Mutational analysis and clinical correlation of 185 consecutive metastatic colorectal patients: Similarities and differences between colon and rectal patients| 2011 ASCO Abstract

Conclusions:

Rectal and colon patients have similar rates of KRAS and PIK3CA mutations. However, BRAF mutations are more common in colon cancer. NRAS mutations are exclusively found in rectosigmoid cancers and may have a different biology than other colorectal cancers. These data suggest that primary tumor location may provide a means to enrich a population for a genotype-directed study.

Abstract: Perforation of a malignant ovarian tumor into the recto-sigmoid colon

Abstract

Ovarian cancer often presents at an advanced stage, but tends to be an intra-peritoneal disease that respects peritoneal planes. Thus, colo-rectal perforation of the tumor is an extremely rare presentation. The surgical treatment of malignant colo-ovarian fistula should include complete cyto-reduction at the same time as the treatment of the fistula. However, prognosis remains poor, because of the advanced stage of neoplasia. We report the case of a patient with an ovarian malignant tumor perforating into the recto-sigmoid colon. CT scan was the cornerstone of the radiological diagnosis. We managed to perform a complete cyto-reduction, including an en-bloc resection of the uterus, the mass, adnexa and recto-sigmoid with removal of the associated pelvic abscess.

Epidemiology and prognosis of ovarian metastases in colorectal cancer (abstract)

Define: metachronous - multiple occurrences/multiple primary cancers


BACKGROUND: National guidelines for prophylactic oophorectomy in women with colorectal cancer are lacking. The aim of this population-based cohort study was to report on the prevalence, incidence and prognosis of ovarian metastases from colorectal cancer, providing information relevant to the discussion of prophylactic oophorectomy.

METHODS: All 4566 women with colorectal cancer in Stockholm County during 1995-2006 were included and followed until 2008. Prospectively collected data regarding clinical characteristics, treatment and outcome were obtained from the Regional Quality Registry.

RESULTS: The prevalence of ovarian metastases at the time of diagnosis of colorectal cancer was 1.1 per cent (34 of 3172) among women with colonic cancer and 0.6 per cent (8 of 1394) among those with rectal cancer (P = 0.105). After radical resection of stage I-III colorectal cancer, metachronous ovarian metastases were found during follow-up in 1.1 per cent (22 of 1971) with colonic cancer and 0.1 per cent (1 of 881) with rectal cancer (P = 0.006). Survival in patients with ovarian metastases was poor.

Exploring the Interface Between Cancer and Psychiatry - Cancer Network

"As a psychiatrist who has cancer, I have developed a deep understanding of the ways in which our training can help us help patients who find themselves forced to deal with the complicated emotional aspects that accompany this disease. My hope is that my insights will help psychiatrists as they wrestle with the problems that plague their patients who are coping with this difficult disease....."

Survival benefit from ovarian metastatectomy in colorectal cancer patients with ovarian metastasis: a retrospective analysis

Abstract

PURPOSE: A recent study demonstrated that colorectal cancer (CRC) with ovarian metastases was less responsive to chemotherapy compared with extraovarian metastases. Hence, the ovary may actually represent a "sanctuary" for metastatic cells from CRC. The aim of the study was to investigate the impact of ovarian metastatectomy on survival of CRC patients with ovarian metastasis.

When Patients Meet Online, Are There Side Effects? - NYTimes.com

Microsatellite instability in colorectal cancer. abstract

open access: The Canadian Facts from the Social Determinents of Health perspective - University of York

Social Determinants of Health:
The Canadian Facts
Juha Mikkonen and Dennis Raphael
Published in May 2010. ISBN 978-0-9683484-1-3

Summary

The primary factors that shape the health of Canadians are not medical treatments or lifestyle choices but rather the living conditions they experience. These conditions have come to be known as the social determinants of health. This information – based on decades of research and hundreds of studies in Canada and elsewhere – is unfamiliar to most Canadians. Canadians are largely unaware that our health is shaped by how income and wealth is distributed, whether or not we are employed and if so, the working conditions we experience.

Our health is also determined by the health and social services we receive, and our ability to obtain quality education, food and housing, among other factors. And contrary to the assumption that Canadians have personal control over these factors, in most cases these living conditions are – for better or worse – imposed upon us by the quality of the communities, housing situations, work settings, health and social service agencies, and educational institutions with which we interact.

