Wednesday, April 11, 2012
Abstract: Adherence to Colorectal Cancer Screening: A Randomized Clinical Trial of Competing Strategies
Abstract: Adherence to Colorectal Cancer Screening: A Randomized Clinical Trial of Competing Strategies
""We have seen benefit from colon cancer screening with fewer people dying from it," said Dr. Theodore Levin, (MedicineNet quote) a gastroenterologist at the Kaiser Permanente Medical Center in Walnut Creek, Calif., and the author of an accompanying journal editorial. "If we want to raise our screening rates then we need to offer people choices other than colonoscopy."
Adherence to Colorectal Cancer Screening
A Randomized Clinical Trial of Competing Strategies
Background Despite evidence that several colorectal cancer (CRC) screening strategies can reduce CRC mortality, screening rates remain low. This study aimed to determine whether the approach by which screening is recommended influences adherence.
Methods We used a cluster randomization design with clinic time block as the unit of randomization. Persons at average risk for development of CRC in a racially/ethnically diverse urban setting were randomized to receive recommendation for screening by fecal occult blood testing (FOBT), colonoscopy, or their choice of FOBT or colonoscopy. The primary outcome was completion of CRC screening within 12 months after enrollment, defined as performance of colonoscopy, or 3 FOBT cards plus colonoscopy for any positive FOBT result. Secondary analyses evaluated sociodemographic factors associated with completion of screening.
Results A total of 997 participants were enrolled; 58% completed the CRC screening strategy they were assigned or chose. However, participants who were recommended colonoscopy completed screening at a significantly lower rate (38%) than participants who were recommended FOBT (67%) (P < .001) or given a choice between FOBT or colonoscopy (69%) (P < .001). Latinos and Asians (primarily Chinese) completed screening more often than African Americans. Moreover, nonwhite participants adhered more often to FOBT, while white participants adhered more often to colonoscopy.
Conclusions The common practice of universally recommending colonoscopy may reduce adherence to CRC screening, especially among racial/ethnic minorities. Significant variation in overall and strategy-specific adherence exists between racial/ethnic groups; however, this may be a proxy for health beliefs and/or language. These results suggest that patient preferences should be considered when making CRC screening recommendations.
health media: Cancer Care Costs Higher in U.S. Than Europe, But Survival Longer - MedicineNet
Cancer Care Costs Higher in U.S. Than Europe, But Survival Longer - MedicineNet
MONDAY, April 9 (HealthDay News) -- The United States spends more on health care than any other country, but those high costs may be paying off in cancer survival, a new report suggests.
U.S. cancer patients often live almost two years longer than similar patients in Europe, arguing for the dollar value of care given, researchers say.
However, Dr. Otis Brawley, the chief medical officer and executive vice president at the American Cancer Society, who was not involved in the study, said that "this paper has a huge fatal flaw in it."
"When you look at survival from time of diagnosis to time of death and you have a screened population that has a lot of diagnoses, you're filling that population with people who don't need treatment and because they are over-diagnosed, they have very long survival," he added.
These researchers attribute increased survival to the treatment, when it is really over-diagnosis, Brawley said. "So they are looking at a bunch of wasted, unnecessary treatment and then saying it was money well spent," he said.
"You don't look at survival rates -- this is a classic misuse of survival rates," Brawley said. "You have to look at death rates for each disease and not survival rates. The measurement should not be expense versus survival -- it should be expense versus mortality rate."
On that scale, the United States does well for some cancers and as well as they do in most of Europe for others, he said. "Mortality rates for breast and colon cancer are close to the mortality rates in Europe, but that may include the effect of over-treatment," Brawley said.
The report was published in the April issue of Health Affairs.
For the study, Tomas Philipson, the chair in public policy at the University of Chicago, and colleagues looked at cancer care in the United States and in 10 European countries from 1983 to 1999.
The investigators found that for most cancers, U.S. patients lived longer than Europeans. Americans lived an average of 11.1 years after diagnosis, compared with 9.3 years for Europeans, they said.
