Friday, January 25, 2013
open access: JCO: Cancer Survivorship: Why Labels Matter
Cancer Survivorship: Why Labels Matter
"...So, to answer the question “Does it really matter how the cancer survivor is defined?” Yes, it does. Is this debate trivial? No, it is not...."
"Until we have a better framework for conceptualizing diseases such as cancer, these definitional issues are unlikely to be resolved. Indeed, they are likely to only become more salient in light of our aging population, with the numbers of cancer survivors estimated to reach 18.1 million in the United States alone in 2020.27 However, in the meantime, it is important to recognize that words not only describe, but also construct, the phenomena under question.28,29 Thus, being more aware of the language we use in research, policy, and practice and the implicit meanings our terms convey seems to be a good place to start."
Cancer spectrum among Irish DNA mismatch repair gene mutation carriers. - ASCO (Lynch Syndrome/MSH2/MLH1)
Cancer spectrum among Irish DNA mismatch repair gene mutation carriers. - ASCO
Abstract:
Methods: We identified 52 LS patients and family members with confirmed pathogenic DNA MMR mutations among 14 kindreds. Clinical data was extracted from the medical records and cancer diagnoses were confirmed from medical records and pathology reports. Tumour tissue was acquired. Immunohistochemistry (IHC) was completed for 4 MMR proteins and tumour lymphocyte infiltration is ongoing.
Results: Spectrum of cancers identified include: CRC, endometrial , gastric, ovarian, renal, breast, prostate, urothelial, NHL, CML, lung, vocal cord, sebaceous carcinoma and cervix. Median age of diagnosis was 44. Thirteen individuals were diagnosed with two primary malignancies, 11 individuals were diagnosed with three primaries and one individual had four cancers. IHC analysis of three breast cancer cases demonstrated loss of MMR protein expression consistent with familial mutation.
Conclusions: Early-onset cancers not traditionally considered manifestations of LS were identified in 14 LS kindreds. An additional 60 pedigrees are being worked up and further IHC and lymphocyte quantification will be reported at the meeting. An expanded LS-associated spectrum of malignancies may exist in certain families.
2012 Review: Improving patient safety through the systematic evaluation of patient outcomes
From the *The Ottawa Hospital, the Department of Medicine, Faculty of
Medicine, University of Ottawa, the Clinical Epidemiology Program, Ottawa Hospital Research Institute, and the Institute for
Clinical Evaluative Sciences, the Department of Surgery, Faculty of Medicine, University of Ottawa, and the Canadian Medical Protective Association, Ottawa, Ont.
Medicine, University of Ottawa, the Clinical Epidemiology Program, Ottawa Hospital Research Institute, and the Institute for
Clinical Evaluative Sciences, the Department of Surgery, Faculty of Medicine, University of Ottawa, and the Canadian Medical Protective Association, Ottawa, Ont.
Improving patient safety through the systematic evaluation of patient outcomes
open access: Understanding the costs of cancer care before and after diagnosis for the 21 most common cancers in Ontario: a population-based descriptive study
Blogger's Note: this is a healthcare systems/registry based study which did not include out-of-pocket patient/caregiver costs; the text of the article references only one mention of ovarian cancer however graphs do include ovarian cancer which show the costs at the middle-upper end of costs; references includes comparisons to U.S. date; as well the study did not include children/adolescent data (Our study also had limitations. We did not examine costs among children and adolescents; currently there are no estimates of costs for this group.)
Understanding the costs of cancer care before and after diagnosis for the 21 most common cancers in Ontario: a population-based descriptive study
open access: Update on first-line treatment of advanced ovarian carcinoma
Update on first-line treatment of advanced ovarian carcinoma
| Blogger's Note: click on 'download article pdf' to view full paper | ||
|---|---|---|
| Published: Jan 25, 2013 |
Dovepress Journal: International Journal of Women's Health
Abstract:
Despite the high response rate to first-line treatment of advanced ovarian cancer, the vast majority of patients relapse. Maximal debulking surgery and chemotherapy with a platinum doublet have remained the standard of care for many years and new approaches are imperative. Recent clinical trials have given grounds for hope. Neoadjuvant chemotherapy, intraperitoneal delivery, and dose-dense strategies have all shown promising results, as has the targeting of angiogenesis. A greater understanding of the molecular landscape of ovarian cancer is helping to identify new treatment options. In this review, we will highlight the key trials and recent progress in these areas.
