Sunday, February 07, 2016
clinical trials search: ovarian cancer AND "Fallopian Tube Cancer"
Search of: Open Studies | Exclude Unknown | ovarian cancer AND "Fallopian Tube Cancer" | Adult, Senior | received from 09/01/2015 to 02/07/2016 - List Results - ClinicalTrials.gov
14 studies found for: Open Studies | Exclude Unknown | ovarian cancer AND "Fallopian Tube Cancer" | Adult, Senior | received from 09/01/2015 to 02/07/2016
clinical trials: ovarian cancer - received 09/01/2015 - 02/07/2016
Search of: Open Studies | Exclude Unknown | ovarian cancer | Adult, Senior | received from 09/01/2015 to 02/07/2016 - List Results - ClinicalTrials.gov
73 studies found for:
Open Studies | Exclude Unknown | ovarian cancer | Adult, Senior | received from 09/01/2015 to 02/07/2016
(Canada) Playing fast and loose with logic at the assisted death hearings
ipolitics Canada
By Wayne Kondro | Feb 2, 2016 8:56 pm | comments |
Who needs shock TV when we can tune into telecasts of Parliament’s Special Joint Committee on Physician-Assisted Dying hearings?
Listening to certain MPs and witnesses creates the impression that Canada stands on the brink of the wholesale slaughter of the innocent, the undesirable and the vulnerable. Given the level of debate, viewers are often left wondering whether some Parliamentarians and witnesses have even read the Supreme Court of Canada’s Carter et.al. v Attorney General of Canada ruling......
NCCN Clinical Practice Guidelines: Genetic/Familial High-Risk Assessment: Breast and Ovarian + link Colorectal Genetics
Blogger's Note: odd the inclusion of Cowden/LFS but not Lynch Syndrome reference, see link below (Colorectal)
NCCN Guidelines
Genetic/Familial High-Risk Assessment: Breast and Ovarian
- NCCN Guidelines
- Breast and/or Ovarian Genetic Assessment
- Hereditary Breast and/or Ovarian Cancer
- Li-Fraumeni Syndrome
- Cowden Syndrome
- NCCN International Translations/Adaptations
Genetic/Familial High-Risk Assessment: Colorectal
NCCN Guidelines: (2015) Ovarian Cancer Including Fallopian Tube Cancer and Primary Peritoneal Cancer
ovarian.pdf
Ovarian Cancer
20th Annual Edition!
- NCCN Guidelines
- Epithelial Ovarian Cancer (including Fallopian Tube Cancer and Primary Peritoneal Cancer)
- Borderline Epithelial Ovarian Cancer (Low Malignant Potential)
- Less Common Ovarian Histologies
- NCCN Guidelines for Patients
- NCCN QUICK GUIDE™ for Ovarian Cancer – Treatment Planning
- NCCN QUICK GUIDE™ for Ovarian Cancer – Treatment Options
- NCCN Educational Events and Programs
- NCCN International Translations/Adaptations
NCCN.orgVersion 2.2015, 06/22/15 © National Comprehensive Cancer Network, Inc. 2015
NCCN Guidelines for Patients
® available at
www.nccn.org/patient
Saturday, February 06, 2016
Genetic/Familial High-Risk Assessment: Breast and Ovarian, Version 2.2015
Version 2.2015
This Article
-
J Natl Compr Canc Netw 2016;14:153-162
The NCCN Guidelines for Genetic/Familial
High-Risk Assessment: Breast and Ovarian provide recommendations for
genetic testing
and counseling and risk assessment and management
for hereditary cancer syndromes. Guidelines focus on syndromes
associated
with an increased risk of breast and/or ovarian
cancer and are intended to assist with clinical and shared
decision-making.
These NCCN Guidelines Insights summarize major
discussion points of the 2015 NCCN Genetic/Familial High-Risk
Assessment: Breast
and Ovarian panel meeting. Major discussion topics
this year included multigene testing, risk management recommendations
for
less common genetic mutations, and salpingectomy
for ovarian cancer risk reduction. The panel also discussed revisions to
genetic testing criteria that take into account
ovarian cancer histology and personal history of pancreatic cancer.
ANN KOLKER Obituary - Washington, DC | The Washington Post Feb 3, 2016
ANN KOLKER Obituary
Ann
F. Kolker, 75, passed away on February 3, 2016 at her home in
Washington, D.C. after a long and valiant battle with ovarian cancer and
leukemia. She was born in Chicago September 3, 1940, where she grew up
in the Hyde Park neighborhood. She graduated from Vassar College in
1962. In 1967 she married Peter Kolker , and they had three children,
Daniel (Cara Spencer), Alexander, and Carlyn (Troy Phipps) and four
grandchildren, Eve, Noah, Caleb and Zeke.
Active
in women''s political and health issues, Ann was an early member of the
National Women''s Political Caucus, and was present at the creation of
EMILY''s List. She worked at the National Women''s Law Center on health
policy and women''s equality issues and related legislation, advocating
for the passage of the Family Medical Leave Act.
