Clinical impact of systematic pelvic and para-aortic lymphadenectomy for pT1 and pT2 ovarian cancer: a retrospective survey by the Sankai Gynecology Study Group. Oshita T, Itamochi H, Nishimura R, Numa F, Takehara K, Hiura M, Tanimoto H, Noma J, Hayase R, Murakami A, Fujimoto H, Kanamori Y, Kitada F, Shitsukawa K, Nagaji M, Minagawa Y, Fujiwara M, Kigawa J. Source Department of Obstetrics and Gynecology, Miyoshi Central Hospital, 531 Higashisakeyamachi, Miyoshi, Hiroshima, 728-8502, Japan, toshita@hicat.ne.jp. Abstract BACKGROUND: The therapeutic value of systematic lymphadenectomy for early-stage epithelial ovarian cancer (EOC) is controversial. This study evaluates the survival impact and adverse events of systematic pelvic and para-aortic lymphadenectomy in patients with pT1 and pT2 EOC. METHODS: A retrospective investigation was performed using data from patients with pT1 and pT2 EOC at multi-institutions belonging to the Sankai Gynecologic Study Group (SGSG). We selected patients who had undergone systematic pelvic and para-aortic lymphadenectomy (Group LA) (n = 284) and patients who had not undergone lymph node resection (Group no-LA) (n = 138). Outcomes for patients and peri-operative adverse events were compared between the two groups. RESULTS: The median operation time was significantly longer in Group LA (288 min) than in Group no-LA (128 min) (P < 0.0001). Total blood loss was significantly higher in Group LA, 43.7 % of patients receiving blood transfusions. There were no significant differences between the treatment groups for progression-free survival (PFS) or overall survival (OS). However, for patients with pT2, PFS was significantly longer in Group LA than in Group no-LA (P = 0.0150). Lymph node metastases were detected in 23 cases (8.1 %) and these patients had significantly shorter PFS than those without metastasis (P = 0.0409). The outcome for patients who underwent chemotherapy after surgery was significantly improved in the Group no-LA, but no improvement was observed in Group LA. CONCLUSIONS: Systematic lymphadenectomy may improve outcomes only in pT2 EOC patients with acceptable peri-operative events. Furthermore, accurate surgical staging may avoid unnecessary adjuvant chemotherapy in selected early-stage cases.

Clinical impact of systematic pelvic and para-aortic lymphadenectomy for pT1 and pT2 ovarian cancer: a retrospective survey by the Sankai Gynecology Study Group.

Abstract

BACKGROUND:

The therapeutic value of systematic lymphadenectomy for early-stage epithelial ovarian cancer (EOC) is controversial. This study evaluates the survival impact and adverse events of systematic pelvic and para-aortic lymphadenectomy in patients with pT1 and pT2 EOC.

METHODS:

A retrospective investigation was performed using data from patients with pT1 and pT2 EOC at multi-institutions belonging to the Sankai Gynecologic Study Group (SGSG). We selected patients who had undergone systematic pelvic and para-aortic lymphadenectomy (Group LA) (n = 284) and patients who had not undergone lymph node resection (Group no-LA) (n = 138). Outcomes for patients and peri-operative adverse events were compared between the two groups.

RESULTS:

The median operation time was significantly longer in Group LA (288 min) than in Group no-LA (128 min) (P < 0.0001). Total blood loss was significantly higher in Group LA, 43.7 % of patients receiving blood transfusions. There were no significant differences between the treatment groups for progression-free survival (PFS) or overall survival (OS). However, for patients with pT2, PFS was significantly longer in Group LA than in Group no-LA (P = 0.0150). Lymph node metastases were detected in 23 cases (8.1 %) and these patients had significantly shorter PFS than those without metastasis (P = 0.0409). The outcome for patients who underwent chemotherapy after surgery was significantly improved in the Group no-LA, but no improvement was observed in Group LA.

CONCLUSIONS:

Systematic lymphadenectomy may improve outcomes only in pT2 EOC patients with acceptable peri-operative events. Furthermore, accurate surgical staging may avoid unnecessary adjuvant chemotherapy in selected early-stage cases.

