Definition of Patients Presenting a High Risk of Developing Peritoneal Carcinomatosis After Curative Surgery for Colorectal Cancer: A Systematic Review.

Definition of Patients Presenting a High Risk of Developing Peritoneal Carcinomatosis After Curative Surgery for Colorectal Cancer: A Systematic Review.

Authors

Honoré C, et al. Show all

Journal

Ann Surg Oncol. 2012 Oct 23. [Epub ahead of print]

Affiliation

Department of Surgical Oncology, Institut Gustave Roussy, Cancer Center, Villejuif, France, chhonore@hotmail.com.

Abstract

BACKGROUND: In colorectal cancer, complete cytoreductive surgery associated with hyperthermic intraperitoneal chemotherapy achieves encouraging results in early peritoneal carcinomatosis (PC), but this early detection can only be accurately accomplished during a systematic second-look surgery. This costly and invasive approach can only be proposed to selected patients. The objective of this study was to identify risk factors predictive of developing PC after curative surgery for colorectal cancer.

METHODS: After a systematic review of the literature published between 1940 and 2011, all clinical studies reporting the incidence of PC after curative surgery for colorectal cancer were searched for factors associated with the primary tumor that were likely to influence the incidence of recurrent PC.

RESULTS: Sixteen clinical studies were considered informative, all nonrandomized, three prospective and 13 retrospective, including 4-395 patients. Overall, the methodological quality of the reported studies was low. Data were available for the following factors: synchronous PC, synchronous ovarian metastases, perforated primary tumor, serosal and/or adjacent organ invasion, histological subtype, and positive peritoneal cytology with reported incidences of recurrent PC between 8 and 75 %. No study was found that mentioned an impact of lymph node invasion, tumor location, laparoscopy, occlusive tumors, or bleeding tumor on recurrent PC.

CONCLUSIONS: Evidence regarding the incidence of recurrent PC after curative surgery for colorectal cancer is poor. Emerging data indicate three situations that could result in a real higher risk of recurrent PC: synchronous PC, synchronous isolated ovarian metastases, and a perforated primary tumor.

'Like doing a jigsaw with half the parts missing': community pharmacists and the management of cancer pain in the community - NeLM

'Like doing a jigsaw with half the parts missing': community pharmacists and the management of cancer pain in the community - NeLM

Akt-activated endothelium constitute the niche for residual disease and resistance to bevacizumab in ovarian cancer

Akt-activated endothelium constitute the niche for residual disease and resistance to bevacizumab in ovarian cancer

Conclusion: Our data highlights the role of an activated endothelium in the constitution of the residual disease and resistance to bevacizumab. These results hint on the concept of using combination therapy to override drug resistance in ovarian cancer and to suppress or eradicate residual disease.


Read More: 

http://www.qscience.com/doi/abs/10.5339/qfarf.2012.BMO7

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• ARTICLE

Society of Abdominal Radiology Is Created by a Merger of the Society of Gastrointestinal Radiologists and the Society of Uroradiology: Form Follows Function

Society of Abdominal Radiology Is Created by a Merger of the Society of Gastrointestinal Radiologists and the Society of Uroradiology

 In March 2012, the Society of Gastrointestinal Radiologists (SGR) and the Society of Uroradiology (SUR) merged to form the Society of Abdominal Radiology (SAR), becoming the largest American subspecialty society serving the diverse interests of abdominal radiologists. In my role as the first president of SAR, I would like to share with the readership of Radiology the reasons why two respected and successful societies undertook this merger, explain how this new society will enhance and expand the missions of its parent organizations, and suggest why the specialty of radiology, regardless of subspecialty interests, will be better served.....