Ann
was diagnosed with ovarian cancer in 1996, and turned this disease into
an opportunity. Realizing that there was not then a unified national
voice to advocate for ovarian cancer research, she was a founder of the
Ovarian Cancer National Alliance, serving as its first executive
director. Later, she worked on health and economic issues with Wider
Opportunities for Women (WOW). She continued her work as a consultant
and served on multiple committees representing the views of patients in
the design and development of clinical trials affiliated with the
National Cancer Institute.
Most of all, Ann was
the keystone of her family, participating actively in the lives of her
children and grandchildren. She had a keen intellect which she used
throughout her life and was a loyal and involved friend to many.
The
celebration of Ann''s life will be held on Sunday February 14, at 11
a.m. at Temple Sinai, 3100 Military Rd., NW, Washington, DC. The family
will be receiving guests at their home Thursday February 4 and Friday
February 5, from 6 to 9 p.m.
|
|
Risk-Reduction Surgery in Pediatric Surgical Oncology: A Perspective
abstract
Objective
A small percentage of
pediatric solid cancers arise as a result of clearly identified
inherited predisposition syndromes and nongenetic lesions. Evidence
supports pre-emptive surgery for children with genetic [multiple
endocrine neoplasia type 2 (MEN2), familial adenomatous polyposis
syndrome (FAP), hereditary nonpolyposis colorectal cancer (HNPCC), and
hereditary diffuse gastric cancer (HDGC) and nongenetic [thyroglossal
duct cysts (TGDC), congenital pulmonary airway malformations (CPAM),
alimentary tract duplication cysts (ATDC), and congenital choledochal
cysts (CCC)] developmental anomalies. Our aim was to explore the utility
of risk reduction surgery to treat and prevent cancer in children........
Impact of FOXL2 mutations on signaling in ovarian granulosa cell tumors
abstract
Highlights
- •
- FOXL2 is the key player in granulosa cell differentiation and its expression is critical in maintaining ovarian phenotype.
- •
- Although more than 260 mutations identified in FOXL2 result in Blepharophimosis–Ptosis–Epicanthus inversus syndrome, only the FOXL2 C134W mutation is unique to granulosa cell tumors of the ovary.
- •
- Mutant FOXL2 has been found to alter hormone production, apoptotis and proliferation in vitro.
- •
- Further insights into FOXL2 signaling can be found at http://www.cancerindex.org/geneweb//FOXL2.htm.Granulosa cell tumors (GCT) are unique sex-cord stromal tumors which account for ∼8% of all ovarian malignancies. They exhibit morphological, biochemical and hormonal features similar to proliferating granulosa cells of the preovulatory follicle, including estrogen and inhibin synthesis. A somatic missense mutation in the forkhead box L2 (FOXL2) gene (C134W) is unique to adult GCT, and absent in other ovarian cancers. FOXL2 is a transcription factor that plays a critical role in ovarian function, in particular, proliferation and differentiation of granulosa cells. The molecular mechanisms underlying the pathogenicity of the mutant FOXL2 remain unresolved. Here we review the molecular alterations known to be associated with mutant FOXL2 and the potential signaling implications. Several studies suggest that dysregulated FOXL2 function may alter cell cycle progression and apoptosis. Further insights into the molecular mechanism of GCT pathophysiology may identify therapeutic targets for the treatment of these tumors.
Ruptured clear cell carcinoma of the ovary presenting as acute abdomen
open access
Highlights
- •
- This is the first report of spontaneous rupture of clear cell ovarian carcinoma.
- •
- Ruptured tumors should remain in the differential diagnosis of acute abdomen.
- •
- Stage 1 due to rupture has a better prognosis than ascites and surface involvement.Here we present the first documented case of a ruptured ovarian clear cell carcinoma presenting as an acute abdomen.
Case
......The patient is a 54 year old G1P1001, postmenopausal woman who presented to the emergency department complaining of severe abdominal pain for the past 24 h. She reported that the pain was diffuse and constant; review of systems was otherwise negative. Past gynecological history was remarkable for endometriosis. Past medical, surgical, family, and social histories were non-contributory. On presentation, her vital signs were remarkable for tachycardia with a pulse of 105. The remainder of her vital signs was within normal limits. On physical exam, her abdomen was distended, diffusely tender, dull to percussion, and positive for both rebound and guarding........ - .......This case is novel in that spontaneous rupture of a clear cell ovarian
tumor had occurred, and the patient presented with peritoneal signs and
an acute abdomen, which is a surgical emergency. Gynecologists often see
patients with ovarian malignancies presenting subacutely with
constitutional and abdominal and pelvic signs and symptoms in an
outpatient setting. However, epithelial ovarian carcinomas, and in
particular ovarian clear cell cancer, ought to remain in the
differential diagnosis in patients presenting with an acute abdomen with
imaging suspicious for malignancy.
Friday, February 05, 2016
The FDA (U.S.) Wants To Hear Your Opinion - genetic testing/results
Your Opinion
The FDA Wants To Hear Your Opinion
February 5, 2016
If you have an opinion about
genetic testing and the best way to return those results, the U.S. Food
and Drug Administration (FDA) wants to hear it at a daylong workshop scheduled for March 2nd.The meeting offers the FDA a chance to get perspectives from the public and medical professionals on how best to convey genetic test results in a way that meets the needs of both patients and practitioners.The meeting comes on the heels of the ambitious Precision Medicine Initiative, announced during last year’s State of the Union address. Genetic testing and patient access and engagement are key components of the initiative. As such the FDA is “considering new approaches in its regulation” of certain types of genetic testing, according to the Federal Register.
