open access: JCO - Art of Oncology - Oncodoxes

Oncodoxes

 "Those outside the field of oncology might think that dealing with cancer and all the suffering and death it entails would be what wears us down. That is of course to some degree the case. However, we are trained not only to make patients better but also to deliver bad news, to alleviate suffering, and to help the dying. And having developed an interest in palliative care along with oncology, I find it can be immensely rewarding guiding patients and families through those difficult times. 

Furthermore, one of the most surprising perspectives gained by medical students and residents rotating in the outpatient oncology setting is how well a majority of patients I see in a day in the office seem.......

"Be Optimistic/Be Honest

Patients come to their physicians seeking help and hope. Educating patients and their families about their diagnosis and prognosis is certainly one of our most important responsibilities. The issue is not whether to tell the truth—we would not intentionally lie to patients. The quandary is how to tell it, how much to tell, and when to do so....."

open access: U.S. - ASCO Recommendations for Achieving High-Quality Cancer Survivorship Care Recommendation

ASCO Recommendations for Achieving High-Quality Cancer Survivorship Care Recommendation


Clinical guidance - Table 5

Develop and disseminate guidance to standardize the long-term follow-up care of adult cancer survivors

Develop evidence-based clinical practice guidelines, assessment tools, and screening instruments to help identify and manage late effects of cancer and its treatment

Make this guidance accessible to oncology providers in all practice settings as well as to primary care providers

Use general health guidelines/guidance existing outside the oncology sphere when providing care for cancer survivors

Models of survivorship care

Promote successful models of survivorship care and tools that optimize the transition process between oncology and primary care providers

paywalled - Preclinical evaluation of statins (simvastatin) as a treatment for ovarian cancer

ScienceDirect.com - Gynecologic Oncology - Preclinical evaluation of statins as a treatment for ovarian cancer

 Highlights

► Continuous and prolonged exposure to simvastatin is required for ovarian cancer cell cytotoxicity.
► Exposure of cells to simvastatin prior to carboplatin is profoundly antagonistic.
► Statins exert conflicting effects on the autophagy pathway.

Purchase $39.95

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Abstract

Objective

To evaluate the potential for statins to treat ovarian cancer.

OXiGENE confirms tolerability in second toxicity analysis of ovarian cancer drug trial - Pharmaceutical Business Review

OXiGENE confirms tolerability in second toxicity analysis of ovarian cancer drug trial - Pharmaceutical Business Review

"As part of the analysis, performed at more than 80 US locations, patients were given the combination of ZYBRESTAT (fosbretabulin tromethamine or CA4P) and Avastin (bevacizumab) and evaluated the toxicity.
Patients are randomized with bevacizumab 15 mg/kg IV in one arm and bevacizumab plus fosbretabulin tromethamine 60 mg/m2 IV in the other arm on the first day as part of the therapy and every three weeks.....

Ovarian Cancer? Now What? | dailyRx

 Blogger's Note: refers to  Research Article:

Prognostically relevant gene signatures of high-grade serous ovarian carcinoma

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Ovarian Cancer? Now What? | dailyRx

open access: JCI - Prognostically relevant gene signatures of high-grade serous ovarian carcinoma

 Blogger's Note: technical

JCI - Prognostically relevant gene signatures of high-grade serous ovarian carcinoma
  
Introduction

High-grade serous ovarian carcinoma (HGS-OvCa) accounts for 60%–80% of the approximately 26,000 women diagnosed with epithelial ovarian carcinoma in the US annually (1, 2). Known risk determinants for the development of ovarian carcinoma include BRCA1/BRCA2 mutations, family history, nulliparity, oral contraceptive use, tubal ligation, pregnancy, and lactation (1, 3). A common treatment regimen consists of tumor debulking, followed by administration of platinum and taxane-based chemotherapy (4). The advanced stage at which most patients present, combined with the high rate of relapse, results in a 5-year survival rate less than 40% (5, 6). Identification of nonresponders and patients with primary platinum resistance (recurrence less than 6 months after last chemotherapy cycle) is an important step toward achieving greater life expectancy for serous ovarian carcinoma patients (7). Gene expression profiles have been established that are associated with overall survival (8, 9), debulking status (10), and response to platinum therapy (11–15). Despite those encouraging developments, no biomarkers for prediction of response to therapy are yet in clinical use.
Gene expression–based outcome predictors have had the greatest impact in breast cancer, where gene signature–based assays of recurrence, chemotherapy efficacy, and metastasis were developed with the potential to guide therapy decisions (16–18). Predictors of prognosis have been developed for other cancers, but have not necessarily led to changes in clinical practice. In addition to predicting survival, the potential of prognostic classifiers lies in the ability to recognize categories of patients that are more likely to respond to particular therapies. For example, the Mesenchymal expression subtype of glioblastoma is being investigated in relation to response to angiogenesis inhibitors such as bevacizumab (19)......

