Monday, February 04, 2013
Editorial: The importance of following the money in the development and sustainability of palliative care
The importance of following the money in the development and sustainability of palliative care
"...Second, we must be vigilant that the ever-increasing imperative for efficiency in health care is always tempered by the need for palliative care specialists to take all the time that is needed to communicate fully with patients and families. Palliative care providers may always have a lower volume of visits or encounters per day than other specialties because of the patience required to understand patients’ values and preferences and to align the goals of care to those values (as much as possible within the constraints imposed by the disease process). We cannot allow the quest for speed to trump the need for patience and wisdom."
The Prague Charter: Urging governments to relieve suffering and ensure the right to palliative care
The Prague Charter: Urging governments to relieve suffering and ensure the right to palliative care
The European Association for Palliative Care (EAPC), the
International Association for Hospice and Palliative Care
(IAHPC), the Worldwide Palliative Care Alliance (WPCA),
and Human Rights Watch (HRW) are working together to
advocate access to palliative care as a human right.
Focused Regional FDG PET/CT Detects More Osseous Metastases Than Does Whole-Body PET/CT.
Abstract
ABSTRACT: A patient with melanoma underwent FDG
PET/CT for surveillance of metastatic disease. The whole-body PET/CT
scan demonstrated a single FDG-avid lesion in the left ilium, suggestive
of an osseous metastasis. Because there was no corresponding CT
abnormality, biopsy was planned using PET/CT guidance. The PET/CT for
biopsy guidance focused over a single pelvic bed position demonstrated
at least 12 FDG-avid osseous metastases, which were not apparent on the
original whole-body PET/CT. This case highlights the limitations of
whole-body PET/CT in the detection of small metastases and suggests that
a PET/CT focused over a specific body region can improve the
sensitivity of detecting small metastases.
MRI of ovarian masses - Journal of Magnetic Resonance Imaging
MRI of ovarian masses - Vargas - 2013 - Journal of Magnetic Resonance Imaging
Abstract
MRI provides exquisite views of the pelvic anatomy through its high spatial resolution and tissue contrast, and as such plays a key role in the work up of ovarian lesions, identifying features that distinguish benign and malignant lesions. In the case of primary tumors it enables local staging and detection of metastatic disease to help guide management options such as complex surgery or the consideration of neoadjuvant chemotherapy. Functional MRI techniques such as diffusion-weighted MRI (DW-MRI), dynamic contrast-enhanced MRI (DCE-MRI) and tumor-selective molecular imaging are currently being evaluated as possible predictive and prognostic biomarkers in the context of ovarian malignancy, and may play a larger role in routine clinical practice in the future. Herein we provide an overview of the conventional and advanced MRI techniques used to characterize ovarian masses and of the role that MR plays in the staging, treatment selection and follow up of patients with ovarian cancer.Who's the doctor? Patients' perceptions of the role of the breast radiologist: a lesson for all radiologists.
"...76% of patients thought that radiologists were radiographers and only 14% knew that radiologists were medical doctors....."
Sunday, February 03, 2013
Changes in short-term health-related quality of life in women undergoing gynecologic oncologic - Abstract
Changes in short-term health-related quality of life in women undergoing gynecologic oncologic - Abstract
METHODS: Women who underwent laparotomy by gynecologic cancer completed the European Organization for Research and Treatment of Cancer (EORTC) Quality of life questionnaires (QLQ-C30 and QLQ-OV28) presurgery and at 1 month.
RESULTS: Of the 181 women studied between January 2007 and March 2008, 116 women (64.1 %) had ovarian cancer, 27 (14.9 %) had cervical cancer, and 29 (16.0 %) had endometrial cancer. By 1 month post-surgery, there was a significant decrease in HR-QOL on the global, abdominal/gastrointestinal (GI) score, body image, chemotherapy side effects, and other single items of the OV28 questionnaire, as well as on physical, role and social functioning, fatigue, nausea and vomiting, pain, insomnia, constipation, appetite loss, and financial difficulties items on C30 questionnaires. Emotional functioning on C30 questionnaires was significantly improved 1 month after surgery. The majority of these items persisted 1 month after surgery only in patients with ovarian cancer. Abdominal/GI score on OV28 questionnaires as well as role and physical functioning on C30 questionnaires were significantly lower between baseline and postsurgical HR-QOL in women with other gynecologic malignancies.
CONCLUSION: The results suggest a significant impact of HR-QOL among gynecologic cancer patients 1 month after laparotomy, particularly among those with ovarian cancer.