What: Patient and Medical Professional Perspectives on the Return of Genetic Test Results
When: March 2, 2016 from 8 a.m. to 4 p.m.
Where: FDA’s White Oak Campus
10903 New Hampshire Ave., Bldg. 31
Conference Center, the Great Room (Rm. 1503)
Silver Spring, MD 20993For more information go here.
As part of the run-up to the meeting, the agency has offered up several case studies
with different scenarios involving genetic testing. For instance, how
to handle reporting on variants associated with different levels of
risks for Alzheimer’s disease, or how to report on results that might
include conflicting information or that have limited evidence. The FDA
wants to hear opinions on how best health care professionals should
handle this kind of information.When: March 2, 2016 from 8 a.m. to 4 p.m.
Where: FDA’s White Oak Campus
10903 New Hampshire Ave., Bldg. 31
Conference Center, the Great Room (Rm. 1503)
Silver Spring, MD 20993For more information go here.
You have three ways to participate:
- Attend. People who want to attend and give their comments in person must register for the event, which has limited seating. The workshop is scheduled to begin at 8 a.m. ET March 2nd at the FDA’s White Oak Campus in Silver Springs, Maryland.
- Watch Webcast. The meeting will also be Webcast. Comments can be sent in the mail addressed to Division of Dockets Management (HFA-305), FDA, 5630 Fishers Lane, and Rm. 1061, Rockville, MD 20852.
- Submit comments online. Comments can also be submitted online by March 31st. All submissions, whether done through the mail or online must include reference to: “Docket No. FDA-2015-N-4809 for `Patient and Medical Professional Perspectives on the Return of Genetic Test Results; Public Workshop; Request for Comments.’”
EvidenceUpdates: Hyperbaric oxygen for patients with chronic bowel dysfunction after pelvic radiotherapy
1) New Articles -- EvidenceUpdates
2) open access full text
Abstract
BACKGROUND: Hyperbaric oxygen has been used as a therapy for patients experiencing chronic intestinal syndromes after pelvic radiotherapy for decades, yet the evidence to support the use of this therapy is based almost exclusively on non-randomised studies. We aimed to provide conclusive results for the clinical benefits of hyperbaric oxygen in patients with chronic bowel dysfunction after radiotherapy for pelvic malignancies.
INTERPRETATION: We found no evidence that patients with radiation-induced chronic gastrointestinal symptoms, including those patients with rectal bleeding, benefit from hyperbaric oxygen therapy. These findings contrast with evidence used to justify current practices, and more level 1 evidence is urgently needed.
| Glover M, Smerdon GR, Andreyev HJ, et al. Hyperbaric oxygen for patients with chronic bowel dysfunction after pelvic radiotherapy (HOT2): a randomised, double-blind, sham-controlled phase 3 trial. Lancet Oncol. 2015 Dec 15. pii: S1470-2045(15)00461-1. doi: 10.1016/S1470-2045(15)00461-1. (Original) PMID: 26703894 | ||
| Read Abstract Read Comments |
Screening for Pancreatic Adenocarcinoma in BRCA2 Mutation Carriers: Results of a Disease Simulation Model
abstract
FDR = first degree relatives
FINDINGS:
One-time screening at age 50 resulted in a LE gain of 3.9 days for the primary BRCA2 cohort, and a gain of 5.8 days for those with BRCA2 and one FDR. Annual screening resulted in LE loss of 12.9 days for the primary cohort and 1.3 days for BRCA2 carriers with 1 FDR, but resulted in 20.6 days gained for carriers with 2 FDRs and 260 days gained for those with 3 FDRs. For patients with ≥ 3 FDRs, annual screening starting at an earlier age (i.e. 35-40) was optimal.INTERPRETATION:
Among BRCA2 mutation carriers, aggressive screening regimens may be ineffective unless additional indicators of elevated risk (e.g., 2 or more FDRs) are present. More clinical studies are needed to confirm these findings.Thursday, February 04, 2016
Patient and caregiver perspectives on managing pain in advanced cancer
Patient and caregiver perspectives (abstract)
Patient and caregiver perspectives on managing pain in advanced cancer: A qualitative longitudinal study (UK)
Background: Despite
advances in treatment of pain in advanced cancer, it remains a major
source of suffering with adverse effects on
patients’ life quality. There is increasing
understanding of its multi-dimensional nature and the variable
responsiveness
of medication to complex pain. Less clear is how
patients and their caregivers respond to and manage pain complexity.
Aim: To explore patients’ and carers’ experiences of advanced cancer pain and the processes that they engage in to manage pain.
Design: Qualitative study employing face-to-face interviews at two time points and audio diaries. Data were analysed using grounded
theory strategies.
Setting/participants: Purposive sample of 21 advanced cancer patients and 16 carers from oncology outpatients in a tertiary cancer centre and a
hospice.
Results: Three
distinct patterns of pain were discerned in patients’ accounts,
distinguishable in terms of complexity, severity, transiency
and degree of perceived control over pain. Pain
was dynamic reflecting changes in the disease process, access to and
effectiveness
of pain relief. For patients and carers, neither
pain relief nor expertise in pain management is secured once and for
all.