When the authors translated survival data to dollars, they found those extra years were worth $598 billion, which is an average of $61,000 per cancer patient.
The value of these survival gains was highest for prostate cancer ($627 billion) and breast cancer ($173 billion), the findings indicated.
To put a monetary value on survival, the researchers used a "statistical-life concept." In many such studies, they said, estimates are based on how much income a person would exchange for a lower risk of mortality.
"Our findings bear on the larger question of whether higher U.S. health care spending is worth it, suggesting -- although not confirming -- that it is," the researchers wrote.
"Further research is required to examine the drivers of spending and their effects on outcomes, including assessing the relative contributions of treatments, screening, the skill of health care personnel and other factors in improving patient outcomes," they concluded.
On the larger issue of the costs of cancer treatment, Brawley said that "we spend money in an irrational way. We harm people by over-treating them and over-treatment costs money."
Many patients are getting treatments that cause harm, but don't really prolong life, Brawley said. It's hard for a doctor to tell a patient there is nothing that can be done.
"That is the kind of thing doctors need to be developing skills in -- it's an emotional hurdle to say 'I can't stop this,'" he said.
Many patients think that giving up is admitting defeat, and want to be treated even if the treatment will do more harm than good, Brawley said.
"We all need to take a step back and take a look at reality and ask whether the patient stands a good chance of benefiting from a particular treatment. If there aren't benefits, then we ought to, perhaps, stop," he said.
"Instead of talking about rationing care, we need to talk about the rational use of care," Brawley added.
Abstract: B Vitamin and/or {omega}-3 Fatty Acid Supplementation and Cancer: Ancillary Findings From the Supplementation With Folate, Vitamins B6 and B12, and/or Omega-3 Fatty Acids (SU.FOL.OM3) Randomized Trial
Abstract: B Vitamin and/or {omega}-3 Fatty Acid Supplementation and Cancer: Ancillary Findings From the Supplementation With Folate, Vitamins B6 and B12, and/or Omega-3 Fatty Acids (SU.FOL.OM3) Randomized Trial
Conclusion We found no beneficial effects of supplementation with relatively low doses of B vitamins and/or
-3 fatty acids on cancer outcomes in individuals with prior cardiovascular disease.
Tuesday, April 10, 2012
open access: BMC Complementary and Alternative Medicine | Abstract | Consumers' experiences and values in conventional and alternative medicine paradigms: a problem detection study (PDS)
BMC Complementary and Alternative Medicine | Abstract | Consumers' experiences and values in conventional and alternative medicine paradigms: a problem detection study (PDS)
"Of 300 questionnaires distributed (Brisbane, Australia), 83 consumers responded."
"A 28% response (83 of 300 questionnaires distributed) was obtained for the consumer participants. More females (58) than males (25) responded. The majority of the consumers were middle-aged (47% aged 35–54 years, n = 47; 21 consumers were 34 or under and 15
were older than 55)." (Blogger's Note: null search results for 'cancer')
Conclusions
This PDS (problem detection study) has emphasized the perceived importance of open communication between consumers,
CAM and conventional providers, and has exposed areas where CAM consumers perceive
that issues exist across the CAM and conventional medicine paradigms. There is a lot
of information which is perceived as not being shared at present and there are issues
of discomfort and distrust which require resolution to develop concordant relationships
in healthcare. Further research should be based on optimisation of information sharing,
spanning both conventional and CAM fields of healthcare, due to both the relevance
of concordance principles within CAM modalities and the widespread use of CAM by consumers.
2012 April Screening for Ovarian Cancer: Evidence Update for the U.S. Preventive Services Task Force Reaffirmation Recommendation Statement
Screening for Ovarian Cancer: Evidence Update for the U.S. Preventive Services Task Force Reaffirmation Recommendation Statement
Screening for Ovarian Cancer
Evidence Update for the U.S. Preventive Services Task Force Reaffirmation Recommendation Statement
Release Date: April 2012By Mary B. Barton, MD, MP, and Kenneth Lin, MD.
