Patterns of recurrence in advanced epithelial ovarian, fallopian tube and peritoneal cancers treated with intraperitoneal chemotherapy

Patterns of recurrence in advanced epithelial ovarian, fallopian tube and peritoneal cancers treated with intraperitoneal chemotherapy

Publication year: 2012
Source:Gynecologic Oncology, Volume 127, Issue 1

Objectives To examine the distribution and outcomes of recurrent disease in patients with ovarian, fallopian tube and peritoneal cancers after optimal cytoreduction and adjuvant intraperitoneal (IP) chemotherapy. Methods All patients diagnosed with ovarian, fallopian tube, or peritoneal cancer between 2004 and 2009 who underwent optimal cytoreductive surgery and received adjuvant intravenous (IV) and IP chemotherapy with paclitaxel and a platinum-based agent were eligible. Age, performance status, tumor origin, stage, and grade were recorded. First recurrences were identified using CA125 values, radiographic studies, operative notes, and pathology reports. Sites of recurrence were classified as intraperitoneal (IP), extraperitoneal (EP) or distant. Kaplan–Meier estimates and Cox multivariate regression models were used to assess the associations between recurrent disease distribution and progression-free survival (PFS) and overall survival (OS). Results One hundred forty-three patients met the criteria for inclusion. The majority were Stage III (86%) and serous histology (77%). Eighty-four (58.7%) received IV/IP paclitaxel/cisplatin per GOG-172 and 59 (41.3%) received IV/IP paclitaxel/carboplatin. Seventy-two percent completed 6cycles. Ninety (62.9%) patients manifested a recurrence. One-hundred twelve sites of recurrence were identified with 70 (62.5%) IP and 42 (37.5%) EP and distant sites. Nineteen (21%) recurred in more than one site, i.e. both IP and EP locations. Site of recurrence did not impact OS, however, patients who recurred in multiples sites had significantly worse OS (p<0.001). Conclusion Approximately 40% of patients treated with IP chemotherapy have a first recurrence outside the peritoneal cavity. Though site of recurrence did not affect OS those with multi-focal recurrence demonstrate worse survival.

Highlights

► 41% of patients manifest a first recurrence outside the peritoneal cavity after IP chemotherapy. ► 72% of patients completed all 6cycles of IP chemotherapy. ► Patients that recur in multiple locations manifest a worse overall survival

Trastuzumab (Herceptin) tied to increased heart failure risk

Trastuzumab (Herceptin) tied to increased heart failure risk Publish date: Aug 31, 2012 Clinical Last Updated: 2012-08-30 18:35:16 -0400 (Reuters Health) By Genevra Pittman NEW YORK (Reuters Health) - The chemotherapy combination of anthracycline and trastuzumab (Herceptin) increased women's risk of heart failure sevenfold in a new retrospective cohort study - and anthracycline wasn't all to blame. The risk of heart failure or cardiomyopathy "was highly increased in patients treated with trastuzumab alone," the researchers reported in a paper released August 30 by the Journal of the National Cancer Institute. Earlier randomized controlled trials also showed a link between the drugs and heart failure risk. But researchers said those risks may have been underestimated because the studies were limited to younger women without comorbidities. "The rates of heart failure might actually be higher than what clinical trials have estimated to be associated with these drugs," lead researcher Erin Bowles from Group Health Research Institute in Seattle, Washington told Reuters Health....

http://www.modernmedicine.com/modernmedicine/Modern+Medicine+Now/Trastuzumab-Herceptin-tied-to-increased-heart-fail/ArticleNewsFeed/Article/detail/786948?contextCategoryId=40139&ref=25

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Agents to prevent chemo-induced nausea lacking: study - - ModernMedicine

http://www.modernmedicine.com/modernmedicine/Modern+Medicine+Now/Agents-to-prevent-chemo-induced-nausea-lacking-stu/ArticleNewsFeed/Article/detail/786880?contextCategoryId=40139&ref=25


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JCO : Journal of Clinical Oncology Blindness: Looking but Not Seeing (the art of oncology)

http://m.jco.ascopubs.org/content/30/25/3141.short?rss=1


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Does tumour biology determine surgical success in the treatment of epithelial ovarian cancer? A systematic literature review