The main drivers of help-seeking and action by
patients to manage pain were the sensory experiences of pain and meaning
attached
to it, not beliefs about analgesia.
Conclusion: The
complex and dynamic nature of pain and how it was understood shaped
help-seeking and pain management. Variable effectiveness
of pain relief for different pain types were
challenging for patients and professionals in achieving relief.
Women Survivors Alliance: CALL FOR STAGE SHOW AUDITIONS: My 2nd Act: Survivor Stories
CALL FOR STAGE SHOW AUDITIONS
My 2nd Act: Survivor Stories from the Stage LIVE Stage Show Production
Call for Auditions in Atlanta and Nashville
Call for Auditions in Atlanta and Nashville
The 2016 My 2nd Act: Survivor Stories from the Stage shows are coming to Atlanta and Nashville in April 2016 and we are currently casting for our survivor story-tellers!
Produced by the Women Survivors Alliance, My 2nd Act: Survivor Stories from the Stage is
a professionally produced stage show hosted at theaters around the
country. These shows are unique as they feature 10 women from the
cities in which the stage show is hosted reading their 7 minute stories
about what they are doing with their life after a cancer diagnosis –
THEIR 2nd Acts! The result? A celebratory, inspiring and empowering
stage show full of emotions – both for the survivors and non-survivors
in the audience. The members of the audience are, in turn, inspired to
create their own 2nd Acts, which in turn inspire others, regardless of
their life challenge. And so on, and so on ….....
GenomeFIRST awarded $400K grant to bring genomic information into patients' care FORTY FORT, Pa
PRNewswire-USNewswire
....The GenomeFIRST Medicine program takes a comprehensive approach to care that includes genomic screening, interpretation and managing results — essentially changing health care by expanding providers' ability to care for their patients before a problem arises. With support from the Robert Wood Johnson Foundation, Geisinger will pilot a scalable model for integrating genomic results into the everyday care of 300 Geisinger patients. The project will focus on the three most common genetic conditions in Geisinger's GenomeFIRST program: Hereditary Breast and Ovarian Cancer Syndrome (HBOC), Lynch Syndrome, and Familial Hypercholesterolemia....
Clinical Cancer Advances 2016: Annual Report on Progress Against Cancer - ASCO
open access
JCO February 4, 2016
eg.
In 2015, researchers reported marked gains in overcoming treatment resistance in several difficult-to-treat forms of blood, ovarian, lung, and breast cancers.
This report features examples of notable research successes achieved thanks to funding from the US National Institutes of Health (NIH), including:
- An early clinical trial that showed that a combination of two novel targeted drugs may slow the growth of a difficult-to-treat form of ovarian cancer.
The FDA approved two first-in-class therapies, olaparib for the treatment of advanced ovarian cancer and palbociclib for the treatment of advanced breast cancer. Each of these drugs blocks a specific molecule that fuels the growth of that cancer.
read full text
Wednesday, February 03, 2016
Preventive surgery for women at high risk of breast and ovarian cancer
health news
In a review article published in the Feb. 4 issue of the New England Journal of Medicine, a pair of Mayo Clinic Cancer Center researchers provide an in-depth look at the issues associated with the care of women in families with hereditary breast and ovarian cancer syndrome who have not yet developed cancer themselves. The article addresses optimal risk assessment for breast and ovarian cancers, the usefulness of risk-reducing surgery, side effects of these procedures, alternative strategies for cancer prevention and the best ways to help with the decision-making process....
Cancer survival in New South Wales, Australia: socioeconomic disparities remain despite overall improvements
open access
Background
Disparities in cancer survival
by socioeconomic status have been reported previously in Australia. We
investigated whether those disparities have changed over time.
Methods
We used population-based
cancer registry data for 377,493 patients diagnosed with one of 10 major
cancers in New South Wales (NSW), Australia. Patients were assigned to
an area-based measure of socioeconomic status. Five-year relative
survival was estimated for each socioeconomic quintile in each ‘at risk’
period (1996–2000 and 2004–2008) for the 10 individual cancers.
Poisson-regression modelling was used to adjust for several prognostic
factors. The relative excess risk of death by socioeconomic quintile
derived from this modelling was compared over time.
Conclusion
While recent health and social
policies in NSW have accompanied an increase in cancer survival
overall, they have not been associated with a reduction in socioeconomic
inequalities.
Liver, breast, ovarian and prostate cancers saw higher case numbers in the less disadvantaged SES groups, whereas the opposite trend occurred for lung cancer.
No significant variation in RER was found for melanoma, ovarian, cervix or uterine cancers.
Melanoma and ovarian cancer again showed no significant variation in RER of death by SES in 2004–2008.
Previous studies of ovarian cancer survival have also found no association with SES [6, 32]. The non-specific nature of symptoms and lack of a definitive screening-diagnostic test could explain this finding, as the majority of diagnoses in all socioeconomic groups in NSW in both periods occurred at an unknown or already advanced stage (Additional file 2: Table S2), by which point effective treatment options are limited [33].
