Editorial :: Cochrane in the United States of America - The Cochrane Collaboration (background/2010 Keystone, Colorado conference)

 Note: The Gynecologic Cancer Review Group section of the Cochrane is based out of the UK. Consumer reviewers may participate irrespective of geographic location as the Cochrane is primarily internet-based.


"On 18 October 2010, the first joint Colloquium between the Campbell and Cochrane Collaborations opens in Keystone, Colorado, USA. The USA last hosted the Cochrane Collaboration Colloquium and annual meeting in 1998 in Baltimore, Maryland. The Colloquium's return to the USA comes on the heels of President Obama's signing of historic health care reform legislation. As reported, "the reforms, which will cost an estimated USD 940 billion over 10 years, will expand the provision of care to 32 million more people, predominantly the poorest, and will result in the country achieving 95% coverage" (MacAskill 2010). At the same time The American Recovery and Reinvestment Act of 2009 has provided USD 1.1 billion for Comparative Effectiveness Research (CER), and established the Patient-Centered Outcomes Research Institute (PCORI). PCORI will make a major annual investment in CER, through the National Institutes of Health (NIH) and the Agency for Healthcare Research and Quality (AHRQ).

The US contribution to the development of The Cochrane Collaboration has been considerable. US-based researchers represented 7/84 (8.3%) of the pioneers attending the first Cochrane Colloquium in October 1993........."cont'd

full free access: PLoS Medicine: Seventy-Five Trials and Eleven Systematic Reviews a Day: How Will We Ever Keep Up? Cochrane Collaboration

"To meet the needs of patients, clinicians, and policymakers, unnecessary trials need to be reduced, and systematic reviews need to be prioritised. Streamlining and innovation in methods of systematic reviewing are necessary to enable valid answers to be found for most patient questions. Finally, clinicians and patients require open access to these important resources."

Cochrane Collaboration review: Interventions for the treatment of borderline ovarian tumours

Plain language summary

Interventions for the treatment of borderline ovarian tumours
Women with borderline (low malignant potential) ovarian tumours do very well after surgery and recurrences may be cured by further surgery. The ideal form of initial surgical treatment for borderline ovarian tumours is controversial. Furthermore, it is not known if additional treatment after surgery reduces the risk of re-appearance of tumours or of death.

In this review, we found six trials which enrolled 340 patients who had undergone surgery for borderline ovarian tumours. These trials compared the number of deaths among women who had various forms of treatment or no additional treatment after surgery. In five of the trials, the women had tumours confined to the ovaries and most were followed up for over 10 years. Only one trial enrolled women with tumours that had spread beyond the ovary, and this trial followed patients up for less than three years, which is not long enough to detect any difference between groups receiving different treatments. None of the trials found any demonstrable benefit from any of the additional forms of treatment. However, all six trials were conducted over 15 years ago and since then platinum-based chemotherapy has become widely used to treat advanced ovarian cancer. However, only one of the trials in our review assessed this more modern type of chemotherapy. Further trials of platinum-based chemotherapy and of less toxic treatments are needed, looking at the benefit of reducing the anxiety and distress of further surgery and treatment for relapse.

One further trial, which recruited 32 women who had borderline ovarian tumours in both ovaries, compared conservative surgery (taking away the most diseased ovary and removing the tumour from the other ovary) with ultra-conservative surgery (removing the tumours without taking away either ovary). Nearly all the women who had ultra-conservative surgery became pregnant compared with half of those who had conservative surgery. Although about two thirds of the women in the trial developed similar tumours again, most women got pregnant before the disease recurred, all had their recurrences treated by further surgery, none developed invasive ovarian cancer nor died of their tumour. This small study suggests that ultra-conservative surgery by an experienced surgeon with careful follow up for recurrence may be recommended for women with bilateral borderline ovarian tumours who still intend to have children but, ideally, this approach should be evaluated in other independent trials. Despite rigorous searches, we did not find any trial directly comparing conservative surgery with radical surgery (surgery to remove all of the female reproductive organs) or comparing keyhole surgery (laparoscopy) with open surgery (laparotomy) for women with borderline ovarian tumours.