Does tumour biology determine surgical success in the treatment of epithelial ovarian cancer? A systematic literature review

http://www.nature.com/bjc/journal/vaop/ncurrent/full/bjc2012376a.html

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Access : Phase I oncology trials incorporating patient choice of dose : British Journal of Cancer

http://www.nature.com/bjc/journal/vaop/ncurrent/full/bjc2012378a.html


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Hormone replacement therapy use continue to fall - - ModernMedicine

http://www.modernmedicine.com/modernmedicine/Endocrinology/Hormone-replacement-therapy-use-continue-to-fall/ArticleNewsFeed/Article/detail/786702?contextCategoryId=40139&ref=25


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Modeling the Longitudinal Transitions of Performance Status in Cancer Outpatients: Time to Discuss Palliative Care

Modeling the Longitudinal Transitions of Performance Status in Cancer Outpatients: Time to Discuss Palliative Care

Publication year: 2012
Source:Journal of Pain and Symptom Management
Rinku Sutradhar, Hsien Seow, Craig Earle, Deborah Dudgeon, Clare Atzema, Amna Husain, Doris Howell, Ying Liu, Jonathan Sussman, Lisa Barbera
Context Understanding the longitudinal transitions of performance status among persons with cancer can assist providers in determining the appropriate time to initiate palliative care support. Objectives To model longitudinal transitions of the performance status in cancer outpatients, to determine the probabilities of improvement and deterioration in performance status over time, and to evaluate the factors associated with rates of transitions. Methods This population-based, retrospective, cohort study comprised adult outpatients diagnosed with any type of cancer and assessed for performance status throughout their observation period using the Palliative Performance Scale (PPS; scale 0–100; 0 indicates death). At every PPS assessment, patients were assigned to one of four states: stable state (PPS score 70–100), transitional state (PPS score 40–60), end-of-life state (PPS score 10–30), or dead. A Markov multistate model under the presence of interval censoring was used to examine the rate of state-to-state transitions. Results There were 11,374 patients representing nearly 71,000 assessments. Patients with lung cancer in the transitional state had a 27.7% chance of being dead at the end of one month vs. 17.5% in patients with breast cancer. The average time spent in the transitional state was 6.6 weeks for patients diagnosed with gastrointestinal cancer vs. 8.8 weeks for patients with breast cancer. The rate at which one moves from the transitional state to death was higher for patients with lung cancer than those with breast cancer. Conclusion We estimated the probability and direction of change in performance status in cancer outpatients. Entry into the transitional state may serve as an indicator for referral for palliative care support. Mean end-of-life sojourn times are too short to allow meaningful integration of palliative care.

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Constipation in Palliative Care: What Do We Use as Definitions and Outcome Measures?

Constipation in Palliative Care: What Do We Use as Definitions and Outcome Measures?

Publication year: 2012
Source:Journal of Pain and Symptom Management

Context 

Advances in the management of constipation in palliative care remain hindered by the lack of agreed-upon diagnostic criteria. Objectives The objective of this work was to emphasize this issue by systematically examining the eligibility and primary outcome measures in studies of constipation in the hospice and palliative care population. Methods A palliative care-specific electronic literature search was undertaken using the validated domain filter "palliative care" and topic filter "constipation" in CareSearch (www.caresearch.com.au), which interrogates PubMed in real time (1965–2011). Studies were included if they were primary reports of the treatment of constipation in a palliative care setting. Articles could be prospective or retrospective; randomized controlled trials, cohort studies, or case series. Results Twenty articles on the palliative care population were included in which there were six different definitions of constipation. Only 12 of 20 articles used their cited definitions of constipation as the studies' primary outcome measures and four of four blinded randomized controlled trials. Articles that used the time between bowel actions or the use of laxatives as the definition of constipation were most likely to report outcomes based on these criteria. Conclusion Constipation is a significant problem in palliative care; however, not having an agreed-upon definition limits research initiatives and the ability to apply these results clinically to people with constipation. Four domains are suggested as pivotal to the diagnosis: any life-long history of constipation (using the Rome Criteria), evaluation of physical changes that may cause or worsen constipation, the subjective sensation (such as feelings incomplete defecation or bloating or fullness), and objective changes (such as frequency or consistency of stools).

Safety Alerts for Human Medical Products > Baxter Healthcare Corporation, Automix Automated Nutrition Compounder Systems: Class I Recall - Risk of Fluid Entry into Device Keypads ( TPN )

http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm317448.htm?source=govdelivery


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Proportion cured models applied to 23 cancer sites in norway.

Proportion cured models applied to 23 cancer sites in norway.