News Organizations' Overall Grades - Health News Review

see 2nd graph and drop down box for selected media sources eg. Reuters....not such good reviews on some of the more popular sites

News Organizations' Overall Grades - Health News Review

Health News Watchdog Blog | HealthNewsReview.org - recent opinions/reviews

Health News Watchdog Blog | HealthNewsReview.org

Are Doctors Too Wary of Drug Companies? - NYTimes.com

Are Doctors Too Wary of Drug Companies? - NYTimes.com

Health Council Canada Symposium website (October 2012)

Health Council Canada

Symposium

Advancing Integrated Health Care in Canada: Practices that Work On October 10, 2012, the Health Council of Canada hosted a national symposium with the aim of bringing together policy makers, health system planners and administrators, health care providers, educators, researchers and people who use health services, to identify, share and promote the spread of innovative practices in integrated care. > Program > Presentations > Press Release

Privacy Key Issue in Genome Decoding

Privacy Key Issue in Genome Decoding

(AICR): 2012 Research Conference 2012 AICR Annual Research Conference on Food, Nutrition, Physical Activity and Cancer

American Institute for Cancer Research (AICR): 2012 Research Conference

Acupuncture for insomnia. [Cochrane Database Syst Rev. 2012] - PubMed - NCBI

Acupuncture for insomnia. [Cochrane Database Syst Rev. 2012] - PubMed - NCBI

open access: Constitutive promoter methylation of BRCA1 and RAD51C in patients with familial ovarian cancer and early-onset sporadic breast cancer

Constitutive promoter methylation of BRCA1 and RAD51C in patients with familial ovarian cancer and early-onset sporadic breast cancer

Imedex e-learning: Webcast: Addressing Current Controversies and Integrating Recent Advances in Ovarian Cancer

Requires registration (free):

 Imedex e-learning: Webcast: Addressing Current Controversies and Integrating Recent Advances in Ovarian Cancer

Genetic Alliance: re: consensus letter Rights of Patients to Access their Test Results

 A Consensus Letter to the HHS Office of Civil Rights and the Centers for Medicare and Medicaid Services on the Need to Finalize the Proposed Rule to Expand the Rights of Patients to Access their Test ResultsOctober 18, 2012

Clinical Oncology News - Drug Trials: Often Long On Hype, Short on Gains

Clinical Oncology News - Drug Trials: Often Long On Hype, Short on Gains

(book) Review - Malignant - Ethics

Review - Malignant - Ethics

 Review - Malignant
Medical Ethicists Confront Cancer
by Rebecca Dresser (Editor)
Oxford University Press, 2012
Review by Jacqui Poltera
Oct 16th 2012 (Volume 16, Issue 42)

"

One of the shortfalls of applied ethics is that it infrequently draws on the first-personal experience of people facing complex ethical decisions to inform ethical theory. Healthcare ethics and bioethics are no exception. For the most part, ethical conclusions are drawn from considering scenarios and case-studies from the third-person perspective. Medical students and ethicists are typically taught to weigh up the ethical merits of a case without a detailed understanding of how or what each person involved is thinking and feeling. The problem with this method is that it can underemphasize ethical complexity in decision-making, particularly when it comes to joint decision making between patients, clinicians and loved ones, and to deciding how we ought to live and treat each other in the face of serious illness.

Malignant Medical Ethicists Confront Cancer redresses this deficit by drawing together the first-personal accounts of a range of medical ethicists from different backgrounds that have experienced cancer as patients and /or as carers. Dan. W Brock, Rebecca Dresser, Norman Frost, Arthur W. Frank, Leon R. Kass, Patricia A. Marshall, and John A Robertson recount their experiences in a refreshingly candid way. This is an accessible and thought provoking collection that sheds light on novel aspects of the experience and ethics of cancer. The combined papers, edited by Rebecca Dresser, are written in an engaging storytelling manner that blends professional ethical analysis with first-personal accounts of the lived experience of cancer.  This method of writing is part of what makes it an important book for cancer patients, carers, health professionals and medical ethicists alike. 

Another strongpoint of this book is it tackles features of people’s cancer journeys that typically do not receive much attention in either public messages about cancer or in academic discussions about the ethics of treating seriously ill people.  More specifically, in recounting their own experiences, the authors highlight the centrality of ethics to people’s daily lives....

Where next for rigorous CAM research?Focus on Alternative and Complementary Therapies

Where next for rigorous CAM research?  Focus on Alternative and Complementary Therapies

Clinical trials: Around half of new treatments perform better than existing treatments

Clinical trials: Around half of new treatments perform better than existing treatments

Researchers show that uncertainty about new treatments meets ethical requirements