Two Distinct Paths: Health Care in the 2012 Presidential Election - The Commonwealth Fund

Two Distinct Paths - The Commonwealth Fund

Two Distinct Paths: Health Care in the 2012 Presidential Election

October 22, 2012

With President Obama and Governor Romney offering fundamentally different visions for the nation's health system, this fall's presidential election provides a stark choice for U.S. voters. To inform public discussion about health care in the election and beyond, The Commonwealth Fund issued a report, Health Care in the 2012 Presidential Election: How the Obama and Romney Plans Stack Up, that contrasts the potential impact of implementing the Affordable Care Act in full, as Obama has pledged to do, with the potential effects of Romney's proposal to repeal the law and replace it with his own vision for the U.S. health system.

The report examines the following issues under each candidate's plan: health insurance expansions, insurance affordability, consumer protections and choice, help for small businesses, Medicare solvency, health care quality improvement, and control of health spending growth.....

Call for Abstracts: 21st Annual Congress on Women’s Health, March 22-24, 2013 in Washington, DC press release

 Call for Abstracts: 21st Annual Congress on Women’s Health, March 22-24, 2013 in Washington, DC

How supportive care teams help dying cancer patients | MD Anderson Cancer Center

How supportive care teams help dying cancer patients | MD Anderson Cancer Center

Consensus Letter: Support the Proposed Federal Rule to Expand the Rights of Patients to Access Their Test Results

Consensus Letter

Every Doctor in America Now Accessible to Consumers Online -- NEW YORK, Oct. 23, 2012 /PRNewswire/ --

Every Doctor in America Now Accessible to Consumers Online -- NEW YORK, Oct. 23, 2012 /PRNewswire/ --

Rating page views versus rating news quality: 2 entirely different metrics

Rating page views versus rating news quality: 2 entirely different metrics:
A WebMD news release last week announced that “WebMD is the First Choice for Consumers and Physicians Seeking Information on the Top Health and Wellness Topics.” The release went on to state that:

WebMD attracted the most visitors of any health information site in September and is again number one in page views in the health category.

That may be so, but our independent analysis of the quality of WebMD health news coverage does not put WebMD news at the top of the quality list. In fact, it’s almost at the bottom of our list.  Granted, there are other types of content that WebMD delivers, and we only evaluate news stories.  But the interactive chart below – available to anyone on our site – shows that WebMD is below the average of all the news sources we’ve reviewed in the past 6.5 years.
WebMD’s average score of 2.78 stars (out of a possible 5) is lower than the 6.5 year average across 1800+ stories of 3.06 stars.


Rankings for visits and page views are good to know if you’re an advertiser. It might not be a good measure of quality of news coverage.  We’re not picking on WebMD.  But if you’re going to make claims about rankings, you have to be ready to have those claims scrutinized.
Here is a quick update on some other average star score grades of other news organizations:

News source	Average star score (out of possible 5)
Associated Press (n=247)	3.59
NPR.org (n=42)	3.57
Los Angeles Times (n=140)	3.51
New York Times (n=124)	3.47
USA Today (n=56)	3.43
Wall Street Journal (n=106)	3.4
Reuters (n=132)	3.26
Washington Post (n=43)	3.23
Chicago Tribune (n=26)	3.08
All 1,813 stories reviewed over 6.5 years	3.06 OVERALL AVERAGE
CNN.com (n=42)	2.98
HealthDay (n=178)	2.86
TIME (n=27)	2.85
WebMD (n=130)	2.78
MSNBC (n=13)	2.38

A few notes about these “scores” –

• Our sampling is imperfect.  It’s the best we can do.  We don’t see everything.  We don’t review everything we see. Our funding has been cut back this year, reducing our volume even further.  And our funding is in jeopardy for the future.  Anyone with suggestions or deep-pocketed sources of industry-free donations – please contact us.
• We review only what we can find online.  We don’t subscribe to the dead-tree printed versions of the newspapers above. Some news organizations make it very difficult to find their health news online. That’s why some leading news organizations don’t appear on the list.
• We review these entities’ blogs as well as their other publications.  Why wouldn’t we?  We all find them the same way – undifferentiated online without caveats about “Oh, this is only a blog…don’t expect us to do critical analysis.”
• Big overall reminder:  we only review stories that include claims about interventions.