Bladder function after modified posterior exenteration for primary gynecological cancer
Bladder function after modified posterior exenteration for primary gynecological cancer
WIKI: Pelvic exenteration (or pelvic evisceration) is a radical surgical treatment that removes all organs from a person's pelvic cavity. The urinary bladder, urethra, rectum, and anus are removed.
Abstract
Highlights
► We evaluate the bladder function after modified posterior exenteration as part of cytoreductive surgery for gynecological cancer.
► Symptoms and bladder function were assessed
before and 3 and 6months after surgery using the validated
questionnaires.
► Preservation of bladder function after modified
posterior exenteration is possible even with unilateral nerve-sparing
dissection.
Objective
Bladder
dysfunction caused by autonomic nerve injury is a well-recognized
complication of pelvic surgery. Modified posterior exenteration with or
without nerve preservation was performed in patients with primary
ovarian, tubal, peritoneal, and endometrial cancer. The aim of this
retrospective study was to evaluate the impact of this surgical
technique on bladder function.
Methods
Among
the 60 consecutive patients in whom modified posterior exenteration was
performed, bilateral and unilateral nerve-sparing surgeries were
performed in 43 (72%) and 15 (25%) patients, respectively. In the
remaining 2 patients (3%), the pelvic autonomic nerves on both sides
were sacrificed. Symptoms and bladder function after bilateral or
unilateral nerve-sparing surgery were analyzed using standardized
questionnaires before and 3 and 6 months after surgery.
Results
All
patients with bilateral nerve-sparing surgery had sufficient
micturition from the early postoperative period. Though 40% of the
patients with unilateral nerve-sparing surgery had difficulty in
spontaneous voiding and needed intermittent catheterization, voiding
ability of them improved and no self-catheterization was required
3 months after surgery. The assessment of patient questionnaires
suggested that bladder function was acceptable in both groups at
6 months. Patients with bilateral nerve-sacrificing surgery complained
of neurogenic bladder requiring self-catheterization even 6 months after
surgery.
Conclusions
This
preliminary study showed that preservation of bladder function after
modified posterior exenteration was feasible with a nerve sparing
approach and that standardized outcome measures could be used to monitor
this. However, careful follow-up is required. Future larger studies are
needed to investigate pelvic autonomic nerve function.
Thursday, January 24, 2013
Characterization of rectal cancer in patients with Lynch syndrome. - ASCO (MSH2)
Characterization of rectal cancer in patients with Lynch syndrome. - ASCO
Conclusions: Although less common than colon cancer, RC (rectal cancer) is an important component of LS and may be overrepresented in MSH2 mutation carriers. Given high risk of synchronous or metachronous cancers, appropriate surveillance for second malignancies is necessary.
open access journal: The Many Faces of Patient Engagement | Journal of Participatory Medicine
The Many Faces of Patient Engagement | Journal of Participatory Medicine
"While the terms used to describe patient engagement are unclear and used differently in the literature, they have also been found to be interpreted and understood differently by patients, providers, and administrative leaders. This leads to ambiguity and confusion."
A phase II trial of Sunitinib malate in recurrent and refractory ovarian, fallopian tube and peritoneal carcinoma
A phase II trial of Sunitinib malate in recurrent and refractory ovarian, fallopian tube and peritoneal carcinoma
Highlights
►
Sunitinib achieved a modest response rate of 8.3 % in ovarian cancer
patients.
► Grade 1/2 toxicity with tyrosine kinase inhibitors can have significant consequences.
► Response to Sunitinib can be seen even following previous antiangiogenic therapy but further dedicated and prospective studies are needed to address this concept.
► Grade 1/2 toxicity with tyrosine kinase inhibitors can have significant consequences.
► Response to Sunitinib can be seen even following previous antiangiogenic therapy but further dedicated and prospective studies are needed to address this concept.
Objective
Ovarian
cancer is a highly angiogenic tumor and a model for antiangiogenic
research. The tyrosine kinase receptor inhibitors target several
receptors allowing for the pharmacological disruption of several
independent pathways. Sunitinib malate® is a multitargeted tyrosine
kinase inhibitor. A phase II study utilizing a modified dosing schedule
was conducted to assess the efficacy and safety of Sunitinib® in
recurrent ovarian, fallopian tube and peritoneal carcinoma.