Massively Parallel Sequencing-Based Clonality Analysis of Synchronous Endometrioid Endometrial and Ovarian Carcinomas (3)
Massively Parallel Sequencing-Based Clonality Analysis of Synchronous Endometrioid Endometrial and Ovarian Carcinomas
Massively Parallel Sequencing-Based Clonality Analysis of Synchronous Endometrioid Endometrial and Ovarian Carcinomas
Abstract
Synchronous early-stage endometrioid
endometrial carcinomas (EECs) and endometrioid ovarian carcinomas (EOCs)
are associated
with a favorable prognosis and have been suggested
to represent independent primary tumors rather than metastatic disease.
We subjected sporadic synchronous EECs/EOCs from
five patients to whole-exome massively parallel sequencing, which
revealed
that the EEC and EOC of each case displayed
strikingly similar repertoires of somatic mutations and gene copy number
alterations.
Despite the presence of mutations restricted to the
EEC or EOC in each case, we observed that the mutational processes that
shaped their respective genomes were consistent.
High-depth targeted massively parallel sequencing of sporadic
synchronous
EECs/EOCs from 17 additional patients confirmed
that these lesions are clonally related. In an additional Lynch Syndrome
case,
however, the EEC and EOC were found to constitute
independent cancers lacking somatic mutations in common. Taken together,
sporadic synchronous EECs/EOCs are clonally related
and likely constitute dissemination from one site to the other.
Canadian Doctors for Medicare: January February 2016 Newsletter
January February 2016 Newsletter
Unfortunately, advocacy groups were not invited to observe the meeting.
Access 30 Highly Cited Articles from Nutrition and Cancer: An Intl Journal
An International Journal
You’ll find 30 HIGHLY-CITED ARTICLES from the CURRENT 2015-2013 volume years. Just click on each article title to download in PDF format or to view in HTML format. FREE ACCESS is available through to year end 2016.
new journal: ESMO Open
Home | ESMO Open
BMJ is pleased to announce the launch of ESMO Open,
the Open Access journal from the European Society for Medical Oncology.
To find out more about the journal’s vision, please watch the video
from the Editor-in-Chief, Professor Christoph Zielinski
EvidenceUpdates: Postoperative Showering for Clean and Clean-contaminated Wounds: A Prospective, Randomized, Controlled Trial
New Articles (includes professional commentaries)
OBJECTIVE: To evaluate wound infection rates, pain scores, satisfaction with wound care, and wound care costs starting 48 hours after surgery.
CONCLUSIONS: Clean and clean-contaminated wounds can be safely showered 48 hours after surgery. Postoperative showering does not increase the risk of surgical site complications. It may increase patients' satisfaction and lower the cost of wound care.
Tuesday, February 02, 2016
Getting to the bottom of financial disclosure issues in the not-for-profit sector - Ottawa
Ottawa Telfer School of Management
Professor Qiu Chen has just published research examining a key transparency issue in the nonprofit sector: to increase opportunities for donations, some managers misreport fundraising and/or administrative expenses as program expenses.....
abstract link: Director Monitoring of Expense Misreporting in Nonprofit Organizations: The Effects of Expense Disclosure Transparency, Donor Evaluation Focus and Organization Performance
The next steps on Zika : Nature News & Comment
Nature News & Comment
The World Health Organization this week declared that clusters of birth defects suspected of being linked to an epidemic of Zika virus in the Americas constituted a “public health emergency of international concern”. Beyond the practical imperative to better control the mosquitoes that spread Zika and other diseases, the most urgent priority on the ground is research to answer basic, but crucial, questions, including whether the birth defects are caused by the virus, and if so, how frequently......
NCI-MATCH: A Status Report and Future Directions Feb 1st
NCI
We will also be opening 12 to 14 additional treatment arms, with the expectation of having as many as 22 to 24 arms open by May 2016.
....Because our experience to date is leading to some modifications in the trial, the pause in enrollment to the screening step is expected to continue until all of these changes are implemented. We expect to resume enrollment of new patients by May 2016.
The ongoing interim analysis, results from which will be publicly presented in early spring, will include data on:
The interim analysis will provide a snapshot of how this ambitious trial unfolded and will help the trial leadership make necessary refinements. Already we are making important changes to NCI-MATCH....
- the diversity of cancer types (common and rare) among patients who have enrolled in the trial
- patients with a mutation that matches to one of the 10 available treatments versus those with no match
- the estimated proportion of patients who may have a mutation that matches to one of the 22 to 24 treatment arms, once all arms become available
- the type and quality of tumor samples submitted by the institutions enrolling patients in the trial
- the performance and turnaround time of the four laboratories supporting the trial with sample processing and genomic testing
Editorial: Does cancer research focus on areas of importance to patients?
Editorials (UK)
Abstract
The majority of research ideas are proposed by clinicians or
scientists and little is currently known about which areas of research
patients feel are important. We performed a 4 week pilot patient survey
at the Royal Marsden (a specialist cancer centre) to investigate
patients’ views on priorities for cancer research. A total of 780
patients completed the survey and the top research priorities were
identified as: detection and prevention of cancer, scientific
understanding, curative treatment and personalised treatment. The top
research priorities were remarkably consistent across age, gender and a
variety of tumour types. We believe that patients’ views should be
considered alongside those of clinicians and researchers when devising
research proposals and strategies.