Saturday, February 02, 2013
Prognostic Factors and Clinical Outcome of Patients With Recurrent Early-Stage Epithelial Ovarian Cancer: An Italian Multicenter Retrospective Study
Abstract
OBJECTIVE:
The objective of this study was to assess the clinical outcome of patients with recurrent early-stage ovarian cancer.METHODS:
The hospital records of 87 patients were reviewed. The median follow-up of survivors from recurrence was 87.6 months.RESULTS:
The 25%, 50%, and 75% quantiles of time to recurrence were 15, 25, and 44 months, respectively. The pelvis was the most common site of failure (39.1%), followed by abdomen (18.3%) and retroperitoneal nodes (18.3%). Treatment at recurrence consisted of chemotherapy in 46 patients, surgery plus chemotherapy in 29, surgery in 3, surgery plus radiotherapy in 2, and other therapies in 7. A macroscopically complete cytoreduction was obtained in 29 (85.2%) of the 34 patients who underwent secondary surgery. Five- and 7-year survival rates after recurrence were 34.3% and 29.6%. By log-rank test, survival after recurrence was related to patient age (≤60 vs >60 years; P = 0.001), time to recurrence (>15 vs ≤15 months; P = 0.049), site of recurrence (retroperitoneum vs pelvis vs other; P = 0.004), and surgery at recurrence (yes vs not; P = 0.001), but not to substage, histotype, grade, prior adjuvant chemotherapy, examination that detected recurrence, and chemotherapy at recurrence. On multivariate analysis, patient age (hazard ratio, 1.836; 95% confidence interval, 1.060-3.180) and surgical treatment at recurrence (hazard ratio, 1.972; 95% confidence interval, 1.084-3.587) were independent prognostic variables for survival after recurrence.CONCLUSIONS:
Patient age and surgery at recurrence were independent prognostic variables for patients with recurrent early-stage ovarian cancer. When feasible, salvage surgery appears to give a survival advantage in this clinical setting.Prevalence and healthcare actions of women in a large health system with a family history meeting the 2005 USPSTF recommendation for BRCA genetic counseling referra
Abstract
METHODS:
As part of a study evaluating ovarian cancer risk perception and screening, 2,524 randomly-selected participants completed a detailed interview (response rate 76%) from an initial eligible cohort of 16,720 women.RESULTS:
Approximately 6% of participants had a family history fulfilling one or more of the USPSTF patterns. Although 90% of these women had shared their family history with their provider, fewer than 20% had been referred for genetic counseling and only 8% had undergone genetic testing. Caucasian women with higher income and education levels were more likely to receive referrals. Among the 95 participants in the total study cohort who reported BRCA testing, 78% did not have a family history that met one of the USPSTF patterns.CONCLUSIONS:
These results suggest a higher prevalence of women with an increased-risk family history than originally predicted by the USPSTF, and lack of provider recognition and referral for genetic services.Impact: Improvements in healthcare infrastructure and clinician education will be required to realize population-level benefits from BRCA genetic counseling and testing.
Primary Peritoneal Cancer in Lynch Syndrome: A Clinical-Pathologic Report of a Case and Analysis of the Literature
Primary Peritoneal Cancer in Lynch Syndrome: A Clinical-Pathologic Report of a Case and Analysis of the Literature
Abstract
Lynch syndrome is a genetic disease, caused by a germ-line mutation in a mismatch repair gene, related to an increased risk of developing colorectal and extracolonic cancer. Despite that, the incidence of primary peritoneal cancer after adnexectomy remains unknown. We here report a case of primary peritoneal cancer in a woman affected by Lynch syndrome who underwent hysterectomy+salpingo-oophorectomy for endometrial cancer 13 yr before. Morphology and immunophenotype allowed to differentiate peritoneal malignancy from the previously diagnosed endometrial carcinoma. Physicians should be aware of the potential risk of primary peritoneal cancer in women affected by Lynch syndrome, despite previous prophylactic surgery.PLOS ONE: Analysis of RAD51D in Ovarian Cancer Patients and Families with a History of Ovarian or Breast Cancer
PLOS ONE: Analysis of RAD51D in Ovarian Cancer Patients and Families with a History of Ovarian or Breast Cancer
Abstract
"Mutations in RAD51D have been associated with an increased risk of hereditary ovarian cancer and although they have been observed in the context of breast and ovarian cancer families, the association with breast cancer is unclear. The aim of this current study was to validate the reported association of RAD51D with ovarian cancer and assess for an association with breast cancer. We screened for RAD51D mutations in BRCA1/2 mutation-negative index cases from 1,060 familial breast and/or ovarian cancer families (including 741 affected by breast cancer only) and in 245 unselected ovarian cancer cases......."...The absence of truncating mutations in 741 breast cancer only families (or 962 breast cancer-affected probands) provides further evidence that RAD51D mutations do not contribute significantly to breast cancer risk."