Methods
A
nonrandomized phase II study was modeled as a two-stage Simon design
initially enrolling 17 evaluable participants in stage one and 18
patients in stage two. Patients received the study drug at 37.5 mg every
day over a 28 day treatment cycle until clinical or radiological
evidence of progressive disease. Disease was evaluated radiographically
and best overall response was defined using the RECIST 1.0 criteria. The
primary objective of this study was to define the response rate
(defined as complete response and partial response) while the secondary
objectives included both the progression free rate as well as the safety
of this agent in this patient population.
Results
The
response rate (PR + CR) was 8.3% (95% confidence interval: 1.8%,
22.5%). The 16-week and 24 week progression-free survival estimate was
36% (95% confidence interval and 19.2%), respectively. The median
progression-free survival estimate was 9.9 weeks. Hypertension and
gastrointestional events were the most common toxicities noted.
Conclusions
A
modest response rate of 8.3% was achieved with Sunitinib malate®. This
phase II study adds to the body of literature of VEGFR inhibitors and
further underscores the need of defining a genetic angiogenic signature.
Venous thromboembolism (VTE) rates following the implementation of extended duration prophylaxis for patients undergoing surgery for gynecologic malignancies
Venous thromboembolism (VTE) rates following the implementation of extended duration prophylaxis for patients undergoing surgery for gynecologic malignancies
Highlights
►
Venous thromboembolism rates within 30 days of surgery were
significantly reduced in gynecologic cancer patients receiving extended
duration prophylaxis.
► The decrease in venous thromboembolism rates was not sustained at 90 days following surgery.
► Additional study is needed to further reduce long-term venous thromboembolism rates in women with gynecologic malignancies.
► The decrease in venous thromboembolism rates was not sustained at 90 days following surgery.
► Additional study is needed to further reduce long-term venous thromboembolism rates in women with gynecologic malignancies.
Objective
To
compare the incidence of venous thromboembolism (VTE) before and after
the implementation of standardized extended duration prophylaxis
guidelines in women undergoing laparotomy for gynecologic cancer.
Methods
In
October 2009, departmental practice guidelines were implemented for VTE
prevention. Patients undergoing laparotomy for gynecologic cancer were
started on low molecular weight heparin (LMWH) within 24 h of surgery
and it was continued for a total of 28 days postoperatively. The
incidence of VTE diagnosed within 30 and 90 days of surgery was
determined and compared to a historic cohort of patients who underwent
surgery prior to implementation of the guidelines.
Results
The
incidence of VTE within 30 days of surgery decreased from 2.7% (8/300)
to 0.6% (2/334) following implementation of VTE prevention guidelines
(78% reduction, p = 0.040). However, when the pre and post-guideline
implementation groups were compared for the development of VTE within
90 days of surgery, there was no significant difference (11/300 (3.7%)
vs. 10/334 (3.0%) respectively, p = 0.619). The median time between
surgery and VTE diagnosis was 12 days in the pre-guideline
implementation group, compared with 57 days in the post-guideline
implementation group (p = 0.012).
Conclusion
Patients
receiving extended duration LMWH were found to have significantly lower
rates of VTE within 30 days of surgery when compared with similar
patients who did not receive extended duration LMWH. However, this
effect was not sustained when the groups were compared for VTE diagnosis
within 90 days of surgery. Additional study is needed to further reduce
long-term VTE rates in this high-risk population.
A prospective study of quality of life in patients undergoing pelvic exenteration: Interim results
Blogger's Note/Opinion: based on the limited information provided in the abstract it is noteworthy of the #'s included in the table (original accrual # etc...; while awaiting further information it would seem conclusions maybe overly optimistic??))
A prospective study of quality of life in patients undergoing pelvic exenteration: Interim results
Abstract
Objective
Little
prospective data exist on quality of life (QOL) after pelvic
exenteration (PE). This ongoing study prospectively examines the QOL
changes following this radical procedure using a comprehensive battery
of psychological instruments.
Methods
Since
2005, enrolled patients were interviewed (EORTC QLQ-C30, EORTC
QLQ-CR38, EORTC QLQ-BLM30, BFI, BPI-SF, IADL, CES-D, IES-R)
preoperatively and at 3, 6, and 12 months after PE for
physical/psychological symptoms. Data were examined using repeated
measure ANOVA.
Results
Sixteen
women (3 anterior, 1 posterior, and 12 total PEs), with more than 1 year
of follow-up, completed all scheduled interviews. Median age was
58 years (range, 28–76 years). Overall QOL (F = 6.3, p < 0.02), ability to perform instrumental daily activities (F = 6.8, p < 0.02), body image (F = 11.9, p < 0.00), and sexual function (F = 8.0, p < 0.01)
all declined at 3 months but were near baseline by 12 months after PE.