Results and discussion
We had a total of 780 respondents, of whom 55% were female. The
majority of patients were between 46–75 years of age: 119 patients (15%)
were less than 45 years, 234 patients (30%) were 46–60 years, 326 (42%)
were 61–75 years and 85 (11%) were >75 years. A large number of
different tumour types were represented (see Table 1),
with the most common being breast, prostate and gynaecological
malignancies. Not all patients answered every question, however 396
(51%) patients stated they were being treated with curative intent and
296 (38%) patients were treated with palliative intent. Some patients
had not yet started treatment or were having supportive care only, but
397 (51%) of patients were currently undergoing treatment and 229 (29%)
were in follow-up/remission.....
Table 1. Tumour types of respondents to the PACER survey.
Utility of endometrial sampling prior to risk-reducing hysterectomy in a patient with Lynch syndrome
open access
Introduction
Women with Lynch syndrome have an autosomal dominant mutation in one
of the DNA mismatch repair genes resulting in an increased lifetime risk
for colorectal and endometrial cancer in addition to cancers of the
ovary, stomach, hepatobiliary tract, pancreas, small bowel, urinary
tract, and central nervous system. The current National Comprehensive
Cancer Network (NCCN) guidelines recommend that individuals with Lynch
syndrome undergo colorectal cancer screening with colonoscopy [1].
There is less data to support gynaecologic screening. However, because
of high lifetime risk of endometrial cancer in women with Lynch syndrome
the NCCN and other consensus guidelines recommend annual or biennial
endometrial sampling beginning at age 30–35 years and risk-reducing
hysterectomy and bilateral salpingo-oophorectomy in women who have
completed childbearing [1, 2].....
Case presentation
A 50-year-old, gravida zero, Ashkenazi Jewish woman underwent
screening for Lynch syndrome. Her paternal grandfather was diagnosed
with colon cancer at age 80, paternal uncle diagnosed with colon cancer
at age 50, and two paternal second cousins diagnosed with premenopausal
endometrial cancer. Both the patient and her father were found to have
the Lynch syndrome mutation MSH6 3959del4, which results in premature
truncation of the MSH6 protein at amino acid position 1325 [3]. Following this screening result, the patient was immediately referred for risk-reducing gynaecologic surgery.
The patient had no personal history of cancer or gynaecologic pathology....Discussion
Women with Lynch syndrome undergoing risk-reducing hysterectomy are at
risk for having an occult endometrial cancer, however the magnitude of
risk remains unknown. The estimated cumulative lifetime risk for
endometrial cancer in Lynch syndrome varies by report and mutation,
ranging from 21–71%. The MSH6 3959del4 mutation (as in the current case)
is associated with the greatest risk of endometrial cancer, affecting
71% of women by age 70 [3].
Prior case reports have described occult endometrial cancer discovered
in patients with Lynch syndrome undergoing risk-reducing surgery [4, 5]. Lachiewicz et al [6]
recently published the first study to explore the prevalence of occult
gynaecologic malignancy at the time of risk-reducing surgery in patients
with Lynch syndrome......
Evidence! New S4PM Survey Shows People Want to Collaborate with Their Doctors and Co-Produce Their Clinical Data
e-Patients.net
A fundamental precept of participatory medicine is that health care should not be a spectator sport—it’s best practiced in a participatory manner. This requires engagement from both the patient and the clinician.....So it was quite gratifying to see the results of a new Society for Participatory Medicine survey. The survey, fielded by ORC International, a professional survey firm, asked 1000 adults five questions. We’re publishing the results in this downloadable PDF infographic.
Monday, February 01, 2016
Expression of p53 and HER2/Neu in Kenyan Women With Primary Ovarian Carcinoma
abstract
Ovarian carcinomas are a leading cause of cancer mortality among women. Two of the more commonly described markers of prognostic significance in primary ovarian carcinomas are p53 and HER2/neu. Overexpression of both markers is associated with poor prognosis. This study aimed to determine the frequency and pattern of p53 and HER2/neu expression in primary ovarian carcinomas in Kenyan women and to describe the clinical and pathologic features of ovarian carcinomas diagnosed at 3 different hospitals in Kenya. Primary ovarian carcinomas diagnosed at the Departments of Pathology at Aga Khan University Hospital, Nairobi; the Aga Khan Hospital, Kisumu; and the AIC Kijabe Hospital in Kenya over a period of 3 years from January 2009 to December 2011 were recorded. Sixty-seven ovarian carcinomas were identified and blocks retrieved from archives. Hematoxylin-eosin-stained slides of these were reviewed and appropriate sections were stained for p53 and HER2/neu using standard immunohistochemical techniques. The primary outcome was presence and intensity of staining for p53 and HER2/neu. The most frequent malignancy was serous carcinoma. A total of 43.3% (95% confidence interval, 32.1%-55.2%) of carcinomas were positive for p53, and 13.4% (95% confidence interval, 7.2%-23.6%) were positive for HER2/neu. Serous carcinoma and adenocarcinoma, not otherwise specified were more likely to be positive for p53. There was no association noted between the histologic grade or pathologic stage and positivity for either p53 or HER2/neu. The expression of p53 and HER2/neu in primary ovarian carcinomas in Kenyan women is not different from that described in the literature.
