Sunday, October 14, 2012
Medscape: Prophylactic Surgery: How Should Surgeons. Respond
"The most common genetic susceptibilities were breast cancer (67.1%) and ovarian cancer (23.0%). Correspondingly, the most common prophylactic procedures were mastectomy (64.3%) and oophorectomy (40.0%).....
Prophylactic Surgery: How Should Surgeons Respond?
Medscape: House GOP Urges Halt to...
"insufficient standards" for EHR meaningful use have left physicians and other providers with systems that cannot "talk with one another." .....
House GOP Urges Halt to EHR Bonuses
Saturday, October 13, 2012
Cancer patients' information needs the first nine months after diagnosis.
Cancer patients' information needs the first nine months after diagnosis.
Abstract
OBJECTIVE:
Cancer patients' information needs about disease, diagnostic tests, treatments, physical care, and psychosocial resources during treatment are examined.METHODS:
Information needs of newly diagnosed, Stages II-IV cancer patients receiving treatment (N=138) were studied over nine months. Information needs were assessed using The Toronto Informational Needs Questionnaire (TINQ). There are five subscales for the TINQ: disease, diagnostic tests, treatment, physical and psychosocial. Health literacy and amount of information wanted were also measured. A repeated measures, univariate two-level model for longitudinal data was analyzed. Separate models for each subscale were constructed and covariates were examined simultaneously for associations with information needs. Models were estimated using FIML.RESULTS:
Although significant reduction of needs was observed over time, total information needs remained high throughout. Gender (women), age (younger), race (African American), education (lesser), and marital status (married) were significantly associated with higher information needs over time. Cancer type and stage were not significantly associated.CONCLUSION:
Cancer patients' information needs decrease yet remain high over time. Patients' information needs are highest near diagnosis and change throughout the course of their treatment.PRACTICE IMPLICATIONS:
As patients obtain and understand information, they will continue to need information in new areas relevant to their care.Patient Engagement is the Blockbuster Drug of the Century (Part 2) - Forbes
Patient Engagement is the Blockbuster Drug of the Century (Part 2) - Forbes
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Clinical outcome of patients with advanced ovarian cancer after resection of liver metastases.
Clinical outcome of patients with advanced ovarian cancer
Anticancer Res. 2012 Oct;32(10):4517-21.
Abstract
Aim: Hepatic resection has become the standard treatment for patients with primary or metastatic liver malignancies. The aim of our study was to evaluate the clinical outcome of hepatic resection in patients with advanced ovarian cancer (AOC).CONCLUSION:
Our data indicate that complete macroscopical tumor resection remains the strongest predictor of survival in patients with liver metastases from AOC.Friday, October 12, 2012
Pande M. Cancer spectrum in DNA mismatch repair gene mutation carriers: results from a hospital based Lynch syndrome registry.
Cancer spectrum in DNA mismatch repair gene mutation carriers: results from a hospital based Lynch syndrome registry
Fam Cancer
Fam Cancer
The spectrum of cancers seen in a hospital based Lynch syndrome registry of mismatch repair gene mutation carriers was examined to determine the distribution of cancers and examine excess cancer risk. Overall there were 504 cancers recorded in 368 mutation carriers from 176 families. These included 236 (46.8 %) colorectal and 268 (53.2 %) extracolonic cancers. MLH1 mutation carriers had a higher frequency of colorectal cancers whereas MSH2, MSH6 and PMS2 mutation carriers had more extracolonic cancers although these differences were not statistically significant. Men had fewer extracolonic cancers than colorectal (45.3 vs. 54.7 %), whereas women had more extracolonic than colorectal cancers (59.0 vs. 41.0 %). The mean age at diagnosis overall for extracolonic cancers was older than for colorectal, 49.1 versus 44.8 years (P ≤ 0.001). As expected, the index cancer was colorectal in 58.1 % of patients and among the extracolonic index cancers, endometrial was the most common (13.8 %). A significant number of non-Lynch syndrome index cancers were recorded including breast (n = 5) prostate (n = 3), thyroid (n = 3), cervix (n = 3), melanoma (n = 3), and 1 case each of thymoma, sinus cavity, and adenocarcinoma of the lung. However, standardized incidence ratios calculated to assess excess cancer risk showed that only those cancers known to be associated with Lynch syndrome were significant in our sample. We found that Lynch syndrome patients can often present with cancers that are not considered part of Lynch syndrome. This has clinical relevance both for diagnosis of Lynch syndrome and surveillance for cancers of different sites during follow-up of these patients.
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Barriers to accessing radiation therapy in Canada: a systematic review
Barriers to accessing radiation therapy in Canada: a systematic review
IntroductionRadiation therapy (RT) is effective treatment for curing and palliating cancer, yet concern exists that not all Canadians for whom RT is indicated receive it. Many factors may contribute to suboptimal use of RT. A review of recent Canadian literature was undertaken to identify such barriers.Methods:
MEDLINE, CINAHL, and EMBase databases were used to search keywords relating to barriers to accessing or utilizing RT in Canada. Collected abstracts were reviewed independently. Barriers identified in relevant articles were categorized as relating to the health systems, patient socio-demographic, patient factors, or provider factors contexts and thematic analysis performed for each context.
Results:
535 unique abstracts were collected. 75 met inclusion criteria. 46 (61.3%) addressed multiple themes. The most cited barriers to accessing RT when indicated were patient age (n=26, 34.7%), distance to treatment centre (n=23, 30.7%), wait times (n=22, 29.3%), and lack of physician understanding about the use of RT (n=16, 21.6%).