2010 Review: Cochrane Collaboration Topotecan for ovarian cancer

Background
Chemotherapeutic agents such as topotecan can be used to treat ovarian cancer. The effects of using topotecan as a therapeutic agent have not been previously been systematically reviewed.
Objectives
To evaluate the effectiveness and safety of topotecan for the treatment of ovarian cancer. 

Results: 

Participants were more likely to respond to topotecan on a 21-day cycle as opposed to a 42-day cycle (RR 7.23, 95% CI 0.94 to 55.36). Small tumor diameter, sensitivity to platinum-based chemotherapy was associated with better prognosis. Small sample size, methodological flaws and poor reporting of the included trials made measurement bias of the trials difficult to assess.

Plain language summary

Topotecan is an active second line chemotherapeutic drug, used to treat patients with relapsed ovarian carcinoma
It appears to have a similar level of effectiveness as paclitaxel and pegylated liposomal doxorubicin, though with different patterns of side effects. Larger, well-designed randomised controlled trials (RCTs) are required to define an optimal regime.

Cochrane Collaboration review: Cytoreductive surgery plus chemotherapy versus chemotherapy alone for recurrent epithelial ovarian cancer

Plain language summary

Secondary surgical efforts to remove recurrent ovarian cancer in women who are no longer in remission
Ovarian cancer is the sixth most common cancer among women. Epithelial ovarian cancer is a disease in which malignant cells form in the tissue covering the ovary. It accounts for about 90% of ovarian cancers., the remaining 10% arise from germ cells and the sex cord and stroma of the ovary. Women with epithelial ovarian cancer that has returned after primary surgery (recurrent disease) may need secondary surgery to remove all or part of the cancer. The option of surgery (debulking or cytoreductive surgery) is currently offered to a select group of women with recurrent ovarian cancer. It is important to ascertain whether this surgery helps women with recurrent disease to survive for longer than if they only got chemotherapy.

We searched for studies that compared secondary cytoreductive surgery and chemotherapy with chemotherapy alone in women with recurrent epithelial ovarian cancer. Although we checked 1431 possible articles, we found no relevant studies. Therefore there is currently no evidence to determine if secondary cytoreductive surgery is better or worse than chemotherapy alone in terms of prolonging life.

The review highlights the need for good quality studies comparing secondary cytoreductive surgery to chemotherapy.

Cochrane Collaboration review: Interventions for improving the adoption of shared decision making by healthcare professionals

The James Lind Alliance announces the launch of online Guidebook for priority setting in research | The Cochrane Collaboration

"Sir Iain Chalmers, co-founder of the JLA says: “It is surprising how difficult it is to find out how research funders decide what research to fund. What is clear is that patients, carers and ordinary ‘jobbing’ clinicians are only very rarely involved in these processes. That is probably one of the reasons that the little evidence there is reveals mismatches between the questions that interest researchers and the questions that interest patients and clinicians. The James Lind Alliance Guidebook will help people who want to try to bridge those gaps.”...cont'd

U.S. Cochrane Center - Colorado conference/advocates' forum

Message from Cochrane Collaboration Consumer Network:

Please save the date (October 17, 2010) for an international Consumer Advocacy Summit, sponsored by Consumers United for Evidence-based Healthcare (CUE), immediately preceding the Cochrane and Campbell Colloquium in Keystone, Colorado.  We will have more program details for you soon!  Your participation in the full day meeting will make it a success!!

Questions can be directed to Janie Gordon, CUE Coordinator at jlgordon@jhsph.edu , (410) 502-4640.

 Thank you!

 Janie Gordon, ScM.