Search of: ovarian cancer | Not yet recruiting | Adult, Senior - List Results - ClinicalTrials.gov

Search of: ovarian cancer | Not yet recruiting | Adult, Senior - List Results - ClinicalTrials.gov

Drug Shortages - Current drug shortages updated.

Drug Shortages: Current drug shortages updated.

Frequency of Triple-Negative Breast Cancer in BRCA1 Mutation Carriers: Comparison Between Common Ashkenazi Jewish and Other Mutations

Frequency of Triple-Negative Breast Cancer in BRCA1 Mutation Carriers: Comparison Between Common Ashkenazi Jewish and Other Mutations

paywalled: JCO: Risks of Less Common Cancers in Proven Mutation Carriers With Lynch Syndrome

Risks of Less Common Cancers in Proven Mutation Carriers With Lynch Syndrome

 Abstract

Purpose Patients with Lynch syndrome are at high risk for colon and endometrial cancer, but also at an elevated risk for other less common cancers. The purpose of this retrospective cohort study was to provide risk estimates for these less common cancers in proven carriers of pathogenic mutations in the mismatch repair (MMR) genes MLH1, MSH2, and MSH6. 

Patients and Methods Data were pooled from the German and Dutch national Lynch syndrome registries. Seven different cancer types were analyzed: stomach, small bowel, urinary bladder, other urothelial, breast, ovarian, and prostate cancer. Age-, sex- and MMR gene–specific cumulative risks (CRs) were calculated using the Kaplan-Meier method. Sex-specific incidence rates were compared with general population incidence rates by calculating standardized incidence ratios (SIRs). Multivariate Cox regression analysis was used to estimate the impact of sex and mutated gene on cancer risk.

Results The cohort comprised 2,118 MMR gene mutation carriers (MLH1, n = 806; MSH2, n = 1,004; MSH6, n = 308). All cancers were significantly more frequent than in the general population. The highest risks were found for male small bowel cancer (SIR, 251; 95% CI, 177 to 346; CR at 70 years, 12.0; 95% CI, 5.7 to 18.2). Breast cancer showed an SIR of 1.9 (95% CI, 1.4 to 2.4) and a CR of 14.4 (95% CI, 9.5 to 19.3). MSH2 mutation carriers had a considerably higher risk of developing urothelial cancer than MLH1 or MSH6 carriers.

Conclusion The sex- and gene-specific differences of less common cancer risks should be taken into account in cancer surveillance and prevention programs for patients with Lynch syndrome.

Salpingo-oophorectomy specimens for endometrial c... [Hum Pathol. 2012] - PubMed - NCBI

Salpingo-oophorectomy specimens for endometrial cancer staging: a comparative analysis of representative sampling versus whole tissue processing

Abstract

Involvement of the ovary and/or fallopian tube by an endometrial cancer is uncommon but clinically significant because this is one of the indications for adjuvant chemotherapy. The authors evaluated whether the routine microscopic evaluation of the adnexal organs in this setting should be of the entire specimen or of representative sections. Slides and reports were reviewed for 105 consecutive patients who underwent a staging salpingo-oophorectomy (205 ovaries, 210 tubes) for endometrial carcinoma/carcinosarcoma. The study period encompassed the periods before and after an institutional policy change from discretionary (predominantly representative) adnexal sampling to obligatory total processing. Ninety-four and 111 ovaries (and 92 and 118 tubes) were entirely and representatively processed, respectively. Even when using the most expansive definition of ovarian gross abnormality (definition with the highest sensitivity and lowest specificity for microscopically confirmed cancer), we still identified 4 (of 148; 2.7%) grossly normal ovaries and 3 (of 187; 1.6%) grossly normal tubes that were found to harbor microscopic cancers. There was no significant increase in the number of grossly occult cancers detected after the policy change, and 5 (71%) of the 7 grossly occult cancers were in the representatively sampled group. Approximately 3.76 more blocks per patient were required for total overrepresentative processing, and the total cost of these additional sections was estimated to be $25.57 per patient. In conclusion, the 1.6% to 2.7% of grossly normal adnexa that proved to be cancerous represents, at least theoretically, the risk for misdiagnosis and understaging that is associated with representative sampling, at relatively modest savings. However, the findings in this study do not provide direct evidentiary support for routine complete processing.