This report is based on research conducted by staff at the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD. The investigators involved have declared no conflicts of interest with objectively conducting this research. The findings and conclusions in this document are those of the authors, who are responsible for its content, and do not necessarily represent the views of AHRQ. No statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.
The information in this report is intended to help clinicians, employers, policymakers, and others make informed decisions about the provision of health care services. This report is intended as a reference and not as a substitute for clinical judgment.
This report may be used, in whole or in part, as the basis for the development of clinical practice guidelines and other quality enhancement tools, or as a basis for reimbursement and coverage policies. AHRQ or U.S. Department of Health and Human Services endorsement of such derivative products may not be stated or implied.
Contents
AbstractIntroduction
Methods
Results
Conclusion
References
Abstract
Background: Ovarian cancer has the highest mortality rate of all gynecologic malignancies, and was the fifth leading cause of cancer death among women in 2004.Purpose: To perform a literature search for new, substantial evidence that would inform the reaffirmation of the U.S. Preventive Services Task Force's recommendation on screening for ovarian cancer.
Data Sources: We searched the MEDLINE and Cochrane databases. The searches were limited to English-language articles on studies of adult humans (age >18 years) that were published between July 1, 2002 and January 15, 2008 in core clinical journals.
Study Selection: For the literature on benefits of screening, we included controlled trials as well as systematic reviews and meta-analyses. For harms, we included controlled trials, cohort studies, case-control studies, and case series, as well as systematic reviews and meta-analyses. Two reviewers independently reviewed titles, abstracts, and full articles for inclusion.
(Results: Our literature search returned 64 potentially relevant titles that were entered into a reference database. A total of 60 articles were excluded after title and abstract review, and two more were excluded after full article review. We excluded 18 studies not related to ovarian cancer, 34 studies that did not describe screening, two studies that described no relevant outcomes, two studies that described a high-risk or special patient population, and three studies that were an inappropriate study type. One additional report of a prospective screening study that was included in the evidence for harms was identified after a supplemental search of MEDLINE for publications by selected authors)
Data Extraction: No new evidence was found on the benefits of screening for ovarian cancer. A single reviewer extracted data from studies on the harms of screening.
Data Synthesis: No new evidence was found on the benefits of screening for ovarian cancer. New evidence on the combination of ultrasonography and cancer antigen-125 blood tests for screening suggests that abnormal test results may result in surgery for a substantial proportion of women who do not have cancer.
Limitations: The search strategy employed may have missed some smaller studies on the benefits and harms of screening for ovarian cancer.
Conclusion: No new evidence was found on the benefits of screening for ovarian cancer. Screening asymptomatic women can result in unnecessary interventions, including surgery.
Platinum Resistance is in the Eye of the Beholder « Dr. Robert A. Nagourney – Rational Therapeutics – Blog including comments from Liz Mane +
Blogger's Note: pls read the whole article including comments for an accurate view of the opinions expressed
~~~~~~~~~~~~~~~~~~~~~~
Platinum Resistance is in the Eye of the Beholder « Dr. Robert A. Nagourney – Rational Therapeutics – Blog
"I was recently apprised of an online conversation surrounding the treatment of platinum refractory and platinum resistant ovarian cancer. To clarify our terminology, platinum refractory disease refers to cancer that progresses during platinum therapy. This would be considered the most platinum resistant of the ovarian patients. The term “platinum resistant” developed over the last two decades, by Markman and others, is used to describe patients who initially respond to platinum-based chemotherapy and then relapse within six months of treatment.
While platinum refractory seems intuitively obvious, it has been suggested that platinum resistance is somewhat more arbitrary........
included comment from
Liz Mane says:
"Dr. N.
I am the one who opined on a chat room that most oncologists won’t redeploy carbo to platinum refractory patients right after unsuccessful front line platinum therapy. However, whoever alerted this comment to you omitted a crucial qualifying aspect of my argument.
