT. The WHI results point the way towards treating each woman as an individual. There is no doubt that HT is not appropriate for every woman, but it may be appropriate for many women, and each individual woman needs to talk this over with her clinician".

The authors note that the initial press reaction, following the lead of the WHI press release, over-emphasised a relatively small increase in breast cancer, so distorting the overall view of the report. 

WHI researcher Professor Matthew Allison (University of California, San Diego), said:
"It is important to put the results of the WHI trials into context. That is, being obese, not exercising or excess alcohol consumption confer higher absolute risks for breast cancer than HT use."

###

Note that a brief summary of the papers in this special issue of Climacteric appears below.
This special issue, "The Women's Health Initiative – a decade of progress" will appear in the June 2012 issue of Climacteric (vol 15, issue 3). This goes on line on 22nd May, at this URL: http://informahealthcare.com/cmt. Climacteric is the official journal of the International Menopause Society (IMS).


ABSTRACT:
Have we come full circle-or moved forward? The Women's Health Initiative 10 years on", by R.D Langer, J.E Manson, and M.A. Allison, Climacteric Vol15 no 3 pp206-213

In mid-summer 2002, the announcement that the Women ' s Health Initiative (WHI) trial of combination hormone therapy (HRT) had stopped jolted the field of women's health. It set off a cascade that first stunned, then meaningfully changed the future for millions of women, their partners, and tens of thousands of clinicians and scientists. With 10 years' hindsight, we can begin to put the lessons learned from the WHI HRT trials into perspective. These trials were primarily designed to test whether women initiating HRT considerably past menopause, and mostly asymptomatic, experienced treatment benefits from HRT expected from studies of generally symptomatic women who started near menopause. The definitive answer was ' no ' . Unfortunately, the findings were generalized to all postmenopausal women regardless of age. Data accumulated from the WHI and other studies over the past decade have shown that, in women with symptoms or other indications, initiating HRT near menopause – the classic pattern of use – will probably provide a favourable benefit : risk ratio. Spurred by the WHI, many hypotheses and some insights about potential mechanisms for HRT effects on diverse organ systems have emerged, along with new perspectives on regimens, compounds, and routes of administration. This overview provides an historical perspective on the WHI design and the evolution of its message; summarizes current perspectives and insights contributed by eminent colleagues; reviews the state of the art; and looks to the future. We have come full circle in some ways, with mounting evidence supporting benefit for HRT started near menopause and with hard lessons learned about pathophysiology, publicity and interpreting data. Now we move on.

Summary of papers This special issue of Climacteric contains a series of articles reviewing the position of HRT, 10 years after the WHI. There is a wealth of information here, which is impossible to communicate in a single press statement. Here are simplified summaries of each article, please refer to each individual article for more details.
Quality of Life The WHI study suggested that HRT use led to minimal improvement in quality of life (QoL). As the WHI study wasn't designed to look at women going through the menopause, it underestimated the real extent of effect of HRT on QoL. This has caused suffering to many women (Pines et al).
HRT for Urogynecological and sexual health Around 50% of postmenopausal women will suffer urogenital atrophy. Studies indicate that locally applied hormone therapy is generally more effective than systemic HRT for urogenital symptoms, including dyspareunia, which can be a critical determinant of a woman's interest in sex.(Nappi & Davis)
Timing of HRT initiation, and cost effectiveness The weight of evidence now supports a ' window-of-opportunity ' for women taking HRT before the age of 60 and/or within 10 years of the menopause. This reduces the risk of coronary heart disease and overall mortality. HRT is more effective for this than other medicines such as statins and aspirin, and is cost-effective. Starting HRT later than this increases risks to women (Hodis et al).
Stroke There is a modest increase in stroke risk with HRT use if stated near the menopause. This risk rises considerably in women who start at older ages. There is some evidence that use of HRT patches (as opposed to pills) may not increase stroke risk, but this needs to be confirmed (Henderson and Lobo).
Venous Thromboembolism There is an increased risk of venous thromboembolism with oral HRT. This may be increased with age and obesity, and may vary by the progestogen used. Observational studies suggest that it may not be associated with transdermal HRTs (patches), but this needs confirmation (Archer and Ogar).
Breast cancer There is an increase in breast cancer with E+P HRT, but this is small. It has also been exaggerated by press reports, causing fear in many women. They conclude that large numbers of women with substantial menopausal symptoms and low breast cancer risk will benefit from HRT use (Gompel and Santen).
Colorectal Cancer This is the second most common cancer in women (after breast cancer). Evidence from the WHI and other trials suggests that current HRT users have a 40% reduction in colorectal cancers. The authors say that it is too early to consider HRT use in the prevention of colon cancer (Barnes and Long) Dementia Initial WHI results showed an increase in dementia for both E+P and E alone users. This review including recent publications from other studies suggests that this may be influenced by the timing of the HRT initiation, with benefits for those starting nearer the menopause, but increased risks for women starting at older ages (Maki and Henderson).
Fractures The WHI "Global Index", which looked at the balance of risks and benefits, inappropriately downgraded the importance of fractures. The authors argue for a more rounded view. They say that that HRT gives more bone benefits than many other drugs (e.g. bisphosphonates), and so restrictions on HRT use as a first-line therapy are not appropriate (de Villiers and Stevenson)
Overall effects of the drop in HRT use This is difficult to gauge, because data varies from country to country. In one large study HRT discontinuation led to a 55% increase in fractures after 6.5 years. There was also a small drop in breast cancers after the drop in use in HRT, most notably in the US, but not seen in all countries, that was consistent with an effect on existing tumours. HRT discontinuation may lead to an increase in cardiovascular disease, but given the long lag time for cardiovascular events this would take substantial time to become apparent (Burger et al)

The WHI and media The author suggests that the WHI's dramatic presentation of the initial findings set the subsequent tone for the way that the media came to view the HRT issue (Simon Brown).