Sunday, September 02, 2012
Canadian Pharmacare: Looking Back, Looking Forward :: Longwoods.com
.....While opinion polls suggest that Canadians' support of medicare has remained more or less constant since its inception, the healthcare system has not.....
http://www.longwoods.com/content/23017
Sent from my iPhone
Epithelial Ovarian Cancer Clinical Trial: A Study of LY2228820 for Recurrent Ovarian…
Official Title: "A Randomized, Double-Blind, Placebo-Controlled Phase 1b/2 Study of LY2228820, a p38 MAPK Inhibitor, Plus Gemcitabine and Carboplatin Versus Gemcitabine and Carboplatin for Women With Platinum-Sensitive Ovarian Cancer"
A study for women with ovarian cancer that has returned at least 6 months after platinum-based chemotherapy.....,
Sent from my iPhone
PLoS ONE: Content Analysis of Oncology-Related Pharmaceutical Advertising in a Peer-Reviewed Medical Journal
Open Access
RESEARCH ARTICLE
Content Analysis of Oncology-Related Pharmaceutical Advertising in a Peer-Reviewed Medical Journal
Sent from my iPhone
Saturday, September 01, 2012
The Impact of Concomitant Medication Use on Patient Eligibility for Phase I Cancer Clinical Trials
Conclusions: This study highlights the high prevalence of concomitant medication use among cancer patients enrolled in phase I clinical trials. Most patients did meet trial eligibility criteria with careful substitution and discontinuation of CM. The most common reason for discontinuation of CM was protocol prohibition. The most common medications discontinued were herbal, proton pump inhibitors, selective serotonin reuptake inhibitor anti-depressants, and non-steroidal anti-inflammatory drugs.
Sent from my iPhone
THEONCOLOGIST : Cancer Patient Disclosure and Patient-Doctor Communication of Complementary and Alternative Medicine Use: A Systematic Review
Cancer Patient Disclosure and Patient-Doctor Communication of Complementary and Alternative Medicine Use: A Systematic Review
Abstract
Objective. To explore the nondisclosure of complementary and alternative medicine (CAM) use among cancer patients, including reasons for and outcomes from nondisclosure of CAM use, within the context of patient-doctor communication.
Method. A systematic review was conducted exploring investigations surrounding the communication of CAM use for patients with cancer published until August 2011.
Results. A total of 21 studies were located, which reported a prevalence of CAM use among patients with cancer ranging between 11% and 95%; of these patients, 20% to 77% did not disclose their CAM use. The main reasons for nondisclosure were the doctor's lack of inquiry; patient's anticipation of the doctor's disapproval, disinterest, or inability to help; and patient's perception that disclosure of CAM use is irrelevant to their conventional care. There is some evidence to suggest that patient-doctor communication about the use of CAM was associated with an enhanced patient-doctor relationship and higher patient satisfaction.
Conclusions. Although the use of CAM by patients with cancer is high, patients frequently fail to disclose its use to their health professionals for reasons emanating from both sides of the dyadic patient-doctor relationship. Because a substantial proportion of patients with cancer may use CAM and there is potential for herb- or vitamin-drug interactions, further research in patient-doctor communication about CAM is necessary to maintain patient safety and wellbeing. The development of effective interventions to improve the disclosure of CAM use should be an integral part of this future research.
Sent from my iPhone
Women’s awareness of cancer symptoms: a review of the literature, Women's Health, Future Medicine
Review
Women's awareness of cancer symptoms: a review of the literature
Improvements in cancer detection and treatment have led to consistent declines in mortality from many cancers. However, many patients present for treatment at a point where more invasive treatment is required and/or treatment outcomes are less than optimal. One factor that has been consistently shown to be associated with late diagnosis and treatment is delay in seeking help for symptoms. This paper reviews the literature on women's awareness of cancer symptoms and aims to identify knowledge gaps that need to be addressed in order to improve help-seeking behaviors. The discovery of substantial gaps in awareness suggest a need for improved community education regarding cancer symptoms.