Conclusions:
Barriers to RT are reported in many areas. The role of provider factors and the lack of attention to patient fears and mistrust as potential barriers were unexpected findings demanding further attention. Solutions should be sought to overcome identified barriers facilitating more effective cancer care for Canadians.
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Search Livertox Database
LIVERTOX provides up-to-date, accurate, and easily accessed information on the diagnosis, cause, frequency, patterns, and management of liver injury attributable to prescription and nonprescription medications, herbals and dietary supplements. LIVERTOX also includes a case registry that will enable scientific analysis and better characterization of the clinical patterns of liver injury. The LIVERTOX website provides a comprehensive resource for physicians and their patients, and for clinical academicians and researchers who specialize in idiosyncratic drug induced hepatotoxicity.
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Paraneoplastic hypercalcemia in clear cell ovarian adenocarcinoma.
Paraneoplastic hypercalcemia in clear ... [Ecancermedicalscience. 2012] - PubMed - NCBI
Paraneoplastic hypercalcemia in clear cell ovarian adenocarcinoma.
Abstract
BACKGROUND:
Hypercalcemia has been reported in association with a number of malignancies, but it is an unusual manifestation of ovarian cancer. This finding at presentation (possibly aggravated by oral calcium intake) led to discovery of a clear cell carcinoma of the ovary. The implications and pathophysiology of this association are reviewed.CASE REPORT:
Following presentation with abdominal symptoms, this premenopausal woman was found to have bilateral adnexal masses and hypercalcemia. Her parathormone-related polypeptide was found to be elevated. After surgery and staging, she received adjuvant carboplatin and paclitaxel (later substituted by docetaxel). She has done well on her long-term follow-up.CONCLUSIONS:
This rare paraneoplastic manifestation of ovarian cancer may be associated with long-term survival if discovered at an early stage. In this instance, further benefit may have been obtained from adjuvant platinum-based chemotherapy.The spectrum of urological malignancy in Lynch syndrome.(in males)
The spectrum of urological malignancy in Lynch sy... [Fam Cancer. 2012] - PubMed - NCBI
The spectrum of urological malignancy in Lynch syndrome.
Abstract
Urological tumours are the third most frequent malignancy in Lynch syndrome after colonic and endometrial cancer. Upper urinary tract tumours are well recognised in Lynch syndrome, but the association with prostate and bladder cancer is controversial. We determined the incidence and cumulative and relative risks of prostate and bladder cancer in a cohort of Lynch syndrome families. Male Lynch syndrome mutation carriers and their genetically untested male first degree relatives (FDR) were identified from the Manchester Regional Lynch syndrome database (n = 821). Time to the development of urological cancer was identified for each urological site (renal pelvis, ureter, bladder and prostate). Cumulative and relative risks were calculated, with results classified by mutation carrier status and specific causative genetic mutations. Eight prostate cancers were identified, only one occurring before the age of 60. Analysis of person-years at risk of prostate cancer by Lynch syndrome mutation carrier status suggests a correlation between MSH2 mutation carriers and a tenfold increased risk of prostate cancer (RR 10.41; 95 % CI 2.80, 26.65). No such association was found with bladder cancer (RR 1.88; 95 % CI 0.21, 6.79). The association of upper urinary tract tumours with MSH2 and MLH1 mutations was confirmed. We have carried out the largest study of male Lynch syndrome mutation carriers to establish the risks of urological malignancy. A tenfold increased risk of prostate cancer is supported in MSH2 with mutation carriers having roughly double the risk of prostate cancer to FDRs. A trial of PSA testing in MSH2 carriers from 40 to 50 years may be justifiable.Thursday, October 11, 2012
Continuity clinics in oncology training programs in Canada | Croke | Current Oncology
Continuity clinics in oncology training programs in Canada | Croke | Current Oncology
"Level of Supervision
Most
pd
s and trainees felt that the staff oncologist should review the
patient with the trainee only when the trainee raises concerns (57% vs.
59%), but only 37% of patients shared that view (
p
= 0.0002). Conversely, 63% of patients felt that the staff
oncologist should review the patient with the trainee at every visit,
either inside (27%) or outside (36%) the exam room (Figure 1)."
"Patient Participation
Of patient respondents, 48% (46 of 95) responded that
they would feel comfortable having a trainee conduct the initial
consult, and 66% (63 of 95) stated they would feel comfortable with a
trainee making treatment recommendations. The main concerns about
cc
s highlighted by patients included the potential for
discontinuity of care as residents rotate through the clinic, a lack of
experience on the part of the trainee, and a lack of competence for
clinical decision-making. Patients stated that potential benefits
include the possibility that trainees may have more time to spend with
patients and that
cc
s may decrease overall wait times. Furthermore, many patients indicated a desire to participate in trainee education."
Conclusions
Continuity clinics are considered beneficial by
pd
s and trainees. Patients desire more trainee supervision than the trainees themselves and the
pd
s do, a factor that should be considered when implementing a
cc
.
Are bilateral cancers hereditary? Part II | Narod | Current Oncology
Are bilateral cancers hereditary? Part II | Narod | Current Oncology
Commentary
Are bilateral cancers hereditary? Part ii
A Countercurrents Series a , S.A. Narod , MD
There is no disputing that cancer susceptibility genes, when mutated,
may give rise to bilateral cancers in those who inherit a mutation. But
is it equally true that all bilateral cancers have a hereditary
origin—that is, are they all caused by an inherited germline mutation?
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