Abstract

BACKGROUND: Statistical cure is reached when a group of patients has the same mortality as cancer-free individuals. Cure models predict the cured proportion and the median survival of fatal cases. Cure models have seldom been applied and tested systematically across all major cancer sites.

METHODS: Incidence and follow-up data on 23 cancer sites recorded at the Cancer Registry of Norway 1963-2007 were obtained. Mixture cure models were fitted to obtain trends and up-to-date estimates (based on period approach) assuming cured and uncured groups exist.

RESULTS: The model converged for cancers of the mouth and pharynx, oesophagus, stomach, colon, rectum, liver, gallbladder, pancreas, lung and trachea, ovary, kidney, bladder, CNS, non-Hodgkin lymphoma (only for males) and leukaemia. The proportion of cured patients increased 1963-2002 for both sexes, with the largest changes (in %) seen for leukaemia (46.4 and 46.7) and CNS (35.9, 42.0), males given first. Median survival time for the uncured cases increased for colon and rectal cancer, and there was a three- fold increase in median survival time for patients with fatal ovarian cancers. Cancers of bladder and CNS had the highest up-to-date proportion cured (in %) (67.4 and 64.0, respectively), pancreas and liver were amongst the lowest (5.7 and 9.9, respectively).

CONCLUSION: Cure models are useful when monitoring progress in cancer care, but must be applied and interpreted with caution. The absolute estimates of the cure proportion are speculative, and should not be calculated where cure is not medically anticipated. © 2012 Wiley Periodicals, Inc.

http://www.ncbi.nlm.nih.gov/m/pubmed/22927104/?i=13&from=ovarian%20cancer

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Anticipatory Loss and Early Mastectomy for Young Female BRCA1/2 Mutation Carriers.

Anticipatory Loss and Early Mastectomy for Young Female BRCA1/2 Mutation Carriers.

Abstract

Young women who carry BRCA1/2 mutations face difficult decisions in managing their hereditary breast/ovarian cancer risk. Through this National Cancer Institute study, we sought to understand the process by which some young women choose risk-reducing bilateral mastectomy (RRBM) instead of alternative risk-management options. Data indicate that electing to undergo RRBM, although difficult, is experienced as a way to sidestep potentially devastating outcomes, such as stressful and costly high-risk screening, chemotherapy or radiation, or putting loved ones through the challenges of a cancer diagnosis. The decision to pursue RRBM is often the product of screening fatigue, encouragement from loved ones, and/or a sense of urgency to put one's high-risk period behind one. By understanding how young carriers make decisions about surgical risk reduction, providers can better guide, counsel, and support patients in the important tasks surrounding this life-changing medical decision, thereby helping to increase the duration and quality of their lives.

PMID

 22927701 [PubMed - as supplied by publisher]

http://www.ncbi.nlm.nih.gov/m/pubmed/22927701/?i=9&from=ovarian%20cancer

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PDF: Emerging treatment options for management of malignant ascites in patients with ovarian cancer

Emerging treatment options for management of malignant ascites in patients with ovarian cancer

http://www.dovepress.com/emerging-treatment-options-for-management-of-malignant-ascites-in-pati-peer-reviewed-article-IJWH

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Emerging treatment options for management of malignant ascites in patients with ovarian cancer.

Emerging treatment options for management of malignant ascites in patients with ovarian cancer.

Abstract

Malignant ascites affects approximately 10% of patients with recurrent epithelial ovarian cancer and is associated with troublesome symptoms, including abdominal pressure and distension, dyspnea, bloating, pelvic pain, and bowel/bladder dysfunction. To date, no effective therapy has been identified for the treatment of malignant ascites in patients with recurrent, advanced ovarian cancer. In this article, we discuss currently existing options for the treatment of ascites associated with ovarian cancer, and review the literature as it pertains to novel, targeted therapies. Specifically, preclinical and clinical trials exploring the use of the antiangiogenic agents, bevacizumab and vascular endothelial growth factor-trap, as well as the nonangiogenic agent, catumaxomab, will be reviewed. Despite current limitations in treatment, knowledge regarding management options in the palliation of ascites is critical to practicing physicians. Ultimately, as with all novel therapies, symptom relief and treatment goals must be weighed against patient discomfort and potentially significant adverse events.

http://www.ncbi.nlm.nih.gov/m/pubmed/22927770/?i=8&from=ovarian%20cancer

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Oophorectomy: the debate between ovarian conservation and elective oophorectomy.

Oophorectomy: the debate between ovarian conservation and elective oophorectomy.