Sent from my iPhone
BRCA carriers, prophylactic salpingo-oophorectomy and menopause: clinical management considerations and recommendations, Women's Health, Future Medicine
BRCA carriers, prophylactic salpingo-oophorectomy and menopause: clinical management considerations and recommendations
Sent from my iPhone
Adhesions during and after surgical procedures, their prevention and impact on women’s health, Women's Health, Future Medicine
Adhesions during and after surgical procedures, their prevention and impact on women's health
Sent from my iPhone
JNCI - patient stories
....."The surest route to failure lies in deciding what patients need to know without asking them,"....
http://m.jnci.oxfordjournals.org/content/early/2012/08/22/jnci.djs391.short?rss=1?rss=1?rss=1
Sent from my iPhone
Presidential Proclamation -- National Ovarian Cancer Awareness Month, 2012 | The White House
The White House
Office of the Press Secretary
For Immediate Release
August 31, 2012
Presidential Proclamation -- National Ovarian Cancer Awareness Month, 2012
NATIONAL OVARIAN CANCER AWARENESS MONTH, 2012
BY THE PRESIDENT OF THE UNITED STATES OF AMERICA
A PROCLAMATION
This year, thousands of American women will lose their lives to ovarian cancer. They are mothers and daughters, sisters and grandmothers, community members and cherished friends -- and the absence they leave in our hearts will be deeply felt forever. During National Ovarian Cancer Awareness Month, we honor those we have lost, show our support for women who bravely carry on the fight, and take action to lessen the tragic toll ovarian cancer takes on families across our Nation.
Sadly, women are all too often diagnosed with this disease when it has already reached an advanced stage. Because early detection is the best defense against ovarian cancer, it is essential that women know the risk factors associated with the disease. Women who are middle-aged or older, who have a family history of ovarian or breast cancer, or who have had certain cancers in the past are at increased risk of developing ovarian cancer. Any woman who thinks she is at risk of ovarian cancer or who experiences symptoms, including abdominal pain, pressure, or swelling -- should talk with her health care provider. To learn more, visitwww.Cancer.gov.
Ongoing progress in science and medicine is moving us forward in the battle against ovarian cancer, and my Administration remains committed to improving outcomes for women suffering from this devastating illness. Through agencies across the Federal Government, we are continuing to invest in research that paves the way for a new generation of tests and treatments. Through the Centers for Disease Control's Inside Knowledge campaign, we are working to raise awareness about the signs and symptoms of ovarian cancer. The Affordable Care Act already bans insurance companies from dropping a woman's coverage because she has ovarian cancer, and from placing lifetime or restrictive annual dollar limits on her coverage. Beginning in 2014, the law will also prohibit insurers from denying coverage or charging higher premiums because a woman has ovarian cancer -- or any other pre-existing condition.
Ovarian cancer affects the lives of far too many women every year, and the tragedy it leaves in its wake reverberates in communities across our country. This month, we stand with all those who have known the pain of ovarian cancer, and we rededicate ourselves to the pursuit of new and better ways to prevent, detect, and treat this devastating disease.
NOW, THEREFORE, I, BARACK OBAMA, President of the United States of America, by virtue of the authority vested in me by the Constitution and the laws of the United States, do hereby proclaim September 2012 as National Ovarian Cancer Awareness Month. I call upon citizens, government agencies, organizations, health care providers, and research institutions to raise ovarian cancer awareness and continue helping Americans live longer, healthier lives. I also urge women across our country to talk to their health care providers and learn more about this disease.
IN WITNESS WHEREOF, I have hereunto set my hand this thirty first day of August, in the year of our Lord two thousand twelve, and of the Independence of the United States of America the two hundred and thirty-seventh.
BARACK OBAMA
Sent from my iPhone
Friday, August 31, 2012
Stage at diagnosis and ovarian cancer survival: Evidence from the International Cancer Benchmarking Partnership
Stage at diagnosis and ovarian cancer survival: Evidence from the International Cancer Benchmarking Partnership
Publication year: 2012Source:Gynecologic Oncology, Volume 127, Issue 1
Camille Maringe, Sarah Walters, John Butler, Michel P. Coleman, Neville Hacker, Louise Hanna, Berit J. Mosgaard, Andy Nordin, Barry Rosen, Gerda Engholm, Marianne L. Gjerstorff, Juanita Hatcher, Tom B. Johannesen, Colleen E. McGahan, David Meechan, Richard Middleton, Elizabeth Tracey, Donna Turner, Michael A. Richards, Bernard Rachet
Objective We investigate what role stage at diagnosis bears in international differences in ovarian cancer survival. Methods Data from population-based cancer registries in Australia, Canada, Denmark, Norway, and the UK were analysed for 20,073 women diagnosed with ovarian cancer during 2004–07. We compare the stage distribution between countries and estimate stage-specific one-year net survival and the excess hazard up to 18months after diagnosis, using flexible parametric models on the log cumulative excess hazard scale. Results One-year survival was 69% in the UK, 72% in Denmark and 74–75% elsewhere. In Denmark, 74% of patients were diagnosed with FIGO stages III–IV disease, compared to 60–70% elsewhere. International differences in survival were evident at each stage of disease; women in the UK had lower survival than in the other four countries for patients with FIGO stages III–IV disease (61.4% vs. 65.8–74.4%). International differences were widest for older women and for those with advanced stage or with no stage data. Conclusion Differences in stage at diagnosis partly explain international variation in ovarian cancer survival, and a more adverse stage distribution contributes to comparatively low survival in Denmark. This could arise because of differences in tumour biology, staging procedures or diagnostic delay. Differences in survival also exist within each stage, as illustrated by lower survival for advanced disease in the UK, suggesting unequal access to optimal treatment. Population-based data on cancer survival by stage are vital for cancer surveillance, and global consensus is needed to make stage data in cancer registries more consistent.