Although, overall, physical function followed a similar trend (F = 14.8, p < 0.00), it did not return to baseline. At the 12-month interview, patients reported increased gastrointestinal symptoms (F = 8.9, p < 0.01) but significantly less stress-related ideation (F = 6.1, p < 0.03) compared to baseline. Pain levels did not change significantly during the study period (F = 0.4, p < 0.74).
Conclusions
Although
patients report lingering gastrointestinal symptoms and some persistent
decline in physical function after PE, most adjust well, returning to
almost baseline functioning within a year. Providers can counsel
patients that many, though not all, symptoms in the first 3 months
following exenteration are likely to improve as they adapt to their
changed health status. These preliminary results await confirmation of a
larger analysis.
Highlights
►
This ongoing prospective study examines quality of life (QOL) in
patients undergoing pelvic exenteration (PE).
► An extensive battery of psychological measures is used to assess multiple QOL endpoints relevant to these patients.
► Despite some persistent decline in physical function and lingering gastrointestinal symptoms, in general, QOL recovers within a year after PE.
► An extensive battery of psychological measures is used to assess multiple QOL endpoints relevant to these patients.
► Despite some persistent decline in physical function and lingering gastrointestinal symptoms, in general, QOL recovers within a year after PE.
Figures and tables from this article:
- Fig. 1. Patient participation.
The FACIT-AI, a new tool for assessing symptoms associated with malignant ascites
The FACIT-AI, a new tool for assessing symptoms associated with malignant ascites
Highlights
►
We wanted to assess the relevance and validity of the FACIT-AI in women
with ovarian cancer and malignant ascites.
► Fourteen patients were surveyed regarding symptoms associated with malignant ascites to create the questionnaire.
► The 13 item questionnaire has content validity among women with malignant ascites and is available for research and clinical use.
► Fourteen patients were surveyed regarding symptoms associated with malignant ascites to create the questionnaire.
► The 13 item questionnaire has content validity among women with malignant ascites and is available for research and clinical use.
Abstract
Objective
The
objectives of this study are to assess the clinical relevance and
validity of the Functional Assessment of Chronic Illness Therapy-Ascites
Index (FACIT-AI) in women with ovarian cancer and malignant ascites,
and to modify the instrument guided by qualitative feedback from
patients with recurrent malignant ascites.
Methods
Fourteen
adult female patients with recurrent symptomatic malignant ascites were
enrolled from three centers. All completed an open-ended symptom list
to identify their primary concerns regarding their condition. They then
completed a draft 10-item FACIT-AI questionnaire created from expert
input. Eleven patients provided comments regarding the FACIT-AI
questionnaire using a written feedback format. Three patients
participated in a “think-aloud” cognitive debriefing interview to ensure
patient comprehension of questionnaire items.
Results
Of
the first 11 patients surveyed, 7 believed that the draft FACIT-AI
contained all important symptoms associated with malignant ascites.
Responses from the remaining 4 patients revealed three symptoms that 2
or more patients nominated for inclusion: urinary frequency,
constipation and emotional distress. These items were added to the
original FACIT-AI to produce a 13-item index of symptoms associated with
malignant ascites.
Conclusions
The
13-item FACIT-AI has content validity among women with malignant
ascites associated with ovarian cancer. It is available for use in
clinical research or practice, with the expectation that more will be
learned about its performance and interpretation over time.
Ten years survival of FIGO stage IIIC epithelial ovarian cancer cases due to lymph node metastases only.
Ten years survival of FIGO stage IIIC epithelial ovarian cancer cases due to lymph node metastases only.