Cochrane Outreach Coordinator

US Cochrane Center

Johns Hopkins Bloomberg School of Public Health

615 North Wolfe Street, Mail Room W 5010

Baltimore, Maryland 21205 USA

Phone:410-502-4640

Email: jlgordon@jhsph.edu

Fax: 410-502- 4623

About consumer participation | Cochrane Consumer Network

Note: "prioritise topics for new reviews"
In response to a request from the Cochrane Network, ovarian cancer women/caregivers were asked to respond to a survey regarding priortisation. This was done, in part, through the ACOR Ovarian Cancer group (http://www.acor.org). A large response was received and the Cochrane Network responded in a positive manner.

 

About consumer participation

The authors of Cochrane reviews may consider a question for a review because of their own interests and experiences as a clinician or a healthcare researcher. These are not always the questions that are of most concern to healthcare consumers and their families and carers.

It is not easy for us, the public, to understand how the questions for Cochrane reviews need to be stated in order to be ‘answerable’ in research terms. You can learn more about this from our Training materials on the Resources webpage.

The purpose of consumer input during the review process is to:

• ensure that a review question is relevant to people requiring health care and who are offered an intervention by their healthcare providers;
• identify outcomes from healthcare interventions that are important for consumers – which may be different from those identified by service providers;
• improve access to reviews by ensuring that the review can be read by a wide audience, and the language is sensitive to consumers;
• weigh up the benefits of a healthcare intervention against the potential harms – from a healthcare user perspective;
• prioritise topics for new reviews.

Healthcare users in Cochrane | Cochrane Consumer Network

Purpose

The World Health Organization (1978) states: The people have the right and duty to participate individually and collectively in the planning and implementation of their health care.

Our core function is to provide consumer input into developing Cochrane systematic reviews of best evidence in health care and in utilising this evidence.

The purpose of this website is to tell you about The Cochrane Collaboration and how we receivers and users of health care, parents and carers can benefit from its work..

Information for consumers | The Cochrane Collaboration

Tamoxifen for relapse of ovarian cancer. Cochrane Collaboration review (abstract)

AUTHORS' CONCLUSIONS: We are unable to make any evidence-based recommendations as we found no comparative studies assessing the effectiveness of tamoxifen in women with recurrent ovarian cancer. There is limited evidence on anti-tumour activity from phase 2 studies, but these contain no data on the effect of tamoxifen on symptom control, QOL or the prolongation of life.

Plain language summary

No evidence to suggest tamoxifen benefits patients with relapsed ovarian cancer
Ovarian cancer often spreads before symptoms show. Cytotoxic drugs are often only partly effective and cause severe side-effects. The main aims of treatment for relapsed disease are symptom control and prolongation of life. No data from RCTs or non-RCTs were found, so there was no evidence that tamoxifen was effective and safe as a treatment for relapsed ovarian cancer. Laboratory studies suggest tamoxifen may be effective as a treatment for women with ovarian cancer. Although, uncontrolled non-comparative trials on patients with relapsed ovarian cancer showed tamoxifen may shrink or stabilise tumours in a small number, there is a strong need for an RCT or good quality non-randomised comparative studies to determine the effectiveness and safety of tamoxifen in terms of overall survival, tumour response, symptom control, quality of life and adverse events.

new and updated website: The Cochrane Collaboration

Cochrane Menstrual Disorders and Subfertility Group: Clomiphene citrate for unexplained subfertility in women

Plain English Summary: "Clomiphene citrate for unexplained subfertility in women Clomiphene citrate is a fertility drug that can increase the number of eggs released for possible fertilisation. It is used by women who do not ovulate regularly and by some who do but still have not become pregnant. Clomiphene citrate does not appear to increase the chance of pregnancy in women who ovulate regularly but have failed to conceive after more than a year of unprotected intercourse and so are considered to be subfertile. An associated risk of treatment with clomiphene citrate is a 10% chance of multiple pregnancy. The results of this review of trials should be used with caution due to the heterogeneity between some of the studies."

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 

Cochrane Symposium - Ottawa May 2010

Upcoming Cochrane Collaboration conference includes seminars for consumers/patients