Highlights
► Where overall survival is low, this is partly attributable to a more adverse stage distribution. ► Stage-specific survival still differs widely between jurisdictions. ► Global cancer surveillance requires consensus on data about diagnostic investigations and stage.Sent from my iPhone
Phase II study of MLN8237 (alisertib), an investigational Aurora A kinase inhibitor, in patients with platinum-resistant or -refractory epithelial ovarian, fallopian tube, or primary peritoneal carcinoma
Phase II study of MLN8237 (alisertib), an investigational Aurora A kinase inhibitor, in patients with platinum-resistant or -refractory epithelial ovarian, fallopian tube, or primary peritoneal carcinoma
Publication year: 2012Source:Gynecologic Oncology, Volume 127, Issue 1
Ursula A. Matulonis, Sudarshan Sharma, Sharad Ghamande, Michael S. Gordon, Salvatore A. Del Prete, Isabelle Ray-Coquard, Elzbieta Kutarska, Hua Liu, Howard Fingert, Xiaofei Zhou, Hadi Danaee, Russell J. Schilder
Objectives Aurora A kinase (AAK), a key mitotic regulator, is implicated in the pathogenesis of several tumors, including ovarian cancer. This single-arm phase II study assessed single-agent efficacy and safety of the investigational AAK inhibitor MLN8237 (alisertib), in patients with platinum-refractory or ‐resistant epithelial ovarian, fallopian tube, or primary peritoneal carcinoma. Methods Adult women with malignant, platinum-treated disease received MLN8237 50mg orally twice daily for 7days plus 14days' rest (21-day cycles). The primary endpoint was combined objective tumor response rate per Response Evaluation Criteria in Solid Tumors (RECIST) and/or CA-125 criteria. Secondary endpoints included response duration, clinical benefit rate, progression-free survival (PFS), time-to-progression (TTP), and safety. Results Thirty-one patients with epithelial ovarian (n=25), primary peritoneal (n=5), and fallopian tube carcinomas (n=1) were enrolled. Responses of 6.9–11.1month duration were observed in 3 (10%) patients with platinum-resistant ovarian cancer. Sixteen (52%) patients achieved stable disease with a mean duration of response of 2.86months and which was durable for ≥3months in 6 (19%). Median PFS and TTP were 1.9months. Most common drug-related grade ≥3 adverse events were neutropenia (42%), leukopenia (23%), stomatitis, and thrombocytopenia (each 19%); 6% reported febrile neutropenia. Conclusions These data suggest that MLN8237 has modest single-agent antitumor activity and may produce responses and durable disease control in some patients with platinum-resistant ovarian cancer. MLN8237 is currently undergoing evaluation in a phase I/II trial with paclitaxel in recurrent ovarian cancer.
