Talking with Patients about Dying — NEJM

Talking with Patients about Dying — NEJM

To the Editor:

Weeks et al. (Oct. 25 issue)1 raise an important concern that patients with advanced cancers may not understand that chemotherapy is not curative. However, as the authors acknowledge, there are challenges in interpreting patients' expectations on the basis of responses to a single, closed-ended interview item.
Our study on informed consent in early-phase oncology trials may shed light on the extent of these challenges. We found that patients express higher expectations of benefit when the query is framed in terms of personal benefit rather than in terms of a population frequency of a particular benefit.2,3 Furthermore, patients with the greatest optimism regarding the benefit of experimental therapy commonly explain their answer in terms of the importance of expressing a positive attitude, not in terms of their assessment of their actual prognosis.2 Thus, interpretation of patient-survey items must account for the fact that what we think we are asking patients may be different than what patients mean by their responses.

Health News - Ovarian cancer risk reduced by prolonged lactation

Health News - Ovarian cancer risk reduced by prolonged lactation

 The research, Ovarian cancer risk is reduced by prolonged lactation: a case-control study in southern China, will published in the American Journal of Clinical Nutrition next month.

PLOS ONE: Inherited Variants in Regulatory T Cell Genes and Outcome of Ovarian Cancer

 Blogger's Note: specific references are made to subtypes (eg. clear cell, mucinous, endometriod, serous)

PLOS ONE: Inherited Variants in Regulatory T Cell Genes and Outcome of Ovarian Cancer

Introduction

Ovarian cancer is the fifth leading cause of cancer death among women in the United States [1]. Five-year overall survival is approximately 45%, and, even with modern surgical and chemotherapeutic strategies, most cases with advanced disease relapse and succumb to the disease [2], [3]. Rare germline BRCA1 or BRCA2 mutations confer improved survival [4]. Common inherited variants could also influence outcome; genome-wide association studies (GWAS) are underway, but have yet to find survival-associated loci [5]. Consideration of novel biological pathways using in-depth analysis of variation in candidate genes holds promise for the identification of prognostic genetic factors.
Several studies demonstrate the importance of the immune system in ovarian cancer outcome.....

"In conclusion, our analysis of 3,662 invasive ovarian cancer cases suggests that inherited variants related to Tregs are associated with ovarian cancer outcome in a subtype-specific manner, even after adjustment for known prognostic features. Our findings underscore the importance of subtype-specific analyses in clinical and epidemiological studies of ovarian cancer, given the established disease heterogeneity, with each histologic subtype expressing different patterns of genetic, epidemiologic and clinical characteristics (reviewed by Karst and Drapkin [56]). Future work should include examination of additional study populations, immunological studies, and correlation of inherited variants with other tumor features, such as levels of Treg infiltration.

open access: PLOS ONE: Clinical Course of Patients Treated for Advanced Ovarian Carcinoma without Surgical Intervention

PLOS ONE: Clinical Course of Patients Treated for Advanced Ovarian Carcinoma without Surgical Intervention

Objective

To describe the clinical course and outcome of patients with non-surgically-treated advanced ovarian cancer attending a single institute.

Introduction

Surgery is central in the treatment of ovarian carcinoma. Surgical staging procedures are employed for apparent stage 1 disease, and extensive cytoreductive surgery is believed to be vital for long-term survival in patients with advanced epithelial ovarian cancer [1], [2]. Patients left with minimal residual disease fare better than patients who remain with bulkier lesions [3]–[5]. Whether the maximal surgical effort should be made upfront, at diagnosis, or after neo-adjuvant chemotherapy is still unclear [6]. Over the last two decades, several studies have addressed the use of chemotherapy prior to surgery in women with advanced epithelial ovarian cancer [7]–[9], and recently, a large randomized trial suggested that neoadjuvant chemotherapy is not detrimental to survival relative to upfront surgery [10].
The finding that some patients with advanced peritoneal disease remain with only minimal or even no residual disease by interval cytoreduction raises the question of the added value of surgery to the clinical course in these cases. This issue is important, because not all patients with advanced ovarian cancer are eligible for surgery owing to background medical conditions that rule out laparotomy and extensive resection or poor performance status, and others refuse surgery for personal reasons. Our search of the literature yielded no contemporary studies of patients with ovarian carcinoma treated without surgery at all.......