On average, new treatments perform better in clinical trials only slightly more often than existing treatments, according to a new systematic review published in The Cochrane Library . The fact that experimental treatments are not more effective may seem disappointing, but the authors of the review say their findings satisfy an important ethical requirement for clinical trials.
Randomised trials compare the effects of one treatment to another. In a randomised trial patients are randomly allocated to different treatment groups to ensure that like will be compared with like. When a new treatment is being tested, it is hoped or even expected that it will be better than the established treatment with which it is being compared. These expectations lead to an ethical dilemma. If the researchers already know that one treatment is better, they would be knowingly allocating some people to an inferior treatment. If randomised trials are to be ethical, therefore, only half of new treatments should turn out to be better than existing ones.
Cochrane researchers looked at evidence from 743 publicly funded randomised trials involving 297,744 patients in total. The trials included new, experimental treatments for cancer and neurological disorders, as well as a range of other diseases. On average, only very slightly more than half of new treatments proved to be better than established treatments.
"When we compared the effects of new treatments to established ones, the pattern was almost symmetrical. This is good news, because it means researchers genuinely don't know whether new treatments are going to be any better," said lead researcher Benjamin Djulbegovic, who works at USF Health Clinical Research, and the H. Lee Moffitt Cancer Center & Research Institute, at the University of South Florida in Tampa, Florida, US. "So, overall, what we show is that we can expect the new treatments to perform better a little bit more often than established treatments, at least in publicly funded trials like the ones we considered."
The researchers found the same pattern in trials going back five decades. The results provide an answer to the question posed 15 years ago in the British Medical Journal by Iain Chalmers, a founder of the Cochrane Collaboration and one of the authors of the review. "In 1997, in a letter published in the BMJ, I asked 'What is the prior probability of a proposed new treatment being superior to established treatments?' I think this review currently provides the best answer to that question," said Chalmers.

(easier to read article) Muscle relaxants linked with increased risk of breathing problems after surgery

Muscle relaxants linked with increased risk of breathing problems after surgery

"But an accompanying editorial argues that, in modern medicine, general anaesthesia is an extremely safe procedure and it would be a mistake to change clinical practice on the basis of this one study, however large and well executed."

Searching content for postoperative respiratory in full text, from Jan 1840 to Oct 2012. | BMJ

Research

Intermediate acting non-depolarizing neuromuscular blocking agents and risk of postoperative respiratory complications: prospective propensity score matched cohort study

BMJ 2012;345:e6329 (Published 16 October 2012)

• Editorial
• PDF
• FREE

(see also) Table 1  Characteristics of study population according to whether or not intermediate acting non-depolarizing neuromuscular blocking agents were administered intraoperatively. Values are frequencies (percentages) unless stated otherwise

open access: BMJ - Effect of hormone replacement therapy on cardiovascular events in recently postmenopausal women: randomised trial

Effect of hormone replacement therapy oncardiovascular events in recently postmenopausalwomen: randomised trial 

Conclusions
After 10 years of randomised treatment, women receiving
hormone replacement therapy early after menopause had a significantly
reduced risk of mortality, heart failure, or myocardial infarction, without
any apparent increase in risk of cancer, venous thromboembolism, or
stroke.

Trial registration ClinicalTrials.gov NCT00252408.

Drugs used to immobilize patients during surgery raise risk of respiratory complications

Drugs used to immobilize patients during surgery raise risk of respiratory complications

Are there candidates for high-dose chemotherapy in ovarian carcinoma? (pdf file)

Journal of Experimental & Clinical Cancer Research 2012, 31:87 doi:10.1186/1756-9966-31-87

pdf

"Results
One hundred and three AOC patients treated with conventional chemotherapy alone (CCA) were compared to 60 patients receiving HDC plus hematopoietic stem cell support. After a median follow-up of 47.5 months there was no overall survival (OS) advantage for the HDC
group in the whole population (p=0.29). Nevertheless, HDC was associated to a better outcome in young patients (≤50 years), both in term of progression-free survival (p=0.02, log-rank test) and OS (p=0.05, log-rank test). Median OS was 54.6 and 36 months in the
HDC and CCA groups, respectively.

Conclusions
Although randomized trials failed to demonstrate any benefit for HDC in AOC patients, this study suggests that young patients may derive a substantial advantage from receiving it after the standard treatment. Further prospective studies are warranted to confirm this gain and to
search for the biological processes associated with this improvement."

Medpage: Gene Screening Tops in Finding Lynch Syndrome

Gene Screening Tops in Finding Lynch Syndrome

Editorial: JAMA: Lynch Syndrome in Patients With Colorectal Cancer Finding the Needle in the Haystack

Editorial: JAMA Network Lynch Syndrome in Patients With Colorectal Cancer Finding the Needle in the Haystack

Editorial | October 17, 2012

JAMA. 2012;308(15):1581-1583. doi:10.1001/jama.2012.14171.

"Identification of individuals at increased risk of hereditary cancer allows for the possibility of screening and early cancer detection, possibly resulting in decreased disease-specific mortality, and is the justification for germline genetic testing for specific cancer risk alleles. However, factors of prevalence and age-specific penetrance, effectiveness and invasiveness of screening procedures, and efficacy of early detection influence the potential benefit of such an approach."