ABSTRACT: Ovarian cancer remains the fifth deadliest cancer among women because of its early asymptomatic nature and lack of efficacious screening methods, leading to frequent late-stage diagnosis. Elective oophorectomy is an option for women undergoing benign hysterectomy as a means of reducing their ovarian cancer risk. Benefits also include reduced risk of repeat surgical operation due to adnexal masses and reduced anxiety related to perceived risk of ovarian and breast cancer. The potential negative side effects of elective oophorectomy, such as decreased cognition and sexual function and increased risk of osteoporosis and cardiac mortality, offer support for ovarian conservation. The implications of this elective procedure and the possible consequences without it require physicians to review the pros and cons with patients in light of the patient's individual circumstances and ovarian cancer risk.

PMID

 22929033 [PubMed - as supplied by publisher]

http://www.ncbi.nlm.nih.gov/m/pubmed/22929033/?i=4&from=ovarian%20cancer

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Changes in short-term health-related quality of life in women undergoing gynecologic oncologic laparotomy: an associated factor analysis.

Changes in short-term health-related quality of life in women undergoing gynecologic oncologic laparotomy: an associated factor analysis.

Journal

Support Care Cancer. 2012 Aug 29

Abstract

PURPOSE: The primary purpose of this study is to evaluate health-related quality of life (HR-QOL) of gynecologic cancer patients undergoing laparotomy.

METHODS: Women who underwent laparotomy by gynecologic cancer completed the European Organization for Research and Treatment of Cancer (EORTC) Quality of life questionnaires (QLQ-C30 and QLQ-OV28) presurgery and at 1 month.

RESULTS: Of the 181 women studied between January 2007 and March 2008, 116 women (64.1 %) had ovarian cancer, 27 (14.9 %) had cervical cancer, and 29 (16.0 %) had endometrial cancer. By 1 month post-surgery, there was a significant decrease in HR-QOL on the global, abdominal/gastrointestinal (GI) score, body image, chemotherapy side effects, and other single items of the OV28 questionnaire, as well as on physical, role and social functioning, fatigue, nausea and vomiting, pain, insomnia, constipation, appetite loss, and financial difficulties items on C30 questionnaires. Emotional functioning on C30 questionnaires was significantly improved 1 month after surgery. The majority of these items persisted 1 month after surgery only in patients with ovarian cancer. Abdominal/GI score on OV28 questionnaires as well as role and physical functioning on C30 questionnaires were significantly lower between baseline and postsurgical HR-QOL in women with other gynecologic malignancies.

CONCLUSION: The results suggest a significant impact of HR-QOL among gynecologic cancer patients 1 month after laparotomy, particularly among those with ovarian cancer.

http://www.ncbi.nlm.nih.gov/m/pubmed/22930239/?i=2&from=ovarian%20cancer

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CANDISC: NCI Trials Program Looks for Net Gains

NCI Trials Program Looks for Net Gains

http://m.cancerdiscovery.aacrjournals.org/content/early/2012/08/15/2159-8290.CD-NB2012-091.full

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Gender bias in leading scientific journals

http://www.sciencedaily.com/releases/2012/08/120830102851.htm?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+sciencedaily+%28ScienceDaily%3A+Latest+Science+News%29&utm_content=Google+Reader


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CEU Bulletin, July 2012 | Cochrane Clinical Answers

Cochrane Clinical Answers

Wiley and the Cochrane Editorial Unit are working on a project to create a new product: Cochrane Clinical Answers (CCAs). CCAs are aimed at clinicians at the point of care, and they use evidence from Cochrane systematic reviews to create short answers to clinical questions. The content is developed by drawing out key information from Cochrane Reviews (an automated process), then a team of freelance clinicians (associate editors) and the CCA Editor use this evidence to create the clinical answers. All CCAs are then signed off by The Cochrane Library Editor-in-Chief, David Tovey.

We currently have 53 CCAs going through the editorial process, 32 of which have been signed off. Alongside the editorial work, the CCA website is being developed, and we are aiming for a clear, uncomplicated design that is easy and quick to use. Market testing of the site has been completed and Wiley is currently working to incorporate both market testing and CEU feedback. The site is due to launch later in the year and will be on display at the Cochrane Colloquium in Auckland. If Cochrane Review Groups would like to be involved in this project in any way, or if they have any questions, please do contact me.