PET-CT vs. Integrated MR-PET Scanning of GYN Cancers - Full Text View - ClinicalTrials.gov

This study is not yet open for participant recruitment.

Verified January 2013 by Massachusetts General Hospital

PET-CT vs. Integrated MR-PET Scanning of GYN Cancers - Full Text View - ClinicalTrials.gov

press release: SGO Addresses Threats to Gynecologic Oncology Care; Proposes Solutions

SGO Addresses Threats to Gynecologic Oncology Care; Proposes Solutions

Released: 1/30/2013 4:00 PM EST
Source Newsroom: Society of Gynecologic Oncology

 

Newswise — CHICAGO, IL (Jan. 30, 2013)—The Society of Gynecologic Oncology (SGO) today proposed new ways to deliver high quality, cost-effective care to women with gynecologic cancers.
The solutions are presented in an SGO report, "Creating a New Paradigm in Gynecologic Cancer Care: Policy Proposals for Delivery, Quality and Reimbursement," available here.

"We face a crisis. Women with gynecologic cancer are often treated by providers lacking sufficient training and experience," said SGO President Ronald D. Alvarez, MD. "Care for these women is often fragmented, uncoordinated, and not based upon established guidelines.
"As a result of this broken system, the cost of providing care to women with gynecologic cancer remains high and these women often suffer poorer outcomes. With limited accountability in our system, the goal of providing consistent, high quality, cost-effective care remains elusive.”
In June 2012, the SGO convened a Practice Summit comprised of thought leaders in the medical subspecialty of gynecologic oncology to assess the health care system and policy environment. Over the following months, participants examined the issues raised at the Summit and developed solutions.

Among the SGO proposals:

• Care of a woman with a suspected or diagnosed gynecologic cancer should be structured like the patient-centered medical home model and be coordinated by a single health care provider (a “team captain”) with multidisciplinary training in the care of women with gynecologic cancer.
• Measurable standards for high quality care for women diagnosed with gynecologic cancer should be determined, validated and tracked. Demonstration projects, registry systems and funding for outcomes-based research are key.
• Several payment systems, including diagnosis-based, episode-of-care reimbursement system in which payment would be based on each diagnostic episode of the woman's illness rather than on specific procedures, should be developed and tested.

"The SGO proposals provide the roadmap towards improving the coordination and quality of gynecologic cancer care, while reducing costs associated with unnecessary testing and inappropriate therapies," said Dr. Alvarez.
About SGO
The Society of Gynecologic Oncology (SGO) is a national medical specialty organization of physicians and allied health care professionals who are trained in the comprehensive management of women with malignancies of the reproductive tract..... www.sgo.org

Lower awareness isn’t behind the UK’s poorer survival - Cancer Research UK - Science Update blog

Lower awareness isn’t behind the UK’s poorer survival - Cancer Research UK - Science Update blog

Immunotherapy Shows Promise for Ovarian Cancer- Penn Medicine (+clinical trials)

Immunotherapy Shows Promise for Ovarian Cancer | Penn Health for Women Newsletter | Penn Medicine

"Launched in July 2007 under the leadership of George Coukos, MD, PhD, the Penn Ovarian Cancer Research Center is making prevention, early detection, treatment and understanding the biology of ovarian cancer a priority......

2013: Controversial stem-cell company moves treatment out of the United States : Nature News & Comment

Controversial stem-cell company moves treatment out of the United States : Nature News & Comment

2012: Controversial bioethicist quits stem-cell company : Nature News & Comment

Controversial bioethicist quits stem-cell company : Nature News & Comment

Risk factors for adverse reactions from contrast agents for computed tomography

 Background
Symptoms of an adverse reaction to contrast agents for computed tomography are diverse ranging, and sometimes serious. The goal of this study is to create a scoring rule to predict adverse reactions to contrast agents used in computed tomography.