...........(I have a Ph.D. in research science though not in bio medical field). My conclusion was,.......
abstract: Medium-sized deletion in the BRCA1 gene: Limitations of Sanger sequencing and MLPA analyses.
Medium-sized deletion in the BRCA1 gene: Limitations of Sanger sequencing and MLPA analyses
Sanger sequencing and MLPA analyses.
Genet Mol Biol. 2012
Abstract
We describe a family with a history of breast and ovarian cancer in which MLPA analysis of the BRCA1 gene pointed to a deletion including a part of exon 11. Further characterization confirmed a loss of 374 bp in a region completely covered by conventional sequencing which had not revealed the deletion. Because this alteration was only detected serendipitously with an MLPA probe, we calculated the probabilities of detecting medium-sized deletions in large exons by methods including initial PCR amplification. This showed that a considerable fraction of medium-sized deletions are undetectable by currently used standard methods of mutation analyses. We conclude that long, widely overlapping amplicons should be used to minimize the risk of missing medium-sized deletions. Alternatively, large exons could be completely covered by narrow-spaced MLPA probes.
abstract: Physician characteristics and beliefs associated with use of pelvic examinations in asymptomatic women.
Physician characteristics and beliefs associated with use of pelvic examinations in asymptomatic women.
Abstract
OBJECTIVE:
To examine physicians' beliefs about the pelvic examination and identify physician characteristics associated with routine use of this procedure in the United States.
METHODS:
A total of 1250 United States family/general practitioners, internists, and obstetrician/gynecologists who participated in the 2009 DocStyles survey completed questions on beliefs regarding the utility of routine pelvic examinations for cancer screening. The survey also asked participants how often they performed this procedure as part of a well-woman exam, to screen for ovarian and other gynecologic cancers, to screen for sexually transmitted infections, and as a prerequisite for prescribing hormonal contraception.
RESULTS:
A total of 68.0% of obstetrician/gynecologists, 39.2% of family/general practitioners, and 18.7% of internists reported routinely performing pelvic examinations for all the purposes examined (<0.001). Adjusted analyses revealed that the factors most strongly associated with use of pelvic examinations for all purposes were being an obstetrician/gynecologist (odds ratio 8.5; 95% confidence interval 5.8-12.6) and believing that this procedure is useful to screen for gynecologic cancers (odds ratio 3.8; 95% confidence interval 2.6-5.5).
CONCLUSION:
Misconceptions about the utility of pelvic examinations to screen for gynecologic cancers are common. More effective strategies to change physicians' beliefs regarding the value of performing pelvic examinations in asymptomatic women are needed.
PMID: 22484240 [PubMed - as supplied by publisher]
abstract: Preoperative Identification of a Suspicious Adnexal Mass: A Systematic Review and Meta-analysis. PET/MRI/U/S
Blogger's Note: this abstract provides little comprehensive information (as per most abstracts) noting that the journal of Gynecologic Oncology is a subscriber-based journal ($$$); 'nail in the coffin' for ovarian cancer/pre-surgical assessment ??