(radiation) Prospective Assessment of the Oncogenic Risk to Patients from Fluoroscopy during Trauma Surgery
abstract
OBJECTIVE:
Concern about radiation exposure during surgery has focused on surgeon exposure. However, the patient receives exposure that is more direct and, in surgery about the pelvis and hip, internal pelvic non-skeletal organs often cannot be shielded without obscuring the region of surgical interest. The purpose of this study was to prospectively evaluate patients' radiation exposure during fracture surgery of the acetabulum, pelvic ring, and femur to calculate future cancer incidence (CI).DESIGN:
Prospective Descriptive Cohort SETTING:: Level One Trauma Center PATIENTS/PARTICIPANTS:: 108 patients with acetabulum, pelvic, or femur fractures requiring operative repair were prospectively enrolled.INTERVENTION:
Dosimeters were placed in locations determined for each surgery type by a medical physicist.MAIN OUTCOME MEASUREMENTS:
Demographics, operative records, and average x-ray emission energy were recorded. Effective dose (ED), specific organ doses, and lifetime cancer incidence (CI) for a 30-year-old patient were calculated.RESULTS:
Diagnoses included 27 acetabular fractures, 30 intertrochanteric femur fractures, 26 femoral shafts, and 25 pelvic ring injuries. Patients with pelvic ring injuries received the highest ED at 0.91 ± 0.74 mSv. The average lifetime increase in CI, for any cancer type, after pelvic ring fixation is 0.0097% for females and 0.0062% for males. The greatest mean single-organ dose to the ovaries (3.82 ± 3.34 mGy) occurred during pelvic ring surgery, correlating to an increased ovarian cancer risk of 0.0013%. The greatest mean single-organ dose to the prostate (6.81 ± 5.91 mSv) also occurred during pelvic surgery, correlating to increased prostate cancer risk of 0.0024%CONCLUSIONS:: Fracture surgery to the pelvis and femur are exceptionally fluoroscopy-dependent; however, the radiation exposure incurred represents a relatively small increased risk of future cancer development in patients.
Comparing the Copenhagen Index (CPH-I) and Risk of Ovarian Malignancy Algorithm (ROMA)
abstract
Comparing the Copenhagen Index (CPH-I) and Risk of Ovarian Malignancy Algorithm (ROMA): Two equivalent ways to differentiate malignant from benign ovarian tumors before surgery?
AIM:
To evaluate the prediction of malignancy in women with pelvic masses using the Copenhagen Index (CPH-I) and Risk of Ovarian Malignancy Algorithm (ROMA).PATIENTS AND METHODS:
Three hundred eighty four women operated due to an ovarian mass were enrolled between January 2010 and June 2015. All patients had histopathological diagnosis, HE4 and CA125 measurement. CPH-I and ROMA were calculated and their performances compared in two distinct scenarios: 1) for the discrimination of benign ovarian disease from epithelial ovarian cancer (EOC), non-epithelial ovarian cancer, borderline ovarian tumors (BOT) and ovarian metastases, and 2) for the discrimination of benign disease from EOC. Receiver Operator Characteristics' Areas Under the Curves (AUC) were calculated for CPH-I and ROMA and compared.RESULTS:
Of the 384 women, 224 presented a benign ovarian tumor, 32 BOT, 87 EOC, 26 non-epithelial ovarian cancer, and 15 had ovarian metastases. The best AUCs were obtained for the discrimination of EOC from benign tumors. CPH-I performed slightly better than ROMA, and both approached 89% sensitivity and 85% specificity. When all malignant tumors (EOC, BOT, ovarian metastases and non-epithelial ovarian cancer - entire cohort) were included, the performance of CPH-I and ROMA declined to nearly 72%, although the specificity remained close to 85%.CONCLUSION:
CPH-I and ROMA performed similarly well for the discrimination of EOC from benign ovarian tumors. However, caution is necessary since, in practical situations, where all the histological possibilities for malignant ovarian tumors must be considered, the sensitivity of CPH-I and ROMA may not surpass 70%.Illumina Providing Genomic Analysis for Precision Medicine
Science news
1 February 2016. Illumina Inc., a developer of genetic systems, is analyzing genomic data at four medical centers to integrate with patients’ electric health records for precision medicine. The San Diego company’s analytical services are expected to sequence and characterize the genomes of more than 200,000 individuals in the U.S. and Canada.
Medical centers taking part in the initiative are Vanderbilt University in Nashville, University of Colorado in Denver, Partners HealthCare in Boston, and Montreal Heart Institute in Quebec, Canada. Vanderbilt is providing 100,000 patients for the project, with the other medical centers offering between 25,000 and 50,000 participants.
The medical centers plan to use the data to discover underlying genetic factors contributing to heart disease, cancer, Alzheimer’s disease, bipolar disorder, and Crohn’s disease, among others. Each facility has a biobank, where specimen samples are collected and will be analyzed by Illumina. Each medical center also uses electronic records for storing patients’ clinical data as well as the genomic analyses.
Illumina will conduct its analysis with genotyping systems that the company says identify mutations and variations quickly. The company also expects to offer methylation sequencing, useful for identifying epigenetic factors, those outside the genome that influence gene expression.