Improving the health of Canadians requires we think about health and its determinants in a more sophisticated manner than has been the case to date. Social Determinants of Health: The Canadian Facts considers 14 social determinants of health:

1. Income and Income Distribution
2. Education
3. Unemployment and Job Security
4. Employment and Working Conditions
5. Early Childhood Development
6. Food Insecurity
7. Housing
8. Social Exclusion
9. Social Safety Network
10. Health Services
11. Aboriginal Status
12. Gender
13. Race
14. Disability

The publication outlines why they are important; how Canada is doing in addressing them; and what can be done to improve their quality. The purpose of the document is to provide promote greater awareness of the social determinants of health and the development and implementation of public policies that improve their quality.

End of life in cancer patients: drugs or words? — Ann Oncol

Note: editorial partial extract from full paper ($$)

Facebook | Darlene Gray: Sask Minister of Health Questioned in Leg Assembly Over the Closure of Regina Gyne Onc Office

Sask Minister of Health Questioned in Leg Assembly Over the Closure of Regina Gyne Onc Office

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THIRD SESSION - TWENTY-SIXTH LEGISLATURE
of the
Legislative Assembly of Saskatchewan
N.S. VOL. 52 NO. 42A MONDAY, APRIL 12, 2010, 1:30 p.m.
LEGISLATIVE ASSEMBLY OF SASKATCHEWAN 4697 April 12, 2010
April 12, 2010 Saskatchewan Hansard 4705

ROUTINE PROCEEDINGS
INTRODUCTION OF GUESTS

Ms. Junor: — Mr. Speaker, I too on behalf of the opposition want to welcome the members from the Red Hat Society, all the women that have come today. From what I know about this group, not only are they very visible because of their hats — and it’s unfortunate that the member didn’t wear hers; that would have been entertaining — I understand that these women are extremely enthusiastic and they have a lot of fun. That’s what I always hear, that you have a lot of fun. Look at all the hats nodding. So I too would like to welcome all the women here today to the legislature.

While I’m on my feet, Mr. Speaker, I want to introduce others who are in the gallery. On the very top row is Darlene Gray, the director of OCATS, the Ovarian Cancer Awareness and Treatment in Saskatchewan, and Elan Morgan board member. Wave? And sitting beside Elan are Joan and Harvey Schneider, also board members. I just want to say about Joan before I sit down and welcome them, Joan was the executive secretary to the president of SUN [Saskatchewan Union of Nurses] when that was me. So I’m very happy to see Joan here today and welcome them all to the Assembly.

QUESTION PERIOD
Gynecologic Oncologists

Ms. Junor: — Mr. Speaker, for two years the minister has ignored the pleas of women with ovarian cancer and gyne-oncologists to address substandard working conditions in southern Saskatchewan. As a result, Dr. Brydon, one of only two gyne-oncologists practising in southern Saskatchewan, has closed her practice because she is burned out. To quote Dr. Brydon, “Physically and emotionally, I can’t cope any more.”
Mr. Speaker, the minister’s incompetence and failure to address the substandard working conditions of gyne-oncologists in Regina is putting at risk the lives of women with ovarian cancer. Why?

The Speaker: — I recognize the Minister of Health.
Hon. Mr. McMorris: — Thank you, Mr. Speaker. First of all, Mr. Speaker, on behalf of the government, we want to thank Dr. Brydon for all the work that she has done in southern Saskatchewan. These people are very specialized doctors. They are, Mr. Speaker, gynecology oncologists, which is a very specialized area. We have had four in our province, Mr. Speaker. Dr. Brydon is closing her practice to move on to other options. The health region, the health region as well as the government, is working hard to ensure that that position will be filled, Mr. Speaker.
But what I will say is that in the last two and a half years of our government, we have done more to recruit physicians into this province compared to the 16 years. And especially when you look at the front page of the Leader-Post, from 2001 to 2006 the net out-migration of health care workers in Saskatchewan was 1,160 health care workers out, Mr. Speaker. In our first two and a half years, we have attracted 164 more physicians to our province than under that government, Mr. Speaker.