A non-synonymous polymorphism in IRS1 modifies risk of developing breast and ovarian cancers in BRCA1 and ovarian cancer in BRCA2 mutation carriers
A non-synonymous polymorphism in IRS1 modifies risk of developing breast and ovarian cancers in BRCA1 and ovarian cancer in BRCA2 mutation carriers
Introduction
Women who carry mutations in BRCA1 or BRCA2
are at a substantially increased risk of developing breast and/or
ovarian cancers. Lifetime risks for breast cancer range from 40–87% and
for ovarian cancer from 11–68% (1, 2).
In addition to variability in the incidence of breast and ovarian
cancers, there is also variability in age at diagnosis and type of
cancer in the index case (proband) (1), even among women who carry the same BRCA mutation (3) and among women in the same family (4). These observations suggest that cancer risk in mutation carriers is modified by other genetic and/or environmental factors.
IRS1
is a docking protein for both the insulin-like growth factor receptor 1
(IGF1R) and the insulin receptor (IR), and as such is central to a
network of intracellular signaling molecules (5)........Methods
Subjects: BRCA1 and BRCA2 mutation carriers
Carriers of pathogenic mutations in BRCA1 and BRCA2 are from one of 36 centers from North America, Europe, the Mediterranean, and Australia participating in CIMBA (13).
NICE issues ACD on bevacizumab for recurrent advanced platinum sensitive or partially platinum sensitive ovarian, fallopian tube, and primary peritoneal cancer - NeLM
NICE issues ACD on bevacizumab for recurrent advanced platinum sensitive or partially platinum sensitive ovarian, fallopian tube, and primary peritoneal cancer - NeLM
The consultation period closes on 22 February 2013
NeLM news service
NICE issues ACD on bevacizumab for recurrent advanced
platinum sensitive or partially platinum sensitive ovarian, fallopian
tube, and primary peritoneal cancer
Source:
NICE
Date published:
01/02/2013 17:26
Summary
by:
Angela Bennett
The National Institute for Health and Clinical
Excellence (NICE) has issued for consultation an Appraisal Consultation
Document (ACD) on the use of bevacizumab for treating advanced ovarian
cancer that has returned six months or more after initial treatment with
platinum-based chemotherapy (platinum-sensitive disease).
The following preliminary recommendations have been made:
The following preliminary recommendations have been made:
Exploring Diagnostic Accuracy In Cancer: A Nationwide Survey of 400 Leading Cancer Specialists (media - BestDoctors.com)
Blogger's Note: there are references to ovarian cancer in this survey
~~~~~~~~~~~~~
"...To this end, in efforts to draw attention to physicians’ valuable perspective on the tools needed to improve diagnostic accuracy rates in cancer cases, the National Coalition on Health Care and Best Doctors conducted a joint survey in late 2012 on the issue. The “Exploring Diagnostic Accuracy in Cancer” survey’s purpose was to solicit subjective responses about misdiagnosis from cancer-related specialists nationwide, focusing on several key items:
- How often participating doctors believe misdiagnoses occur;
- What physicians feel are the most significant barriers to accurately and completely diagnosing and characterizing cancers; The tools doctors feel would help them best combat misdiagnosis;
- Which types of cancer doctors believe are most often misdiagnosed; What issues physicians believe most often lead to errors in interpretation of pathology specimens; and
- Which actions doctors believe would most add to increasing the availability of data on misdiagnosis.
alternative view/website:
BestDoctors.com (what we do section)
Exploring Diagnostic Accuracy in Cancer:
A Nationwide Survey of 400 Leading Cancer Specialists
The National Coalition on Health Care, in tandem with Best Doctors, has released results of a nationwide survey of 400 leading cancer specialists, focused on what doctors feel are the most significant barriers in efforts to accurately diagnose cancers; the types of cancer they believe are most often misdiagnosed; and the tools and improvements they most need to combat misdiagnosis.
Scroll down and click the survey image to read summary and full survey results.
press release: Fruit and Vegetable Intake is Associated With Lower Risk of ER- Breast Cancer
Blogger's Note: the original paper and accompanying editorial are paywalled; this press release has more detail (without requiring $$$)
Fruit and Vegetable Intake is Associated With Lower Risk of ER- Breast Cancer
"...The researchers found that total fruit and vegetable intake was statistically significantly linked to a lower risk of ER- breast cancer, but not with risk of overall breast cancer or risk of ER+ breast tumors. The results showed that the lower risk was mostly associated with higher vegetable consumption. “These findings support the value of examining etiologic factors in relation to breast cancer characterized by hormone receptor status in large pooled analyses because modest associations with less common breast cancer subtypes may have been missed in smaller studies,” the authors write....."
paywalled: Editorial - Fruit and Vegetable Intake and Breast Cancer Risk: A Case for Subtype-Specific Risk?