Highlights
► Aurora A kinase may have a role in the pathobiology of ovarian cancer. ► Investigational agent MLN8237 (alisertib) is an oral Aurora A kinase inhibitor. ► MLN8237 has modest antitumor activity in platinum-resistant ovarian cancer.Sent from my iPhone
Tubal epithelial lesions in salpingo-oophorectomy specimens of BRCA-mutation carriers and controls
Tubal epithelial lesions in salpingo-oophorectomy specimens of BRCA-mutation carriers and controls
Publication year: 2012Source:Gynecologic Oncology, Volume 127, Issue 1
Marjanka J.J.M. Mingels, Thijs Roelofsen, Jeroen A.W.M. van der Laak, Joanne A. de Hullu, Maaike A.P.C. van Ham, Leon F.A.G. Massuger, Johan Bulten, Mijke Bol
Objective A precursor lesion for ovarian carcinoma, tubal intraepithelial carcinoma (TIC), has been identified in BRCA-mutation carriers undergoing prophylactic bilateral salpingo-oophorectomy (pBSO). Other lesions were also identified in fallopian tubes, but different terminology, interpretation, and lack of knowledge of normal epithelium, have hampered to unravel their possible role in carcinogenesis. The aim of this study is to classify tubal epithelial lesions in BRCA-mutation carriers and controls to enable comparison of prevalence, area of localization, and possible malignant potential. Methods Two hundred twenty-six BRCA1/2-mutation carriers were included; ovaries and fallopian tubes, embedded completely, were reviewed. Controls included 105 women who underwent BSO for non-malignant reasons. Tubal epithelial lesions included the following categories: hyperplasia, minor epithelial atypia, TIC, and invasive carcinoma. Results Tubal neoplasia was identified in 7.1% (invasive carcinoma, 0.9%; TIC, 6.2%) of BRCA-mutation carriers compared to none in controls (p =0.004, Fisher's exact test). Hyperplasia and minor epithelial atypia were identified in 41.6% BRCA-mutation carriers and compared to 58.1% in controls (p =0.005, Pearson's chi square). Invasive carcinoma and TIC showed preference for the fimbrial ends (p =0.027, Pearson's chi square), while hyperplasia and minor epithelial atypia displayed more variation in localization. Conclusions Invasive tubal carcinoma and TIC were limited to BRCA-mutation carriers, whereas hyperplasia and minor epithelial atypia were commonly found in both BRCA-mutation carriers and controls. It is suggested that hyperplasia and minor atypia represent variations of normal tubal epithelium instead of premalignant lesions. Furthermore, total salpingectomy is strongly recommended as most but not all TIC occurred in the fimbriae.
Highlights
►Tubal epithelium was reviewed in the largest cohort to date of both BRCA-mutation carriers and controls. ►Tubal neoplasia was limited to BRCA-mutation carriers, whereas tubal hyperplasia and minor atypia were more often identified in controls. ►Total salpingectomy rather than only fimbriectomy is essential for prophylactic tubal and ovarian cancer prevention.Sent from my iPhone
Phase II evaluation of dasatinib in the treatment of recurrent or persistent epithelial ovarian or primary peritoneal carcinoma: A Gynecologic Oncology Group study
Phase II evaluation of dasatinib in the treatment of recurrent or persistent epithelial ovarian or primary peritoneal carcinoma: A Gynecologic Oncology Group study
Publication year: 2012Source:Gynecologic Oncology, Volume 127, Issue 1
Russell J. Schilder, William E. Brady, Heather A. Lankes, James V. Fiorica, Mark S. Shahin, Xun C. Zhou, Robert S. Mannel, Harsh B. Pathak, Wei Hu, R. Katherine Alpaugh, Anil K. Sood, Andrew K. Godwin
Objectives Preclinical data suggest an important role for the sarcoma proto-oncogene tyrosine kinase (SRC) in the oncogenesis of epithelial ovarian cancer (EOC) or primary peritoneal carcinoma (PPC). The Gynecologic Oncology Group (GOG) conducted a Phase II trial to evaluate the efficacy and safety of dasatinib, an oral SRC-family inhibitor in EOC/PPC, and explored biomarkers for possible association with clinical outcome. Methods Eligible women had measurable, recurrent or persistent EOC/PPC and had received one or two prior regimens which must have contained a platinum and a taxane. Patients were treated with 100mg orally daily of dasatinib continuously until progression of disease or adverse effects prevented further treatment. Primary endpoints were progression-free survival (PFS) ≥6months and response rate. Serial plasma samples were assayed for multiple biomarkers. Circulating free DNA was quantified as were circulating tumor and endothelial cells. Results Thirty-five (35) patients were enrolled in a two-stage sequential design. Of the 34 eligible and evaluable patients, 20.6% (90% confidence interval: 10.1%, 35.2%) had a PFS ≥6months; there were no objective responses. Grade 3–4 toxicities were gastrointestinal (mostly nausea and emesis; n =4), pulmonary (dyspnea and/or pleural effusion; n =4) and pain (n =5), and infrequent instances of anemia, malaise, insomnia, rash, and central nervous system hemorrhage. Lack of clinical activity limited any correlation of biomarkers with outcome. Conclusion Dasatinib has minimal activity as a single-agent in patients with recurrent EOC/PPC.