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Dietary Reference Intakes for Calcium and Vitamin D

Dietary Reference Intakes for Calcium and Vitamin D

Committee to Review Dietary Reference Intakes for Vitamin D and Calcium Food and Nutrition Board A. Catharine Ross, Christine L. Taylor, Ann L. Yaktine, and Heather B. Del Valle, Editors INSTITUTE OF MEDICINE OF THE NATIONAL ACADEMIES THE NATIONAL ACADEMIES PRESS Washington, D.C. www.nap.edu

Front Matter (R1-R16)   Summary (1-14) 1 Introduction (15-34) 2 Overview of Calcium (35-74) 3 Overview of Vitamin D (75-124) 4 Review of Potential Indicators of Adequacy and Selection of Indicators: Calcium and Vitamin D (125-344) 5 Dietary Reference Intakes for Adequacy: Calcium and Vitamin D (345-402) 6 Tolerable Upper Intake Levels: Calcium and Vitamin D (403-456) 7 Dietary Intake Assessment (457-478) 8 Implications and Special Concerns (479-512) 9 Information Gaps and Research Needs (513-522)             Appendix A: Acronyms, Abbreviations, and Glossary (523-536) Appendix B: Issues and Interests Identified by Study Sponsors (537-538) Appendix C: Methods and Results from the AHRQ-Ottawa Evidence-Based Report on Effectiveness and Safety of Vitamin D in Relation to Bone Health (539-724) Appendix D: Methods and Results from the AHRQ-Tufts Evidence-Based Report on Vitamin D and Calcium (725-1012) Appendix E: Literature Search Strategy (1013-1018) Appendix F: Evidence Maps (1019-1024) Appendix G: Cases Studies of Vitamin D Toxicity (1025-1034) Appendix H: Estimated Intakes of Calcium and Vitamin D from National Surveys (1035-1044) Appendix I: Proportion of the Population Above and Below 40 nmol/L Serum 25-Hydroxyvitamin D Concentrations and Cumulative Distribution of Serum 25-Hydroxyvitamin D Concentrations: United States and Canada (1045-1058) Appendix J: Workshop Agenda and Open Session Agendas (1059-1064) Appendix K: Biographical Sketches of Committee Members (1065-1074) Index (1075-1102) Summary Tables: Dietary Reference Intakes (1103-1116)

Hopelessness and Complementary Therapy Use in Patients With Ovarian Cancer

Hopelessness and Complementary Therapy Use in Patients With Ovarian Cancer

 Abstract

Background: Hopelessness negatively affects ovarian cancer patients' quality of life (QOL). Research validating the effects of complementary and alternative medicine (CAM) use on QOL and hope is scarce, even though QOL and hope are reasons that patients cite for using CAM therapy. Clinicians need effective, evidence-based interventions to improve QOL and reduce hopelessness.

Objective: The objectives of this study were to examine factors influencing hopelessness in patients with newly diagnosed disease, long-term survivors, and patients experiencing ovarian cancer recurrence and to examine the effects of CAM on hopelessness in the same population.

Methods: Surveys of ovarian cancer patients (N = 219) undergoing treatment at a comprehensive cancer center in the United States were analyzed. Descriptive, correlation, and multivariate analyses described variables and demonstrated the effects of sociodemographics, disease state, psychological distress, QOL, CAM use, and faith on hopelessness.