UK: Ovarian cancer survival 'held back by stocism and embarrassment' | GPonline.com

Ovarian cancer survival 'held back by stocism and embarrassment' | GPonline.com

 March is Ovarian Cancer Awareness Month and also perhaps an opportunity to audit our progress against the disease, writes consultant medical oncologist Dr Sarah Blagden. Lifting the twin barriers of stoicism and embarrassment could help improve survival rates, she argues......

Ovarian Cancer Action is launching a dedicated helpline for GPs and healthcare professionals to access general information about the disease. The helpline number is: 0207 380 1747 and will be accessible Monday – Friday from 9am – 5pm. Click here for more information

Study prompts rethink of how ovaries develop - University of Adelaide

Study prompts rethink of how ovaries develop

Friday, 8 February 2013


New research from the University of Adelaide will rewrite the text books on how an ovary is formed, as well as providing new insights into women's health and fertility.

The study, published today in the journal PLOS ONE, also names a new type of cell that plays a key role in the development of ovaries and ovarian follicles, which are responsible for the production of eggs in women.

The discovery is expected to prompt further studies around the world to better understand how ovaries and ovarian follicles develop in female fetuses. This could be critical to treating or preventing a range of health conditions in later life, including infertility and ovarian cancer.

"For more than a decade, scientists have believed that ovarian follicle cells are derived from the epithelial cells on the surface of the ovary as it develops," says research leader Professor Ray Rodgers, from the University of Adelaide's Robinson Institute.

"Instead, contrary to conventional thinking, we've found a new cell type that is the precursor to both the cells on the surface of the ovary and the follicular cells. We call this the GREL (Gonadal Ridge Epithelial-Like) cell."

Professor Rodgers says this work could lead to new insights into a range of conditions, such as premature ovarian failure, early menopause, polycystic ovarian syndrome (PCOS) and ovarian cancer.

"The role of the ovarian follicle in many of these conditions is very important," he says. "For example, the PCOS ovary is associated with an increased number of growing follicles that at some point just stop working.

"With early menopause, there is a theory that some women may not have had enough egg-producing ovarian follicles at development, so once their reserve of follicles has been used up earlier, menopause sets in.
"Ovarian cancer is a different story - about 90% of ovarian cancers are of an epithelial type. However, our study has shown us for the first time that when the ovary is first developing, it doesn't have an epithelial layer. Why this is, we're not sure yet."

 

PLOS ONE - Open Access Peer-Reviewed

Research Article

A New Model of Development of the Mammalian Ovary and Follicles
"In the current study we used bovine ovaries because the adult ovary has defined regions with a medulla, cortex and tunica in proportions similar to the human ovary."

Ensuring Equal Access to Cancer Research: What Does Informed Consent Look Like in a Health Literate Organization? | Education Network to Advance Clinical Trials

Ensuring Equal Access to Cancer Research: What Does Informed Consent Look Like in a Health Literate Organization? | Education Network to Advance Clinical Trials

An appeal to world leaders: stop cancer now : The Lancet

Blogger's Note: sign in/on for free access

An appeal to world leaders: stop cancer now : The Lancet

".... With the Stop Cancer Now! appeal on World Cancer Day the European School of Oncology aims to galvanise everyone who has been affected by cancer, and wants to help save millions of others from suffering the same experience, to put pressure on governments and policy makers to do what they have to do, and do it now."

The failure of cancer medicine? : The Lancet

The failure of cancer medicine? : The Lancet

"... So let us return to the question we began with—has cancer medicine failed patients? In the words of cancer experts, the answer is yes. But the cancer community, together with other essential parts of the health care system (eg, primary care), recognise the deficiencies of the past. They are determined to write not a new war plan but a new future for patients at risk of—or living with—cancer. 2013 must be a watershed year for cancer."

Dishing out cancer treatment (assay testing) : Nature Biotechnology : Nature Publishing Group

Dishing out cancer treatment : Nature Biotechnology : Nature Publishing Group

 "Despite their limitations, in vitro assays are a simple means for assessing the drug sensitivity of a patient's cancer. After consulting experts in the community, we think such assays deserve a second look..........A key critique of the cultured tumor cell approach is that the cells are not representative of those in the patient. In the 1980s and 1990s, only relatively crude tests of cellular physiology and morphology were available to optimize protocols. Today, however, a whole gamut of genomic, transcriptomic, proteomic and metabolomic profiling technologies are available to systematically optimize the culture conditions and track cells in vitro so they resemble those in vivo......