Highlights
► No objective responses with 7 of 34 patients had PFS ≥6months. ► The agent was well tolerated with the major toxicities being grade 3 nausea/emesis, pain and pulmonary. ► No detectable relationships between clinical outcome and biomarkers.Sent from my iPhone
Height, weight, BMI and ovarian cancer survival
Height, weight, BMI and ovarian cancer survival
Publication year: 2012Source:Gynecologic Oncology, Volume 127, Issue 1
Joanne Kotsopoulos, Joel R.K. Moody, Isabel Fan, Barry Rosen, Harvey A. Risch, John R. McLaughlin, Ping Sun, Steven A. Narod
Objectives Ovarian cancer is a highly fatal gynecologic malignancy. Prognosis is primarily based on clinicopathologic features. There is interest in the role of modifiable factors including overweight and obesity, although data to date have been inconclusive. Here we evaluate the relationship between body size and ovarian cancer survival among 1423 women diagnosed with epithelial ovarian cancer in a large population-based study. Methods Information on risk factors and characteristics was collected by telephone. Vital status was determined both by computerized record-linkage and by chart review. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for height, weight and body mass index (BMI) in association with ovarian cancer-specific mortality. Results Height, weight and BMI 5years prior to diagnosis did not significantly predict ovarian cancer survival in this study. The HR for ovarian cancer-specific mortality for women with a weight of >61kg compared with >50–55kg was 0.91 (95%CI 0.71–1.20). The HR among women with a BMI≥30kg/m2 compared to 18.5– <25kg/m2 was 1.11 (95%CI 0.87–1.42). These findings did not vary by histologic subtype. Conclusions Our results do not support a role of height, adult weight or adiposity in ovarian cancer prognosis.
Highlights
► The role of modifiable host factors including overweight and obesity on ovarian cancer prognosis is not clear. ► We evaluated the relationship between body size and ovarian cancer survival among 1423 women diagnosed with epithelial ovarian cancer. ► Our results do not support a role of height, weight or adiposity in ovarian cancer prognosis.Sent from my iPhone
The utilization of palliative care in gynecologic oncology patients near the end of life
The utilization of palliative care in gynecologic oncology patients near the end of life
Publication year: 2012Source:Gynecologic Oncology, Volume 127, Issue 1
Janelle Fauci, Kellie Schneider, Christy Walters, Jonathan Boone, Jenny Whitworth, Ellie Killian, J. Michael Straughn
Background Palliative and supportive care services provide excellent care to patients near the end of life. It is estimated that enrollment in such services can reduce end-of-life costs; however, there is limited data available regarding the impact of palliative services in end-of-life care in gynecologic oncology patients. We examined the use of palliative services in gynecologic oncology patients during the last six months of life. Methods After IRB approval, a retrospective chart review of patients with a diagnosis of a gynecologic malignancy who died between June 2007 and June 2010 was performed. Abstracted data included demographics, admission and procedural history, use of anti-cancer therapy, and palliative care utilization during the last six months of life. Results 268 patients were identified. Most patients were white (76.9%) and had ovarian cancer (56.7%). During the last six months of life, 155 (57.8%) patients underwent anti-cancer therapy with chemotherapy, 19 (7.1%) patients were treated with radiation therapy, and 17 patients (6.3%) underwent treatment with both. 218 patients (81.3%) had at least one admission during this time (range 0–14). The most common reason for admission was gastrointestinal complaints (37.1%), followed by admissions for procedures (18.3%). The median time between the last admission and death was 32days. 157 patients (58.6%) underwent at least one procedure during the last six months of life (range 0–11). The most common procedure performed was paracentesis (22.6%). 198 (73.9%) patients died at home or in a palliative care unit. 189 (70.5%) patients were referred to hospice or palliative care. 3.2% underwent a procedure or treatment with chemotherapy or radiation after hospice enrollment. The median time between hospice enrollment and death was 22days. 55% of patients were enrolled in hospice less than 30days before death. Of the 79 patients not referred to hospice, only 16.5% had documentation of refusing hospice services. Conclusions During the last six months of life, the majority of gynecologic oncology patients receive anticancer therapy and many have repeated hospital admissions. While the majority of patients are referred for palliative care, it appears that most patients spend less than 30days on hospice. Earlier referral could decrease the number of hospital admissions and procedures while providing invaluable support during this end of life transition.
Highlights
► Enrollment in hospice may dramatically reduce the number of admissions and procedures performed during the last weeks of life. ► The majority of patients are ultimately referred to hospice, however most patients were referred less than 30days before death. ► Discussing end-of-life issues with pat...Sent from my iPhone
Subscribe to:
Posts
(
Atom
)