~~~~~~~~~~~~~~~~~~~
abstract: Preoperative Identification of a Suspicious Adnexal Mass: A Systematic Review and Meta-analysis [Gynecol Oncol. 2012] - PubMed - NCBI
Abstract
OBJECTIVE:
To systematically review the existing literature in order to determine the optimal strategy for preoperative identification of the adnexal mass suspicious for ovarian cancer.METHODS:
A review of all systematic reviews and guidelines published between 1999 and 2009 was conducted as a first step. After the identification of a 2004 AHRQ systematic review on the topic, searches of MEDLINE for studies published since 2004 was also conducted to update and supplement the evidentiary base. A bivariate, random-effects meta-regression model was used to produce summary estimates of sensitivity and specificity and to plot summary ROC curves with 95% confidence regions.RESULTS:
Four meta-analyses and 53 primary studies were included in this review. The diagnostic performance of each technology was compared and contrasted based on the summary data on sensitivity and specificity obtained from the meta-analysis. Results suggest that 3D ultrasonography has both a higher sensitivity and specificity when compared to 2D ultrasound. Established morphological scoring systems also performed with respectable sensitivity and specificity, each with equivalent diagnostic competence. Explicit scoring systems did not perform as well as other diagnostic testing methods. Assessment of an adnexal mass by colour Doppler technology was neither as sensitive nor as specific as simple ultrasonography. Of the three imaging modalities considered, MRI appeared to perform the best, although results were not statistically different from CT. PET did not perform as well as either MRI or CT. The measurement of the CA-125 tumour marker appears to be less reliable than do other available assessment methods.CONCLUSION:
The best available evidence was collected and included in this rigorous systematic review and meta-analysis. The abundant evidentiary base provided the context and direction for the diagnosis of early-staged ovarian cancer.abstract: BRCA genetic testing of individuals from families with low prevalence of cancer: experiences of carriers and implications for population screening : small study 14 Ashkenazi Jewish women
BRCA genetic testing of individuals from families with low prevalence of cancer: experiences of carriers and implications for population screening : Genetics in Medicine : Nature Publishing Group
Purpose:
BRCA genes are associated with hereditary breast and ovarian cancers. Guidelines worldwide currently recommend BRCA genetic testing in asymptomatic individuals only if they belong to “high-risk” families. However, population screening for BRCA1/2
may be the logical next step in populations with a high prevalence of
founder mutations, such as Ashkenazi Jews. This study aimed to explore
(i) the impact of a positive BRCA genetic test result on
individuals who have neither a personal history nor a familial history
of cancer and (ii) their attitudes toward the concept of population
screening.
Methods:
Semistructured in-depth interviews were carried out with 14 Ashkenazi Jewish women who were asymptomatic BRCA carriers and who belonged to families with low prevalence of cancer.
Results:
Three main findings emerged: (i) having no family
history of cancer was a source of optimism but also confusion; (ii)
engaging in intensified medical surveillance and undergoing preventive
procedures was perceived as health-promoting but also tended to induce a
sense of physical and psychological vulnerability; and (iii) there was
overall support for BRCA population screening, with some reservations.
Conclusion:
Women belonging to low-cancer-prevalence families within a “high-risk” ethnic community view BRCA
genetic testing positively despite the difficulties entailed, because
it allows prevention or early detection of cancer. However, implementing
a BRCA population screening program should be carried out with
proper pre- and post-testing preparation and support for the individuals
undergoing testing.
abstract: A systematic review evaluating the relationship between progression free survival and post progression survival in advanced ovarian cancer
Blogger's Note:
this is and has been an ongoing issue in clinical trials as most use still use overall survival (OS) (as per this paper and others) as the endpoint as opposed to progression free survival; it is a technical debate having wide implications for ovarian cancer treatments/patients, without access to the full text paper and based on the abstract alone, one outstanding issue would be the impact of QOL/side effects/number of prior treatments, so in plain english as an example - clinical trial x includes standard treatment vs other, no more than eg. 3 prior chemos would be a component of the clinical trial - therefore - what was/is the mix of patients in the trial - all of which impact survival ratios irrespective of PFS/OS; opinions as usual are welcome
~~~~~~~~~~~~~~~~~
A systematic review evaluating the relationship between progression free survival and post progression survival in advanced ovarian cancer:
Objective
Although overall survival is the ultimate goal of cancer therapy, many clinical and health economic decisions are taken when only progression free survival (PFS) data are available. This study evaluates the relationship between PFS and post progression survival (i.e. the time between disease progression and death) to estimate how many months a new drug for ovarian cancer might add to overall survival if the number of months the drug added to PFS (relative to a standard drug) was already known.
Methods
A literature search was conducted over Medline for randomised controlled trials published between January 1990 and July 2010 that evaluated the effect of a drug treatment in comparison to alternative drug treatment in patients with either advanced stage primary or recurrent ovarian cancer.
A systematic review of progression free and post progression survival (PPS) was performed. The relationship between PFS and PPS was evaluated by a graphical method and standard statistical tests.