Table 3 Predict point’s decision with Logistic Regression

Adverse reaction history for radio contrast
Urticaria
Allergic history for any drugs
Contrast agent concentration over 70 (%)
Age under 50 years
Total contrast agent dose over 65 (g)

Clinical and pathological features of hepatoid carcinoma of the ovary

Clinical and pathological features of hepatoid carcinoma of the ovary:

Hepatoid carcinoma of the ovary (HCO), a rare invasive malignant tumor composed mainly of epithelioid cells, presented with unilateral or bilateral ovarian masses and elevated serum alpha-fetoprotein (AFP), has been found mainly in post-menopausal women. We hereby report on the case of a 53-year-old Chinese woman who presented with abdominal distension and a lower abdominal mass with high serum levels of CA-125 and AFP. She was later diagnosed with bilateral HCO. After surgery and following chemotherapy, the patient had no recurrence of tumor or ascites. The hepatoid cells were positive for AFP, p53 and CK7 by immunohistochemistry. Her serum CA-125 and AFP levels had decreased significantly after surgery. Our results suggest that testing and monitoring of serum levels of AFP and CA-125 are considered as potential biomarkers in the diagnosis and progression of this malignancy, and that tissue immunohistochemical staining for AFP, p53 and CK7, plays an important role in distinguishing HCO from other ovarian tumors.

(Canada) New standard for hospitals on reporting adverse drug reactions released today

New standard for hospitals on reporting adverse drug reactions released today

Immunovaccine Signs Agreement for Phase I/II Clinical Trial of DPX-0907 in Breast and Ovarian Cancer Patients

Immunovaccine Signs Agreement for Phase I/II Clinical Trial of DPX-0907 in Breast and Ovarian Cancer Patients

tech: Firefox to block Silverlight and Java -- but not Flash

Firefox to block Silverlight and Java -- but not Flash:

To improve security and cut crashes, Firefox will block plug-ins including Microsoft Silverlight, Adobe Reader, Apple's QuickTime and Oracle's Java, Mozilla said.

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open access: Stratifying Risk of Urinary Tract Malignant Tumors in Patients With Asymptomatic Microscopic Hematuria (Lynch Syndrome patients)