JAMA Network Gene Screening Tops in Finding Lynch Syndrome

JAMA:  Identification of Lynch Syndrome Among Patients With Colorectal Cancer

ABSTRACT

 

Context  Lynch syndrome is the most common form of hereditary colorectal cancer (CRC) and is caused by germline mutations in DNA mismatch repair (MMR) genes. Identification of gene carriers currently relies on germline analysis in patients with MMR-deficient tumors, but criteria to select individuals in whom tumor MMR testing should be performed are unclear.

Objective  To establish a highly sensitive and efficient strategy for the identification of MMR gene mutation carriers among CRC probands.

Design, Setting, and Patients  Pooled-data analysis of 4 large cohorts of newly diagnosed CRC probands recruited between 1994 and 2010 (n = 10 206) from the Colon Cancer Family Registry, the EPICOLON project, the Ohio State University, and the University of Helsinki examining personal, tumor-related, and family characteristics, as well as microsatellite instability, tumor MMR immunostaining, and germline MMR mutational status data.

Main Outcome Measures  Performance characteristics of selected strategies (Bethesda guidelines, Jerusalem recommendations, and those derived from a bivariate/multivariate analysis of variables associated with Lynch syndrome) were compared with tumor MMR testing of all CRC patients (universal screening).

Results  Of 10 206 informative, unrelated CRC probands, 312 (3.1%) were MMR gene mutation carriers. In the population-based cohorts (n = 3671 probands), the universal screening approach (sensitivity, 100%; 95% CI, 99.3%-100%; specificity, 93.0%; 95% CI, 92.0%-93.7%; diagnostic yield, 2.2%; 95% CI, 1.7%-2.7%) was superior to the use of Bethesda guidelines (sensitivity, 87.8%; 95% CI, 78.9%-93.2%; specificity, 97.5%; 95% CI, 96.9%-98.0%; diagnostic yield, 2.0%; 95% CI, 1.5%-2.4%; P < .001), Jerusalem recommendations (sensitivity, 85.4%; 95% CI, 77.1%-93.6%; specificity, 96.7%; 95% CI, 96.0%-97.2%; diagnostic yield, 1.9%; 95% CI, 1.4%-2.3%; P < .001), and a selective strategy based on tumor MMR testing of cases with CRC diagnosed at age 70 years or younger and in older patients fulfilling the Bethesda guidelines (sensitivity, 95.1%; 95% CI, 89.8%-99.0%; specificity, 95.5%; 95% CI, 94.7%-96.1%; diagnostic yield, 2.1%; 95% CI, 1.6%-2.6%; P < .001). This selective strategy missed 4.9% of Lynch syndrome cases but resulted in 34.8% fewer cases requiring tumor MMR testing and 28.6% fewer cases undergoing germline mutational analysis than the universal approach.

Conclusion  Universal tumor MMR testing among CRC probands had a greater sensitivity for the identification of Lynch syndrome compared with multiple alternative strategies, although the increase in the diagnostic yield was modest.

The Phantom of Death Improving Quality of Life - You Live Until You Die

The Phantom of Death Improving Quality of Life

Abstract

The purpose of this study was, using secondary analysis on data collected from previous empirical studies, to focus on improving the quality of life due to the new possibilities for living after a cancer diagnosis. No matter how long or short the life will be, quality of life in palliative care is about “living in the best way” until death. The data analysis identified 4 main themes; death as a main concern, reevaluating life, living a normal life with support, and living until death. The key message is that the patients are living until they die. Palliative care should facilitate and support the patients in their new life situation in order to sustain their quality of life. They are still alive—living until death.

Listening to stories: Valuing knowledge from patient experience

Listening to stories: Valuing knowledge from patient experience
 

Purchase $31.50

---

Abstract

This paper reports on a research project which explored students' perceptions of learning from listening to patient stories. There is a plethora of literature to support the value of learning from service users within professional education programmes and a growing body of literature suggesting that storytelling is an effective learning and teaching strategy. However, little evidence focuses on the process of learning from patients' stories during practice placements and this study was designed to address this knowledge gap. The study adopted a descriptive phenomenological approach employing in-depth, conversational interviews with a sample of twelve pre-qualifying nursing, midwifery and social work students. The findings confirm the value of service users as a resource for student learning and indicate that listening to patient stories was a strategy which all respondents adopted to access this source of knowledge. This paper recommends that educators should recognise and value this alternative form of knowledge; provide the space and opportunities for students to listen to stories during their placements and actively facilitate reflection on these learning experiences.