Wednesday, February 20, 2013
Ketamine in the management of cancer pain - Reply to K.A. Jackson et al and W. Leppert
Reply to K.A. Jackson et al and W. Leppert
"....We stand by our conclusion that subcutaneous ketamine when
used in a dose-escalating regimen over 5 days confers no net clinical
benefit at a population level for patients with advanced cancer. Furthermore, we were unable to identify any predictors of response in this cohort. The fact that these patients “have few other options” does not justify the use of a drug that is not only ineffective but also has
significant toxicity. Although there is a large body of contrary anecdotal
evidence, there is increasing evidence from randomized controlled
trials that supports our claim.....
REFERENCES
1. Jackson KA, Franco M, William L: Ketamine and cancer pain: The reports of my death have been greatly exaggerated. J Clin Oncol doi 10.1200/
JCO.2012.47.1235
2. Leppert W: Ketamine in the management of cancer pain. J Clin Oncol doi 10.1200/JCO.2012.47.5939
3. Hardy J, Quinn S, Fazekas B, et al: Randomized, double-blind, placebocontrolled study to assess the efficacy and toxicity of subcutaneous ketamine in the management of cancer pain. J Clin Oncol 30:3611-3617, 2012
4. Kunz R, Oxman AD: The unpredictability paradox: Review of empirical
comparisons of randomised and non-randomised clinical trials. BMJ 317:1185-1190, 1998
5. Quibell R, Prommer EE, Mihalyo M, et al: Ketamine. J Pain Symptom
manage 41:640-649, 2011
6. Davis MP, Mitchell G: Reconstructing analgesic trials: Reasons for following the lead of oncologists. Curr Opin Support Palliat Care 6:490-493, 2012
7. Fallon M: A randomised, double-blind, placebo-controlled, parallel-group study comparing oral racemic ketamine and S ketamine in the treatment of cancer-related neuropathic pain. Palliat Med 22:440, 2008 (suppl 1)
8. Salas S, Frasca M, Planchet-Barraud B, et al: Ketamine analgesic effect by continuous intravenous infusion in refractory cancer pain: Considerations about clinical research in palliative care. J Palliat Med 15:287-293, 2012
9. Bell RF, Eccleston C, Kalso EA: Ketamine as an adjuvant to opioids for
cancer pain. Cochrane Database Syst Rev 11:CD003351, 2012
10. Jackson K, Ashby M, Howell D, et al: The effectiveness and adverse event profile of “burst” ketamine in refractory cancer pain: The VCOG PM 1-00 study. J Palliat Care 26:176-183, 2010
DOI: 10.1200/JCO.2012.47.9469; published online ahead of print at
www.jco.org on February 19, 2013
Tuesday, February 19, 2013
Young adult daughters of BRCA1/2 positive mothers: What do they know about hereditary cancer and how much do they worry?
Abstract
OBJECTIVE:
The objectives of this study are to determine (i) what daughters, ages 18-24 years, of BRCA1/2 mutation carriers understand about their 50% chance of carrying a BRCA1/2 mutation and about risk reduction or management options for mutation carriers, (ii) the extent and nature of daughters' cancer-related distress, and (iii) the effects of knowing mother's mutation status on daughters' future plans.Incidence of right-sided colonic tumors (non-appendiceal) in patient's ≥ 40 years of age presenting with features of acute appendicitis
Abstract
INTRODUCTION:
Non-appendiceal tumors can mimic and present with clinical features of acute appendicitis in patients of age 40 year or above. The aim of this prospective study is to investigate the incidence of right-sided (non-appendiceal) colonic tumors in patients presenting with clinical features of acute appendicitis.METHODS:
A prospective data analysis of 1,662 patients using appendectomy database was performed from 2005-2011. Patients above age 40 years or older were included. Patients were compared for demographic data, clinical presentation, radiological findings, operative technique & findings, histo-pathological findings and postoperative complications. The primary outcome was incidence of right-sided colonic (non-appendiceal) tumors presenting with features of acute appendicitis. Secondary outcomes measured were, role of diagnostic radiology, negative appendectomy rate, length of stay and changing trends in operative techniques.RESULTS:
From 1662 patients initially reviewed, only 179 patients (10.77%) age 40 years or above mean (56 ±11.75), median 54 (40 - 89), with clinical features of acute appendicitis were included in the final analysis. F:M ratio was (1:1.06). CT scan showed in only 1 patient (1.25%, OR=0.806, p=0.695), suspicion of caecal tumour and underwent right hemicolectomy. Histological examination of specimen showed, 2 patients (1.11%, OR=1.10, p=0.47) had primary appendiceal tumors, in which one patient was histologically reported as appendiceal mucocele (mucinous cystadenoma with low-grade dysplasia), while the other one had appendeceal carcinoid (Goblet cell carcinoid). In the other tumor group one patient had metastatic involvement of appendix from ovarian tumor. The time to appendectomy in radiological group was delayed by (9.2±3.7hrs). 131 (73.1%) had laparoscopic while 48 (26.81%) underwent open appendectomy. The negative appendectomy rate was (1.12%) and 30 days complication rate was (11.73%, p=0.27). Mean length of stay was 3.54 ± 2.1 days.CONCLUSION:
Right-sided colonic (caecal) tumors rarely present with features of acute appendicitis. Only those patients with atypical presentation and findings should have pre- operative radiological evaluation.A Study to Evaluate the Cause of Bone Demineralization in Gynecological Cancer Survivors - the Oncologist
Blogger's Note: this was a small study with patients of early stage/low grade tumors overrepresented; as the study focused on premenopausal women the use of post surgical HRT was not an apparent mitigating factor
A Study to Evaluate the Cause of Bone Demineralization in Gynecological Cancer Survivors
Abstract
Background. An
association between gynecological cancer and the risk for osteoporosis
has never been formally evaluated. Women treated
for these cancers are now living longer than ever
before and prevention of treatment-induced morbidities is important. We
aimed to distinguish, in gynecological cancer
survivors, if cancer therapy has additional detrimental effects on bone
health
above those attributable to hormone withdrawal.
Monday, February 18, 2013
Podcast: What Can Scientists Learn From the Public? - ScienceNOW
Podcast: What Can Scientists Learn From the Public? - ScienceNOW
BOSTON—What can scientists learn from the public? Science
Podcast host Sarah Crespi speaks with social scientist Hans Peter
Peters of the Ethics in Neurosciences Research Center in Julich,
Germany. Peters gave a talk here today at the annual meeting of AAAS (which publishes ScienceNOW) about how scientists in different countries and age groups think about public engagement.
2013 ESGO Interactive Scientific Program Now Online
The stimulating scientific program will feature world-class experts, who will provide their valuable insights and research.
ESGO 2013 is proud to present its Keynote speaker Prof. Ian Jacobs,
Dean of the Faculty of Medical/Human Sciences & Vice President of
the University of Manchester and Director of MAHSC (Manchester Academic
Health Science Centre).
Prof. Jacobs will be giving a special session on PROGRESS IN RISK PREDICTION, DIAGNOSIS AND SCREENING FOR OVARIAN CANCER.
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To view the full scientific programme and list of confirmed speakers, click here.
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Trabectedin as single agent in relapsed advanced ovarian cancer: results from a retrospective pooled analysis of three phase II trials
Abstract
Three phase II studies evaluated trabectedin monotherapy as second-/third-line therapy in patients with refractory/recurrent ovarian cancer
(ROC). ..........Trabectedin given
as a single agent q3w as 3-h infusion is the schedule of choice for the
treatment of ROC, and its efficacy and safety profile favorably compares
with other active salvage treatments.