Results: Patients ages 65 years or older (-0.95, P = .03), with strong faith (-0.28, P = .00), and good QOL (0.11, P = .00) directly reduced hopelessness scores (mean, 3.37). Massage therapy substantially reduced hopelessness scores (-1.07, P = .02); holding age constant, employed patients were twice as likely to use massage (odds ratio, 2.09; P = .04). Patients who had newly diagnosed and recurrent ovarian cancer were more hopeless because of greater distress from symptoms and adverse effects of treatment.

Conclusion: Patients who used massage therapy were significantly less hopeless, as were those with strong faith and well-controlled disease symptoms and treatment for adverse effects.

Implications for Practice: Support of spiritual needs and symptom management are important interventions to prevent and/or reduce hopelessness, especially for patients with newly diagnosed and recurrent ovarian cancer. Further research testing the positive effect of massage interventions on hopelessness is needed.

Task Force, Again, Recommends Against Hormone Replacement Therapy for Postmenopausal Women « news@JAMA

Task Force, Again, Recommends Against Hormone Replacement Therapy for Postmenopausal Women « news@JAMA

Although some recent studies have hinted that hormone replacement therapy may be beneficial for some postmenopausal women, the US Preventive Services Task Force continues to recommend against its use for the prevention of chronic medical conditions. The task force’s recommendation, a reaffirmation of its earlier position, appears today in the Annals of Internal Medicine.
For many years, clinicians routinely prescribed hormone replacement therapy for many postmenopausal women for the purpose of preventing such chronic conditions as heart disease, dementia, and osteoporosis. But the therapy fell out of favor, prompted by the release of trial results from the Women’s Health Initiative, published in JAMA in 2002 and 2004, which suggested the risks of taking estrogen alone or combined with progestin outweighed the benefits.
In making its recommendation, the task force considered 51 full-text articles from 9 trials published between January 2002 and November 2011. The task force concluded that estrogen plus progestin and estrogen alone decreased the risk for bone fractures but increased the risk for stroke, thromboembolic events (deep vein thrombosis and pulmonary embolism), gallbladder disease, and urinary incontinence. Estrogen plus progestin increased the risk for breast cancer and probable dementia, while estrogen alone decreased the risk for breast cancer. The task force recommendations apply to average-risk women who have undergone menopause and do not apply to the use of hormone therapy to treat symptoms of menopause, such as hot flashes or vaginal atrophy.
The authors of the recommendation said that because their findings are based on trials enrolling older women who were years past menopause, more research is needed involving women who are transitioning through menopause or who are immediately postmenopausal.
In one small study of such women, recently published in BMJ, the authors noted that conflicting findings from observational and randomized studies might reflect the fact that the randomized trials often involved women who start hormone therapy many years (5 to 20 years) after menopause and said the positive cardiovascular effects seen in observational studies probably were the result of hormone replacement therapy starting shortly after menopause. In their study, which included 1006 healthy Danish women who were recently postmenopausal or who were undergoing menopause, the authors concluded that after 10 years, women being treated with hormone replacement therapy greatly reduced their risk of mortality, heart failure, or heart attack, without any apparent increase in cancer, venous thromboembolism, or stroke risk when compared with women taking a placebo

MyChart Mobile - Sunnybrook (Toronto) User Guide

MyChart™Mobile

2012 SOGC: Genetic Considerations for a Woman’s Annual Gynaecological Examination

Genetic Considerations for a Woman’sAnnual Gynaecological Examination

Abstract

Objective: To provide the physician with an overview of common
genetic conditions that should be considered during a women’s
annual gynaecological assessment to determine the patient’s risk
or to initiate specific testing or referral to another subspecialty
service, depending on personal or family history.


Recommendations
The levels of evidence are not adequate for evidence-based
recommendations to be made.