Results
Thirty-seven trials involving 15,850 patients met the inclusion criteria. The review found that increases in median PFS generally lead to little change in post-progression survival. Percentage gains in PFS are generally associated with no percentage gains or with very slight percentage gains or losses in post-progression survival
Conclusion
If the effect of a new drug treatment for ovarian cancer is to extend median PFS by x months, then it is reasonable to estimate that the treatment will also extend median overall survival by x months. This information will be useful for individual and collective decision making.
LinkedIn: Respectful Insolence author: Orac -Medicine and evolution, part 13: The fly in the ointment of personalized cancer therapy
Medicine and evolution, part 13: The fly in the ointment of personalized cancer therapy
"About a year ago, I addressed what might seem to the average reader to be a very simple, albeit clichéd question: If we can put a man on the moon, why can't we cure cancer? As I pointed out at the time, it's a question that I sometimes even ask myself, particularly given that cancer has touched my life. Three years ago, my mother-in-law died of a particularly nasty form of breast cancer. Even though I am a breast cancer surgeon, I still wonder why there was nothing that could save her (and still is nothing that could have saved her if it existed then) from a decline over several months followed by an unpleasant death. Yet, as a cancer researcher, I do understand somewhat. A couple of years ago, I wrote in depth about the complexity of cancer from a science-based viewpoint, as compared, of course, to the incredibly simplistic view...............
JCO search: "clear cell ovarian"
Blogger's Note: these search results are not entirely specific but date back to 1987
JCO - Searching journal content for clear cell ovarian (all words) in title or abstract.
Displaying results 1-60 of 93a must! JCO Podcast - Commentary: Low-Stage Ovarian Clear Cell Carcinoma: Population-Based Outcomes in British Columbia, Canada, With Evidence for a Survival Benefit As a Result of Irradiation
Blogger's Opinion/Notes:
- it is very worthwhile to listen to this podcast
- radiation therapy in ovarian cancer has a very long history and in particular biases
- this podcast is a stunningly frank observation regarding clear cell ovarian cancer/radiation therapy, observation/s on the recent Hoskins clear cell report including the issues of size of studies eg. clear cell ovarian cancer (in particular) has a low incidence rate and therefore, agreeably (mine) that this is a point/statistic which cannot be changed eg. rare cell types
- this blog has many past posts over decades of research regarding radiation/irridation therapy in clear cell/ovarian cancer
- a blog/or otherwise search on this issue would be wise to understand the points being made in these two articles
- note also the Hoskins abstract regarding survival rates in clear cell ovarian cancer which, IMHO, have been widely ignored (stats issues) for decades (eg. early stage survival rates ~90% - popular stats quotes)
~~~~~~~~~~~~
JCO Podcast
Low-Stage Ovarian Clear Cell Carcinoma: Population-Based Outcomes in British Columbia, Canada, With Evidence for a Survival Benefit As a Result of Irradiation
Users can play the podcast directly in the audio player embedded below. If Flash is disabled on your browser, you can save the file directly to your computer or open on your mobile device by clicking on "download file."
Management of Low Stage Ovarian Clear Cell Carcinoma
by Martin Gore
(Download file - duration 0:08:22, file size 7.69 MB)
abstract: Low-Stage Ovarian Clear Cell Carcinoma: Population-Based Outcomes in British Columbia, Canada, With Evidence for a Survival Benefit As a Result of Irradiation
Low-Stage Ovarian Clear Cell Carcinoma: Population-Based Outcomes in British Columbia, Canada, With Evidence for a Survival Benefit As a Result of Irradiation
Abstract
Purpose
To evaluate the population-based outcomes of stage I and II ovarian clear cell carcinoma (OCCC) in a North American population
treated with carboplatin/paclitaxel and abdominopelvic irradiation.