Fruit and Vegetable Intake and Breast Cancer Risk: A Case for Subtype-Specific Risk?
"...These studies indicate that considering ER-positive and ER-negative breast cancer as a single disease in diet association studies has likely resulted in an underestimation of risk and a possible failure to detect even modest effects that may modify ER-negative breast cancer risk.....
Fruit and Vegetable Intake and Risk of Breast Cancer by Hormone Receptor Status
Fruit and Vegetable Intake and Risk of Breast Cancer by Hormone Receptor Status
Conclusions We observed no association between total fruit and vegetable intake and risk of overall breast cancer. However, vegetable consumption was inversely associated with risk of ER− breast cancer in our large pooled analyses.
Enhancing Citizen Engagement in Cancer Screening Through Deliberative Democracy
Enhancing Citizen Engagement in Cancer Screening Through Deliberative Democracy
Abstract
Cancer screening is widely practiced and
participation is promoted by various social, technical, and commercial
drivers, but
there are growing concerns about the emerging
harms, risks, and costs of cancer screening. Deliberative democracy
methods
engage citizens in dialogue on substantial and
complex problems: especially when evidence and values are important and
people
need time to understand and consider the relevant
issues. Information derived from such deliberations can provide
important
guidance to cancer screening policies: citizens’
values are made explicit, revealing what really matters to people and
why.
Policy makers can see what informed, rather than
uninformed, citizens would decide on the provision of services and
information
on cancer screening. Caveats can be elicited to
guide changes to existing policies and practices. Policies that take
account
of citizens’ opinions through a deliberative
democracy process can be considered more legitimate, justifiable, and
feasible
than those that don’t.
Friday, February 01, 2013
Frequency of mutations in mismatch repair genes in a population-based study of women with ovarian cancer (Lynch Syndrome)
Frequency of mutations in mismatch repair genes in a population-based study of women with ovarian cancer.
Abstract
BACKGROUND:
Mutations in genes for hereditary non-polyposis colorectal cancer (HNPCC) in ovarian cancer patients remains poorly defined. We sought to estimate the frequency and characteristics of HNPCC gene mutations in a population-based sample of women with epithelial ovarian cancer.METHODS:
The analysis included 1893 women with epithelial ovarian cancer ascertained from three population-based studies. Full-germline DNA sequencing of the coding regions was performed on three HNPCC genes, MLH1, MSH2 and MSH6. Collection of demographic, clinical and family history information was attempted in all women.RESULTS:
Nine clearly pathogenic mutations were identified, including five in MSH6, two each in MLH1 and MSH2. In addition, 28 unique predicted pathogenic missense variants were identified in 55 patients. Pathogenic mutation carriers had an earlier mean age at diagnosis of ovarian cancer, overrepresentation of cancers with non-serous histologies and a higher number of relatives with HNPCC-related cancers.CONCLUSIONS:
Our findings suggest that fewer than 1% of women with ovarian cancer harbour a germline mutation in the HNPCC genes, with overrepresentation of MSH6 mutations. This represents a lower-range estimate due to the large number of predicted pathogenic variants in which pathogenicity could not definitively be determined. Identification of mismatch repair gene mutations has the potential to impact screening and treatment decisions in these women.BMC Cancer | open access First description of an acinic cell carcinoma of the breast in a BRCA1 mutation carrier: a case report
BMC Cancer | Abstract | First description of an acinic cell carcinoma of the breast in a BRCA1 mutation carrier: a case report
Background
Acinic cell carcinoma (ACC) is a rare malignant epithelial neoplasm characterized
by the presence of malignant tubular acinar exocrine gland structures. Diagnosis is
generally made in salivary glands and in the pancreas. ACC of the breast has been
reported in few cases only. Carriers of inherited mutations in the BRCA1 gene are
prone to the development of breast cancer, mainly invasive ductal or medullary type
carcinomas. We describe for the first time a BRCA1 mutation carrier with a diagnosis
of ACC of the breast.....
Over half of countries struggling to prevent and manage cancer
Over half of countries struggling to prevent and manage cancer
"...Research suggests that currently a third of all cancer deaths are due to modifiable risks....
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