The Speaker: — I recognize the member from Saskatoon Eastview.
Ms. Junor: — Mr. Speaker, that tired rhetoric is no consolation to women who have ovarian cancer. Mr. Speaker, in every other jurisdiction, including Saskatoon, gyne-oncologists work in a hospital setting with the proper support around them — not so in Regina where the specialists have to find their own office space and work without the support of a nurse.

Mr. Speaker, to the minister: is he going to provide immediate office space and examining room space in the Regina General Hospital along with the proper nursing support, or is he going to continue to ignore the issue until the second gyne-oncologist closes her practice?

The Speaker: — I recognize the Minister of Health.
Hon. Mr. McMorris: — Mr. Speaker, we have a gynecological oncology program working group that was established, Mr. Speaker, under our government. This working group has patient support, is represented through patient support groups. It also has a gynecology oncologist, the four that were in the province, working on this group as well as the health authorities of Regina Qu’Appelle, Saskatoon, and the Saskatchewan Cancer Agency to deal with this issue to have an ongoing program.

Mr. Speaker, the ministry officials have informed me that progress is being steadily made, Mr. Speaker. And yes, there are going to be decisions made by physicians to step aside. But, Mr. Speaker, we’re going in the right direction. It isn’t the working of that group . . .
[Interjections]

The Speaker: — Order. Order. I’d ask the opposition members to give the minister the same opportunity to respond as the government gave the member to ask the question. I recognize the minister.
Hon. Mr. McMorris: — Mr. Speaker, it isn’t the working of that group that would get into the micromanagement of what happens within a health region or the Cancer Agency. That is the auspices of the Cancer Agency or the regional health authority in their particular area, Mr. Speaker.

The Speaker: — I recognize the member from Saskatoon Eastview.
Ms. Junor: — Mr. Speaker, this is clearly a lack of leadership. The working group has been ongoing for over two years. They’re going to just keep spinning their wheels unless the minister says, do this. The minister’s incompetence and failure to address the problems means there’s now only one gyne-oncologist looking after all of southern Saskatchewan women. This will put additional pressures on the remaining gyne-oncologist and potentially will increase the wait time for women who are waiting for even an initial diagnosis.

My question to the minister is this: will the Sask Party government be forced to send women out of the province for diagnosis and treatment because of their incompetence and failure?

The Speaker: — I recognize the Minister of Health.
Hon. Mr. McMorris: — As I had mentioned earlier that the health region, the Saskatchewan Cancer Agency, the Regina Qu’Appelle Health Region will be working hard in the next . . . in the past but as we move forward over the next month or so to attract another gyne-oncologist into the province. I am very proud of our government having set up a physician recruitment agency that will deal with this very issue, these very issues, Mr. Speaker.

Unfortunately that hadn’t been done for many, many years — never even contemplated under the former government when we saw hundreds and hundreds of doctors leaving this province, Mr. Speaker. In the last two and a half years, we’ve seen more doctors come to the province than leave — an increase of about 164. There is more work to do. That’s why we set up a recruitment agency, Mr. Speaker. And that’s why we’ve also increased the number of training seats in the College of Medicine and the number of residency positions, up to 108 residency positions in the province, Mr. Speaker, that will bode this province very well into the future.

The Speaker: — I recognize the member from Saskatoon Eastview.
Ms. Junor: — Mr. Speaker, ducking and weaving, I mean there is no answer in the minister’s rhetoric. And Dr. Brydon’s leaving her practice now because the province will not set up a gyne-cancer unit in Regina. This unit would allow women to be diagnosed, treated, and receive follow-up care in one place. To quote Dr. Brydon:
I actually don’t think that the way the system is structured in this province at this time allows anybody to do the job that needs to be done properly and that is because we do not have a gynecologic women’s cancer unit the way all other provinces do.
Mr. Speaker, to the minister: is the minister going to establish a gyne women’s cancer unit in the province now, or is he going to wait and wait and wait, and talk and talk, and talk and continue to risk the lives of women with ovarian cancer?