 Blogger's Note: this research article did not include any references to Lynch Syndrome nor past history of any cancer/s; a large portion of the included references were >10 yrs

~~~~~~~~~~~~~~~

Stratifying Risk of Urinary Tract Malignant Tumors in Patients With Asymptomatic Microscopic Hematuria

"...For malignant findings, the incidence of renal cancer was extremely low in our study (0.3%), and no ureteral or transitional cell carcinomas of the upper urinary tract were identified in either cohort....." 

" This study has several potential limitations that should be taken into consideration when interpreting our results. Not all urologists participated in the data collection; therefore, not all patients who may have undergone microhematuria evaluation were included in either cohort, and these patients may be systematically different from those who were included. Data were entered for only 50% of patients who underwent cystoscopy for microhematuria during the period. The similarity in cancer diagnosis rates among those followed up according to plan vs not, however, suggests that this likely played only a small role....."

Conclusion 

These data suggest that microscopic hematuria is an unreliable indicator of urinary tract malignant tumors. Patients with microscopic hematuria younger than 50 years and with no history of gross hematuria may not benefit from further evaluation and therefore could avoid unnecessary risk from radiation exposure and invasive endoscopy. These findings may be used to simplify referral guidelines for evaluation in asymptomatic patients with microscopic hematuria and reduce the number of unnecessary evaluations.

open access: Access to opioid analgesics and pain relief for patients with cancer : Article : Nature Reviews Clinical Oncology

Access to opioid analgesics and pain relief for patients with cancer : Article : Nature Reviews Clinical Oncology

Access to pain relief is a crucial concern for patients with cancer, and remains so at all stages of the illness trajectory. This Review covers the scope of the problem and considers the optimal palliative strategy, mainly through the use of opioids. It also discusses various barriers to effective pain management around the world, including regulatory and attitudinal barriers towards opioids, and the unwillingness of national governments to integrate palliative care effectively in cancer control efforts.

Key points

• Pain is the most-common and feared symptom in patients with cancer, and is frequently present at all stages of illness
• Opioids are the mainstay of cancer pain management, and can relieve pain effectively in the majority of patients
• Pain in patients with cancer is best considered as a domain within the broader context of palliative care
• Lack of opioids, trained health-care professionals, and palliative-care programmes are the most common barriers to effective pain management in cancer patients......

New NCCN Guidelines for Patients® Available for Adolescents and Young Adults with Cancer

New NCCN Guidelines for Patients® Available for Adolescents and Young Adults with Cancer

New NCCN Guidelines for Patients® Available for Adolescents and Young Adults with Cancer

New NCCN Guidelines for Patients® Available for Adolescents and Young Adults with Cancer

FDA allows IND application for ImmunoCellular’s ICT-140 to treat ovarian cancer

FDA allows IND application for ImmunoCellular’s ICT-140 to treat ovarian cancer

Treatment for Neuropathic Pain in Patients with Cancer: Comparative Analysis of Recommendations in National Clinical Practice Guidelines from European Countries

Treatment for Neuropathic Pain in Patients with Cancer: Comparative Analysis of Recommendations in National Clinical Practice Guidelines from European Countries 

Abstract

Introduction

Neuropathic pain is a common symptom, present in 39% of the patients with cancer pain. Treating this type of pain is challenging, as this patient group is often frail and has comorbidities which increase the risk of side events and hence influences their quality of life. Clinical practice guidelines (CPGs) can be helpful for clinicians, especially when scientific evidence is uncertain or weak. In this study, we focused on the quality of the review of the literature used in treatment recommendations in the selected European CPGs.

Methods

In a previous study, 9 CPGs from European countries that contained at least one paragraph on treatment for neuropathic pain in cancer were included. Recommendations with their grade (according SIGN 55 classification) and supporting literature (first author, patients' population, year and type of publication) were compared between CPGs.

Results

In all CPGs, amitriptylin was mentioned as the drug of first choice. Six guidelines proposed also gabapentinoids. Only 30 of the 163 citations (18%) were based on studies in patients with cancer. Seven CPGs did not argue the indirect evidence due to extrapolation of study results from non-cancer to patients with cancer.

Conclusion

The majority of guideline development groups extrapolated their results from non-cancer publications to formulate recommendations. Consequently, these guidelines fail to address important issues such as altered kinetics and side effect profiles in these patients. We recommend creating specific recommendations by an international expert group for the treatment for neuropathic pain in patients with cancer supported by targeted research in patients with cancer.

Nutrition / Diet: Do The Health Benefits Of Berries Make It Past Your Mouth?

Do The Health Benefits Of Berries Make It Past Your Mouth?

JCO: Comments - Rational Follow-Up After Curative Cancer Resection

Blogger's Note: not specific to ovarian cancer 

Rational Follow-Up After Curative Cancer Resection

"...Intensive follow-up for early detection of disease recurrence may
be necessary for clinical trials designed to determine the efficacy of
novel treatments. However, outside of such trials, focusing solely on
detecting recurrences of the index cancer during follow-up attenuates
clinical energy and financial resources that could help patients live
with and manage adverse effects of cancer treatment. Obviously,when
new treatments for recurrent or metastatic disease effectively prolong
survival, studies of the intensity of follow-up to assess survival benefit
should be undertaken. However, research on follow-up after curative
resection might be better focused on more-immediate aspects of
patient-centered cancer care, such as management or prevention of
treatment adverse effects. Currently, there are remarkably few trials addressing these issues. Recent maturation of the field of clinical quality-of-life research along with the clinical acceptance of validated patient-reported outcome measures provides a significant opportunity to improve this deficit. 42"

Exemestane Versus Anastrozole in Postmenopausal Women With Early Breast Cancer: NCIC CTG MA.27—A Randomized Controlled Phase III Trial

Exemestane Versus Anastrozole in Postmenopausal Women With Early Breast Cancer: NCIC CTG MA.27—A Randomized Controlled Phase III Trial