Declining Second Primary Ovarian Cancer After First Primary Breast Cancer

Declining Second Primary Ovarian Cancer After First Primary Breast Cancer

Abstract

Purpose Although ovarian cancer incidence rates have declined in the United States, less is known of ovarian cancer trends among survivors of breast cancer. Therefore, we examined second primary ovarian cancers after first primary breast cancer.

 

Methods Data were obtained from the Surveillance, Epidemiology, and End Results program (1973 to 2008). Standardized incidence ratios (SIRs) were calculated as the observed numbers of ovarian cancers among survivors of breast cancer compared with the expected numbers in the general population. Absolute rates were measured as the incidence rates for second primary ovarian cancer by year of diagnosis of the first primary breast cancer adjusted for age of breast cancer diagnosis and years since diagnosis. 

Results SIRs for second primary ovarian cancer were elevated over the entire study period (SIR, 1.24; 95% CI, 1.2 to 1.3), whereas the absolute rates declined with an estimated annual percentage change near 1% (−1.34% to −0.09% per year). Secular trends for second ovarian cancers were similar after estrogen receptor (ER) –positive and ER-negative breast cancers, whereas the age-specific patterns varied significantly by ER expression (P for interaction < .001). The largest SIR was among women age less than 50 years with ER-negative breast cancer (SIR, 4.35; 95% CI, 3.5 to 5.4). 

Conclusion Persistently elevated SIRs along with decreasing absolute rates over the entire study period suggest that ovarian cancers in both the general population and survivors of breast cancer are declining in parallel, possibly because of common risk factor exposures. Analytic studies are needed to further assess the parallel overall trends and the age-specific interaction by ER expression.

paywalled: The impact of having a sister diagnosed with breast cancer on cancer-related distress and breast cancer risk perception

Blogger's Note/Opinion: we are to assume within the abstract "the disease" means breast cancer only;  this study, unfortunately,  precludes risk perception/s based on other cancers in the families - a narrow view but may be addressed by 'further studies'

The impact of having a sister diagnosed with breast cancer on cancer-related distress and breast cancer risk perception

Abstract

BACKGROUND:

A family history of breast cancer has been shown to affect psychosocial functioning. However, the majority of research has focused on the daughters of patients with breast cancer and families with multiple relatives with the disease. The purpose of the current study was to examine cancer-related distress and breast cancer risk perception, and further examine the predictors of these outcomes, in the sisters of newly diagnosed patients with breast cancer without a previous family history of the disease.

open access: Patient Experience, Outcomes, and Participatory Medicine | Journal of Participatory Medicine

Patient Experience, Outcomes, and Participatory Medicine | Journal of Participatory Medicine

In the January 17, 2013 issue of the New England Journal of Medicine, Manary and his colleagues argue that patient reports of their health care experiences actually reflect the quality of the care they receive.[1] This runs counter to the opinions of others who believe that patient reports merely reflect, for example, a measure of the providers’ bedside manner, the amenities that accompany the visit, or the providers’ marketing expertise.

Drug shortages extracting "terrible toll" on patients: Canadian Medical Assoc

Drug shortages extracting "terrible toll" on patients: CMA

Laparoscopic Gyn Surgery: Fasting Better Than Bowel Prep

Laparoscopic Gyn Surgery: Fasting Better Than Bowel Prep

 "Surgical view slightly improved when women had a minimal-residue diet 2 days before laparoscopic gynecologic surgery, followed by mechanical bowel preparation, but the technique was accompanied by such significant preoperative adverse effects that fasting alone remains the preferred alternative for bowel handling, according to a randomized controlled trial.....

Health behaviour advice to cancer patients: the perspective of social network members : British Journal of Cancer

Health behaviour advice to cancer patients: the perspective of social network members : British Journal of Cancer

 Abstract

Background:

Survival for many cancers is improved by healthier lifestyles, but giving lifestyle advice to cancer patients may seem insensitive. We investigated attitudes of members of cancer patients’ social networks towards doctors giving lifestyle advice.

Methods:

We identified social network members through a population survey of UK adults (n=2024, age 50) by asking respondents whether anyone close to them had ever had cancer (n=1273). Individuals with a cancer diagnosis themselves (n=222) were termed cancer survivors. Attitudes towards doctors giving advice to cancer patients on physical activity, diet and weight were each assessed with eight items.