Vanderbilt University, providing about half of the samples, will add the Illumina analyses to its BioVu collection of de-identified blood samples offered by patients with their consent. The university says it has some 150 research studies underway making use of BioVu. Nancy Cox, director of Vanderbilt’s Genetic Institute, says in an Illumina statement that BioVu “is at the core of a vision that will combine genome variation, biomarker data, patient electronic medical record information and pharmacogenomic data to advance personalized medicine.”
Montreal Heart Institute, offering about a quarter of the samples, will use Illumina’s multi-ethnic genotyping services to identify genetic predictors of responses to drugs for treating cardiac and metabolic disorders. A part of those samples, says the institute, will also be included in a study following a group of patients over time who took part in an earlier clinical trial.
Terminology of chronic pain: the need to "level the playing field
open access (pdf)
Pain medicine as a separate subspecialty is in its infancy, only fairly recently being recognized as such by the American Board of Medical Specialities.1 As it continues to find its way in the ever-changing world of medicine, terminology becomes an important consideration. Terms carry tremendous impact: for example, when a patient is told he or she has “cancer”, the impact emotionally will undoubtedly make further explanation difficult. To patients and their families, the word “cancer” has the effect of being hit with an emotional baseball bat. In the pain world, there was a recent, albeit failed, attempt to change the name of pain specialists to “algiatrists”.2 It was thought this would help define what such specialists did as opposed to other specialties. Accordingly, terminology matters, yet little attention has been paid to the terms we use to categorize and diagnose our patients. “Chronic cancer pain” and “chronic noncancer pain” are replete in the literature; however, the distinction here is actually obscure. A patient with pain from a cancer etiology has no different physiology than a patient with pain of noncancer etiologies.
Download Article [PDF]
Effectiveness of Prevention Strategies for Contrast-Induced Nephropathy: A Systematic Review and Meta-analysisEffectiveness of Prevention Strategies for CIN
open access: Effectiveness of Prevention Strategies for Contrast-Induced Nephropathy: A Systematic Review and Meta-analysisEffectiveness of Prevention Strategies for CIN
Limitation: Too few studies were done in patients receiving IV contrast media.
Comparative Effect of Contrast Media Type on the Incidence of Contrast-Induced Nephropathy
open access: Comparative Effect of Contrast Media Type on the Incidence of Contrast-Induced Nephropathy: A Systematic Review and Meta-analysisComparative Effect of Contrast Media Type
Limitations: Few studies compared LOCM. Procedural details about contrast administration were not uniformly reported. Few studies specified clinical indications or severity of baseline renal impairment.
Intraperitoneal Therapy For Ovarian Cancer With Carboplatin Trial - Full Text View - ClinicalTrials.gov
Full Text View - ClinicalTrials.gov
Japanese Gynecologic Oncology Group
| Intervention | Phase | |
|---|---|---|
|
Drug: Paclitaxel(intravenous) + Carboplatin(intravenous) Drug: Paclitaxel(intravenous) + Carboplatin(intraperitoneal) |
Phase 2 Phase 3 |
JCO: Discussion - Intraperitoneal Therapy for Ovarian Cancer
Reply to F.M. Muggia
- Corresponding author: Michael A. Bookman, MD, Arizona Oncology, 603 N Wilmot Rd, Suite 151, Tucson, AZ 85711
+ Author Affiliations
Muggia1 offers some interesting comments on our own editorial,2
and we appreciate the opportunity to briefly respond. Of note, we
believe that new approaches might actually take us further
than anticipated because of individualized therapeutic
decisions, early incorporation of synthetic lethality and immune
checkpoint
inhibition, exploitation of the peritoneal-tumor
microenvironment, and development of new molecular targets associated
with
drug resistance. However, these topics were clearly
beyond the scope of a short editorial regarding intraperitoneal (IP)
chemotherapy.
We also need to learn from the limitations,
as well as from the strengths, of prior clinical research. Whether IP
cytotoxic
chemotherapy should be a standard component of future
research should not simply be accepted, but should be based on ongoing
scientific and clinical validation as well as
prioritization of limited resources. In this regard, we should aspire to
move
beyond citing pharmacologic advantage, which is
conveniently measured within the peritoneal infusate, but is of
uncertain
relevance to the tumor or host. We need to broadly
consider the complex biologic and clinical implications of drug exposure
within the tumor microenvironment, a unique feature of
this disease.
It is worth remembering that none of the
reasonable modifications to the IP regimen of the GOG-0172 trial have
been validated
in a prospective randomized trial, and there are no
data to support that IP administration of cisplatin 75 mg/m2,
or that substituting IP carboplatin (area under the curve = 6) or
changing the paclitaxel dose and schedule, will be superior
to treatment with a standard intravenous
platinum-taxane therapy. This could be especially relevant if the
pharmacologic advantage
is a truly critical determinant of long-term outcomes.
In addition, primary intravenous therapy has evolved from the GOG-0172
trial to include the substitution of carboplatin and
the potential incorporation of dose-dense, weekly paclitaxel or
bevacizumab.
It is clear that we need to make appropriate
adjustments in IP treatment delivery, but this would be much easier to
accomplish
if we understood the targets and mechanisms of IP
chemotherapy that are associated with clinical benefit.
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