Karen Pettersen (kpettersen@wiley.com), CCA editor

http://www.editorial-unit.cochrane.org/ceu-bulletin-july-2012#Bull2

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Chat With a Doctor: Ovarian Cancer — Health Hub from Cleveland Clinic

http://health.clevelandclinic.org/2012/08/chat-with-a-doctor-ovarian-cancer/?utm_source=rss&utm_medium=rss&utm_campaign=chat-with-a-doctor-ovarian-cancer


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Am. J. Epid. - The Forgotten Griever: A Nationwide Follow-up Study of Mortality Subsequent to the Death of a Sibling

The Forgotten Griever: A Nationwide Follow-up Study of Mortality Subsequent to the Death of a Sibling

http://m.aje.oxfordjournals.org/content/176/4/338.short?rss=1

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Fruit and vegetable intake and impact on pancreatic cancer....

".....Associations were similar for men and women separately and across studies. These results suggest that fruit and vegetable intake during adulthood is not associated with a reduced pancreatic cancer risk."

http://www.google.ca/reader/i/?source=mog&hl=en&gl=ca#stream/feed%2Fhttp%3A%2F%2Faje.oxfordjournals.org%2Frss%2Fcurrent.xml


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Risks of Primary Extracolonic Cancers Following Colorectal Cancer in Lynch Syndrome

Risks of Primary Extracolonic Cancers Following Colorectal Cancer in Lynch Syndrome:

Background
Lynch syndrome is a highly penetrant cancer predisposition syndrome caused by germline mutations in DNA mismatch repair (MMR) genes. We estimated the risks of primary cancers other than colorectal cancer following a diagnosis of colorectal cancer in mutation carriers.

Methods
We obtained data from the Colon Cancer Family Registry for 764 carriers of an MMR gene mutation (316 MLH1, 357 MSH2, 49 MSH6, and 42 PMS2), who had a previous diagnosis of colorectal cancer. The Kaplan–Meier method was used to estimate their cumulative risk of cancers 10 and 20 years after colorectal cancer. We estimated the age-, sex-, country- and calendar period–specific standardized incidence ratios (SIRs) of cancers following colorectal cancer, compared with the general population.

Results
Following colorectal cancer, carriers of MMR gene mutations had the following 10-year risk of cancers in other organs: kidney, renal pelvis, ureter, and bladder (2%, 95% confidence interval [CI] = 1% to 3%); small intestine, stomach, and hepatobiliary tract (1%, 95% CI = 0.2% to 2%); prostate (3%, 95% CI = 1% to 5%); endometrium (12%, 95% CI = 8% to 17%); breast (2%, 95% CI = 1% to 4%); and ovary (1%, 95% CI = 0% to 2%). They were at elevated risk compared with the general population: cancers of the kidney, renal pelvis, and ureter (SIR = 12.54, 95% CI = 7.97 to 17.94), urinary bladder (SIR = 7.22, 95% CI = 4.08 to 10.99), small intestine (SIR = 72.68, 95% CI = 39.95 to 111.29), stomach (SIR = 5.65, 95% CI = 2.32 to 9.69), and hepatobiliary tract (SIR = 5.94, 95% CI = 1.81 to 10.94) for both sexes; cancer of the prostate (SIR = 2.05, 95% CI = 1.23 to 3.01), endometrium (SIR = 40.23, 95% CI = 27.91 to 56.06), breast (SIR = 1.76, 95% CI = 1.07 to 2.59), and ovary (SIR = 4.19, 95% CI = 1.28 to 7.97).

Conclusion

Carriers of MMR gene mutations who have already had a colorectal cancer are at increased risk of a greater range of cancers than the recognized spectrum of Lynch syndrome cancers, including breast and prostate cancers.

How Radiation Oncologists Would Disclose Errors: Results of a Survey of Radiation Oncologists and Trainees

How Radiation Oncologists Would Disclose Errors: Results of a Survey of Radiation Oncologists and Trainees:

Purpose: To analyze error disclosure attitudes of radiation oncologists and to correlate error disclosure beliefs with survey-assessed disclosure behavior.

Conclusions: The surveyed radiation oncologists chose to respond with full disclosure at a high rate, although ideal disclosure practices were not uniformly adhered to beyond the initial decision to disclose the occurrence of the error.

ongoing: (gyn cancers) ChemoFx® PRO - A Post-Market Data Collection Study - Full Text View - ClinicalTrials.gov

ChemoFx® PRO - A Post-Market Data Collection Study - Full Text View - ClinicalTrials.gov