Results:

Most social network members (88–93%) and survivors (87–93%) agreed that advice on diet, activity and weight would be ‘beneficial’, ‘helpful’ and ‘encouraging’, and 84–87% thought it was ‘the doctor’s duty’ to provide it. Few network members (10–18%) or survivors (10–24%) believed it was ‘unnecessary’, ‘interfering’, ‘insensitive’ or implied ‘blame’. Adjusted analyses using composite scores showed that attitudes did not differ between the groups.

Conclusion:

Few cancer survivors or members of social networks of individuals with cancer thought lifestyle advice would be insensitive, and most thought it would be beneficial. These results help counter doubts about the acceptability of lifestyle advice in the cancer context.

open acess: BJC - (UK) Measures of promptness of cancer diagnosis in primary care: secondary analysis of national audit data on patients with 18 common and rarer cancers

Blogger's Note: ovarian cancer is included in this study

British Journal of Cancer - Measures of promptness of cancer diagnosis in primary care: secondary analysis of national audit data on patients with 18 common and rarer cancers

U.S. FDA: Approved Drugs > Doxorubicin Hydrochloride Liposome (Injection)

Approved Drugs > Doxorubicin Hydrochloride Liposome (Injection)

 Doxorubicin Hydrochloride Liposome (Injection)
On February 4, 2013, the U. S. Food and Drug Administration approved doxorubicin hydrochloride liposome injection (Sun Pharma Global FZE), a generic version of DOXIL Injection (doxorubicin hydrochloride liposome; Janssen Products, L.P.) for the treatment of ovarian cancer in patients whose disease has progressed or recurred after platinum-based chemotherapy and for AIDS-related Kaposi’s sarcoma after failure of prior systemic chemotherapy or intolerance to such therapy.

 

FDA’s Office of Generic Drugs expedited the review of this generic application because of the drug shortage for DOXIL. DOXIL is under drug shortage because of manufacturing issues.......

FDA Issues Another Warning on Fake Version of Cancer Drug Avastin - US News and World Report

FDA Issues Another Warning on Fake Version of Cancer Drug Avastin - US News and World Report

WEDNESDAY, Feb. 6 (HealthDay News) -- Doctors need to be on the lookout for another counterfeit version of the injectable cancer drug Avastin (bevacizumab), the U.S. Food and Drug Administration warned on Wednesday.....

Mixed reviews for report touting unnecessary cancer tests (media) re: Consumer Reports on cancer tests

Mixed reviews for report touting unnecessary cancer tests | The Ithaca Journal | theithacajournal.com

Should doctors make moral judgments about their patients?

BMJ Group blogs: BMJ » Blog Archive » Julian Sheather: Should doctors make moral judgments about their patients?

open access: (2010) BMC Medical Informatics and Decision Making | Full text | The anxious wait: assessing the impact of patient accessible EHRs for breast cancer patients

Blogger's Note:

* Sunnybrook Health Sciences Centre, Toronto (Odette Cancer Centre) has a fully functional (and excellent)  EHR site for patients - https://www.mychart.ca/pages/main.cfm; 


* University of Health Network (which includes Princess Margaret Hospital, Toronto Western and Toronto General hospital, as of today's date,  does not

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BMC Medical Informatics and Decision Making -  The anxious wait: assessing the impact of patient accessible EHRs for breast cancer patients

Cancer treatment summaries and follow-up care instructions: which cancer survivors receive them?

Abstract

PURPOSE:

Medically underserved subgroups of survivors bear a disproportionate burden of cancer-related health problems. Treatment summaries and follow-up care instructions are one possible strategy to address disparities in cancer-related health among cancer survivors. However, it is not known which cancer survivors receive these documents. This paper sought to identify and describe patterns in the receipt of treatment summaries and follow-up care instructions.

METHODS:

Data from the Behavioral Risk Factor Surveillance System's 2010 cancer survivorship module were used for this study. This study involved 6,897 adult cancer survivors. Multivariate logistic regression was used to test for associations between survivor's demographic and cancer-related factors and receipt of treatment summaries and follow-up care instructions.

RESULTS:

Treatment summaries were received by 31 % of survivors. Demographic characteristics and type of health care provider were associated with treatment summaries (LR χ (2) (31) = 101.02, p < .001). Follow-up care instructions were received by 71 % percent of cancer survivors. Survivors' demographic and cancer-related characteristics were associated with follow-up care instructions (LR χ (2) (31) = 231.51, p < .001). Written follow-up instructions were received by 66 % of survivors who reported receipt of follow-up instructions. Receipt of written follow-up instructions was associated with gender and age.

CONCLUSION:

Demographic and cancer-related patterns exist in the receipt of treatment summaries and follow-up care instructions. These patterns map to documented gaps in survivor cancer-related outcomes. Research that tests associations between treatment summaries and follow-up care instructions and cancer-related health outcomes is needed.