Abstract
PURPOSE OF INVESTIGATION:
In this paper the authors have analyzed the long-term survival of women with Stage III ovarian cancer due to lymph node metastasis.MATERIALS AND METHODS:
This retrospective study included 27 patients with FIGO Stage IIIC epithelial ovarian carcinoma due to lymph node metastases observed consecutively at the Mangiagalli Clinic of Milan from 1982 to 2008.RESULTS:
Two cases had Fallopian tube carcinoma. A total of ten recurrences were observed. Median time to recurrence was 158 months. The five-year disease-free survival (DFS) was 57.7%. The ten-year corresponding value was 53.2%. Median survival time was 158 months, with median follow-up time of 169 months. The five-year (overall survival) OS rate was 77.1%; the ten-year rate was 55.4%.CONCLUSION:
Women with ovarian cancer Stage IIIC due to nodal involvement have a five-year OS of about 80% and a ten-year OS of about 50%.Wednesday, January 23, 2013
Routine bimanual pelvic examinations: practices and beliefs of US obstetrician-gynecologists
Routine bimanual pelvic examinations: practices and beliefs of US obstetrician-gynecologists
Objective
Less-than-annual
cervical cancer screening is now recommended for most US women, raising
questions about the need for routine annual bimanual pelvic
examinations. Little is known about clinicians' bimanual pelvic
examination practices, their beliefs about its importance, or the
reasoning underlying its performance in asymptomatic women.
Study Design
We
conducted a nationwide survey of US obstetrician-gynecologists.
Respondents (n = 521) reported their examination practices and beliefs
based on vignettes for asymptomatic women across the lifespan.
Results
Nearly
all obstetrician-gynecologists perform bimanual pelvic examinations in
asymptomatic women across the lifespan, although it is viewed as less
important for a newly sexually active 18-year-old. Reasons cited as very
important included adherence to standard medical practices (45%),
patient reassurance (49%), detection of ovarian cancer (47%), and
identification of benign uterine (59%) and ovarian (54%) conditions.
Conclusion
Obstetrician-gynecologists
perform bimanual pelvic examinations in the vast majority of
asymptomatic women, but the importance placed on the examinations and
reasons for conducting them vary.
Blogger's Note: see article link for further tables
- FIGURE 1. Clinicians who would perform bimanual pelvic examination and consider it very important, by vignetteHenderson. Obstetrician-gynecologists' beliefs about bimanual pelvic examinations. Am J Obstet Gynecol 2013.
Hyperthermic Intraperitoneal Chemotherapy with Carboplatin for Optimally-cytoreduced, Recurrent, Platinum-sensitive Ovarian Carcinoma: A Pilot Study
Hyperthermic Intraperitoneal Chemotherapy with Carboplatin for Optimally-cytoreduced, Recurrent, Platinum-sensitive Ovarian Carcinoma: A Pilot Study
Highlights
►
Hyperthermic intraperitoneal carboplatin in the setting of optimal
secondary cytoreduction surgery is feasible.
► Patients receiving hyperthermic intraperitoneal carboplatin were able to tolerate subsequent consolidation therapy.
► Patients receiving hyperthermic intraperitoneal carboplatin were able to tolerate subsequent consolidation therapy.
Abstract
Objective
We
aimed to evaluate the feasibility and tolerability of hyperthermic
intraperitoneal carboplatin (HIPEC-carboplatin) following secondary
cytoreduction for recurrent, platinum-sensitive ovarian cancer.
Methods
In
a single institution prospective, pilot study, ten patients underwent
secondary cytoreductive surgery followed by HIPEC-carboplatin at
1000 mg/m2. Consolidation (6 cycles) was with platinum-based regimens.
Adverse and quality of life were measured throughout treatment.
Results
Twelve
patients were enrolled of which 2 were excluded (one each for
extra-abdominal disease indentified before surgery and suboptimal
cytoreduction). All 10 remaining patients received prescribed
HIPEC-carboplatin. There were no intra-operative complications or AEs
attributable to HIPEC -therapy. Grade 1/2 nausea was the most common
post-operative toxicity (6/10 patients). Two patients had grade 4
post-operative neutropenia and thrombocytopenia but only one experienced
transient treatment delay. The median hospital stay was 5.5 days. 69/70
(98%) of planned chemotherapy doses were ultimately delivered with 1
patient electively forgoing her final treatment. At a median (range)
follow-up of 16 (6–23) months, three patients have recurred at 8, 14,
and 16 months from surgery. The median disease-free and overall
survivals have not been reached. Fact-O scores were significantly lower
following surgery (126 vs. 108, p < .01), but improved by completion
of therapy (108 vs 113, p = 0.27).
Conclusions
HIPEC-
carboplatin at 1000 mg/m2 following optimal cytoreduction for ovarian
cancer is feasible. Surgical complications were not observed, and
post-operative AEs were largely within expected ranges. Consolidation
using standard platinum-based regimens was feasible following
HIPEC-carboplatin, and preliminary survival data suggests efficacy.
Further investigation of HIPEC-carboplatin in the setting of debulkable
cancer recurrence is warranted.
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