Patients and Methods
Retrospective analysis was performed of 241 patients referred in the
carboplatin/paclitaxel era. Irradiation was to be used
with a few defined exceptions. However, because
of differing beliefs as to its effectiveness, its use was consistently
avoided
by specific oncologists, allowing the
opportunity to study its possible effect on disease-free survival (DFS)
in these concurrent
cohorts.
Results
Five- and
10-year DFS rates were 84% and 70% for stage IA/B; 67% and 57% for stage
IC; and 49% and 44% for stage II, respectively.
Five- and 10-year DFS rates for those with stage
IC disease based purely on rupture were similar to rates for patients
with
stage IA/B, at 92% and 71%, respectively.
The
remaining patients with stage IC had 48% 5- and 10-year DFS.
Multivariate analysis
using a decision tree identified positive
cytology as the most important factor (72% relapse rate if positive and
27% if negative
or unknown).
If, in addition, the capsule
surface was involved, then the relapse rate was 93%. Irradiation had no
discernible
survival benefit for patients with stage IA and
IC (rupture alone), whereas for the remainder of patients with stage IC
and
stage II, it improved DFS by 20% at 5 years
(relative risk, 0.5); the benefit was most evident in the cytologically
negative/unknown
group.
Conclusion
DFS is
similar in this North American population with early OCCC to the DFS
reported in Asia. A potential benefit from irradiation
was evident in a subset.
Monday, April 09, 2012
The Drug Shortage Wars | The Health Care Blog (ovarian cancer untreated for weeks)
The Drug Shortage Wars | The Health Care Blog
“I should have gotten cancer last month,” she told me.
That was the first thought from my patient
after she’d heard the news: her ovarian cancer would remain untreated
for weeks, due to a critical shortage of the chemotherapy agent
doxorubicin. Like her, several thousand patients have been affected by
critical shortages of chemotherapy agents like doxorubicin (Doxil) and
methotrexate—common medicines that are essential backbones of cancer
chemotherapy. But hundreds of other people have also been affected by
critical shortages of pills around the country—limiting the supply of
critical ICU medications like intravenous versed, or tuberculosis drugs
like isoniazid.
Why are these shortages happening, and what can be done about them?....
Related Posts
worth reading: Lessons for journalists & the public about medical conference news
Blogger's Note: this is worth reading mostly in particular to the reading of published abstracts and the ultimate findings/abstract accuracy
Lessons for journalists & the public about medical conference news
Abstract - Biotargets of Cancer in Current Clinical Practice - Ovarian Cancer
Medicine
Abstract -
Abstract
Ovarian cancer is the fifth most common
cancer in women and is the most lethal of all gynecologic cancers.
Early-stage ovarian
cancer is curable while women who are diagnosed with
advanced ovarian cancer continue to have poor long-term survival due
to recurrence of disease. Unfortunately, most women are
diagnosed with advanced-stage disease. Early detection is a primary
objective for clinicians and scientists, yet single modality
(CA-125, transvaginal ultrasound) screening tests have been
ineffective.
More recent novel approaches combining modalities and
utilizing serial serum sampling are being tested and hold great promise.
In addition, the recent application of proteomics to this
clinical question has the potential to identify new and important
biotargets.
Unfortunately, the majority of ovarian
cancer patients have advanced-stage disease, and although most will die
of their disease,
their survival is quite heterogenous (different).
The ability to
stratify patients according to prognosis could help guide therapy. The
current “gold standard” for prognosis uses patient,
surgical, and tumor characteristics, yet these have the tendency to be
notoriously inaccurate. This prognostic uncertainty and
the drive to identify predictive factors by which we can select novel
and targeted therapy have stimulated researchers to look
beyond traditional markers and test and validate molecular and genomic
biomarkers, which are anticipated to soon complement or
even eclipse traditional factors clarifying prognosis and select
treatments.
For patients with advanced-stage disease, a multitude of
prognostic factors have been characterized. While promising, none
of these biotargets have been validated at present to be
clinically useful. More recent application of genomic technologies
is likely to yield clinically relevant signatures and/or
biotargets which will provide the basis for personalization of care
for these patients.
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