Key Words: Genetic risk, genetic mutation, gynaecology,
inheritance, family history, uterus, ovary, endometrial, vagina,
colon, gastric, renal, breast, cardiac, thrombophilia, diabetes,
epilepsy, uterine leiomyomata uteri, uterine leiomyomas

Table 4. Estimated number and lifetime risk of women
who would develop or die of various types of cancer
in 2007 (incidence rates/death rates)


"Despite these risks, a recent publication23 reported that a
financially stable and well-educated population of women
had very little knowledge or understanding of hereditary
cancer risks. Cancers studied in this population included
hereditary breast cancer, Lynch syndrome, and p16-related
melanoma. Although approximately 11% were identified
as being at high-risk for at least 1 of the 3 syndromes
(breast cancer 88.5%, Lynch syndrome 6.1%, p16-related
melanoma 3.8%), < 3% had ever had genetic counselling
or testing."

Table 6 summarizes the primary and preventive care
periodic assessments by female age groups.48

paywalled: Cell Biology: Looking for a Sugar Rush

Looking for a Sugar Rush

Science 19 October 2012:
Cell Biology

Looking for a Sugar Rush

Our cells' sugars, called glycans, polysaccharides, or sometimes carbohydrates, are arguably as important as the nucleic acids DNA and RNA, proteins, and lipids. Yet scientists have never had the tools to synthesize and alter glycans in the same systematic way they've been able to with DNA and proteins, making glycans one of the least understood classes of molecules in biology. With an appreciation for the role of sugars rising rapidly among researchers and an influx of scientific talent into the field, glycoscience researchers say the time is ripe to make a big push to forge the suite of tools that they need to study their quarry. That was also the conclusion of a report released in August by the U.S. National Research Council.

2010 ScienceDirect.com - Cancer Epidemiology - Measuring the effect of including multiple cancers in survival analyses using data from the Canadian Cancer Registry

Cancer Epidemiology - Measuring the effect of including multiple cancers in survival analyses using data from the Canadian Cancer Registry

Purchase $31.50

---

Abstract

Background: In survival analyses using cancer registry data, second and subsequent primary cancers diagnosed in individuals are typically excluded. However, this approach may lead to biased comparisons of survival between cancer registries, or over time within a single registry. Purpose: To examine the impact of including multiple primary cancers in the derivation of survival estimates using data from a population-based national cancer registry.  

Methods: Five-year relative survival estimates for persons aged 15–99 years at diagnosis were derived using all eligible primary cases from the Canadian Cancer Registry (CCR)—a population-based registry containing information on cases diagnosed from 1992 onward—and then again using first primary cases only. Any pre-1992 cancer history of persons on the CCR was obtained by using auxiliary information.  

Results: The inclusion of multiple cancers resulted in lower estimates of 5-year relative survival for virtually all cancers studied. The effect was somewhat attenuated by age-standardization (e.g., from 1.3% to 1.0% for all cancers combined), and was greatest for bladder cancer (−2.4%) followed by oral cancer (−1.9%)—cancers that had the first and third lowest proportions of first cancers, respectively. For the majority of cancers the difference was less than 1.0%. Cancers for which there was virtually no difference (e.g., lung, pancreatic, ovarian and liver) tended to be those with a poor prognosis.  

Conclusion: Inclusion of second and subsequent primary cancers in the analysis tended to lower estimates of relative survival, the extent of which varied by cancer and age and depended in part on the proportion of first primary cancers.

Legislative Interference with the Patient–Physician Relationship — NEJM

Legislative Interference with the Patient–Physician Relationship — NEJM

Correspondence: NEJM - Early Cardiovascular Death in Patients with Cancer — NEJM

 Note:  a case could be made for neoadjuvant therapy

Early Cardiovascular Death in Patients with Cancer — NEJM

"... These data suggest that patients who underwent surgery after a cancer diagnosis were more than twice as likely to die from a cardiac cause within the first month than those who did not undergo surgery. This proportion appears similar to the increased risk among patients with cancer that was previously attributed to the psychological stress of a cancer diagnosis. We think that in the future, investigators reporting cardiovascular death in patients with a recent diagnosis of cancer should report the rates of surgery, since it probably has an effect on the rates of early cardiovascular deaths among these patients, possibly over and above any influence of psychological stress."