The Speaker: — I recognize the Minister of Health.
Hon. Mr. McMorris: — Mr. Speaker, we know and understand the very importance of this issue, Mr. Speaker. That’s why we set up a working group that has patient representative groups on it, that has the oncologists on it, that has the Cancer Agency, that has the health regions, to look at how to best manage this project, Mr. Speaker. There has been progress made, absolutely. But it’s interesting that they would stand and criticize the way the program and the way the health system is being run, when they have been in government for 16 years prior, setting up the very program they’re criticizing now, Mr. Speaker.
Mr. Speaker, we’re looking at how we can improve this program as we move forward. We’re looking at how we can have the proper complement of gyne-oncologists within the province, Mr. Speaker, because we know that it is a very important issue, and we’re working to improve the health of women in our province, Mr. Speaker.

'New' Evidence for Clinical Practice Guidelines: 'New' Evidence for Clinical Practice Guidelines: Should we Search for 'Preference Evidence'?

Abstract

Clinical practice guidelines (CPGs) are systematically developed statements to assist both patient and practitioner decisions. They link the practice of medicine more closely to the body of underlying evidence, shift the burden of evidence review from the individual practitioner to experts, and aim to improve the quality of care. CPGs do not routinely search for or include evidence related to patients' values and preferences.

We argue that they should.

We think that such evidence can tell us whether a decision is preference sensitive; how patients feel about important health outcomes, treatment goals, and decisions; and whether preferences vary in different types of patients. The likely effects of reviewing the literature are a general sensitization to the importance of preferences in decision making, the recognition that some decisions are simply all about preferences, a more considered approach to forming preferences among patients and other stakeholders, and more effective integration of preferences into decisions.

Announcement: Annual International Gathering - Ovarian Cancer/ACOR

ACOR

Further information/registration (free): http://www.ocats.ca

European Medicines Agency (EMA): the Agency takes a further step in its interaction with patients and consumers | A global voice for patients

REFLECTION PAPER ON THE FURTHER INVOLVEMENT OF PATIENTS AND CONSUMERS IN THE AGENCY’S ACTIVITIES

Open Poll - Pelvic Exams While Under Anesthesia

Poll is Open
please contribute your views (men & women)
Patients, Consumer and Health Care Professionals

Cochrane Canada Symposium (includes consumers/patients)

Subject: Cochrane Canada Symposium

Workshop: Cochrane Canada 8th Annual Symposium - Evidence in Uncertain Times: Meeting the Challenge
Date: 19-20 May 2010, Presymposium: 17-18 May 2010
Location: Ottawa, Ontario, Canada
Details: We invite researchers, health policy makers and managers, health professionals, and patients to join the Canadian Cochrane Centre as we discuss Evidence in Uncertain Times at our 8th annual symposium. Abstract submission for workshop, oral and poster presentations is open until 12 February 2010. Early Bird registration ends on 19 March 2010
Email: ccnc.symposium@uottawa.ca
Website: www.ccncsymposium.com 

Muir-Torre syndrome-is it really a new syndrome? Am J Dermapathology

Note: that there is an overlap here with Lynch Syndrome

"This syndrome is defined as the coexistence of sebaceous adenomas, sebaceus carcinomas, keratoacanthomas, and pedunculated tumors, some with lobulated structure. The cutaneous involvement (sebaceous gland tumor) is associated with at least a single internal malignancy; mostly colonorectal or genitourinary malignancies."

ACOR in Time Magazine - 'Group Therapy'

A Physician's Perspective on Health 2.0 and Participatory Medicine

32 minute video

Patient Participation: Current Knowledge and Applicability to Patient Safety — Mayo Clinic Proceedings

"...Patient-related factors, such as acceptance of the new patient role, lack of medical knowledge, lack of confidence, comorbidity, and various sociodemographic parameters, all affect willingness to participate in the health care process. Among health care workers, the acceptance and promotion of patient participation are influenced by other issues, including the desire to maintain control, lack of time, personal beliefs, type of illness, and training in patient-caregiver relationships. Social status, specialty, ethnic origin, and the stakes involved also influence patient and health care worker acceptance.

A Revision Of The EU Clinical Trials Directive Supported By European Cancer Organization

"Certain groups of patients have been particularly hard hit: children, patients with rare cancers, patients who would profit greatly from international trials that optimise already existing treatments and which, therefore, do not find commercial sponsorship, and elderly patients with other health problems, including secondary cancers due to earlier treatments."