Cancer risk in systemic lupus: An updated international multi-centre cohort study
Abstract
OBJECTIVE:
To update estimates of cancer risk in SLE relative to the general population.METHODS:
A multisite international SLE cohort was linked with regional tumor registries. Standardized incidence ratios (SIRs) were calculated as the ratio of observed to expected cancers.CONCLUSION:
These data estimate only a small increased risk in SLE (versus the general population) for cancer over-all. However, there is clearly an increased risk of NHL, and cancers of the vulva, lung, thyroid, and possibly liver. It remains unclear to what extent the association with NHL is mediated by innate versus exogenous factors. Similarly, the etiology of the decreased breast, endometrial, and possibly ovarian cancer risk is uncertain, though investigations are ongoing.FDA Action on Vicodin May Mean More Pain, Not Less Addiction or Overdose | TIME.com
FDA Action on Vicodin May Mean More Pain, Not Less Addiction or Overdose | TIME.com
"....However, according to numerous studies and government statistics the majority of those who become addicted to opioids don’t get hooked after receiving legitimate prescriptions from doctors for pain treatment. More than two-thirds of people who used opioids recreationally in 2010-2011 obtained the medications from friends or relatives for free, mostly with their permission. And, of people in treatment for chronic pain without a prior history of drug problems, a Cochrane review found that less than 1% became addicted to the medication, with 44% dropping out of treatment due to side effects from the drugs......
Money and Power Embrace Patient Engagement - Forbes
Money and Power Embrace Patient Engagement - Forbes
".... The broader concept of patient-centered care first gained widespread notice as a result of a 2001 Institute of Medicine report calling it one of six core goals of a 21st-century health care system. Patient-centeredness was defined as “care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions.” A 2012 IOM report got even more specific, endorsing “engaged, empowered patients” as part of a system “anchored on patient needs and perspectives” and promoting “patients, families and other caregivers as vital members of the continuously learning team.”
The formal title of that report was, “Best Care at Lower Cost: The Path to Continuously Learning Health Care in America.” Even the “goo-goos” of American medicine are following the money.
Gynecologic Oncology Case Reports - Hypercalcemia in a child with a juvenile granulosa cell tumor of ovary: Report of an unusual paraneoplastic syndrome and review of the literature
open access: Gynecologic Oncology Case Reports - Hypercalcemia in a child with a juvenile granulosa cell tumor of ovary: Report of an unusual paraneoplastic syndrome and review of the literature
Highlights
► hypercalcemia is an extremely rare paraneoplastic syndrome in children
► small cell carcinoma is the commonest ovarian tumor associated with hypercalcemia and must be ruled out because of poor prognosis
► we report the only third case of juvenile granulosa cell tumor associated with paraneoplastic hypercalcemia
Obesity and risk of ovarian cancer subtypes: evidence from the Ovarian Cancer Association Consortium
Obesity and risk of ovarian cancer subtypes: evidence from the Ovarian Cancer Association Consortium
Abstract
Whilst
previous studies have reported that higher body-mass index (BMI)
increases a woman's risk of developing ovarian cancer, associations for
the different histological subtypes have not been well defined. As the
prevalence of obesity has increased dramatically, and classification of
ovarian histology has improved in the last decade, we sought to examine
the association in a pooled analysis of recent studies participating in
the Ovarian Cancer Association Consortium. We evaluated the association
between BMI (recent, maximum, and in young adulthood) and ovarian cancer
risk using original data from 15 case-control studies (13,548 cases,
17,913 controls). We combined study-specific adjusted odds ratios (ORs)
using a random-effects model. We further examined the associations by
histological subtype, menopausal status and post-menopausal hormone use.
High BMI (all time-points) was associated with increased risk. This was
most pronounced for borderline serous (recent BMI: pooled OR=1.24 per
5kg/m2; 95%CI 1.18-1.30), invasive endometrioid (1.17; 1.11-1.23) and
invasive mucinous (1.19; 1.06-1.32) tumours. There was no association
with serous invasive cancer overall (0.98; 0.94-1.02), but increased
risks for low grade serous invasive tumours (1.13, 1.03-1.25) and in
pre-menopausal women (1.11; 1.04-1.18). Among post-menopausal women, the
associations did not differ between HRT users and non-users. Whilst
obesity appears to increase risk of the less common histological
subtypes of ovarian cancer, it does not increase risk of high grade
invasive serous cancers, and reducing BMI is therefore unlikely to
prevent the majority of ovarian cancer deaths. Other modifiable factors
must be identified to control this disease.
National Guideline Clearinghouse | Ovarian germ cell tumours (Alberta, Canada)
National Guideline Clearinghouse | Ovarian germ cell tumours.
Guideline Title
Ovarian germ cell tumours.
Bibliographic Source(s)
| Alberta Provincial Gynecologic Oncology Tumour Team. Ovarian germ cell tumours. Edmonton (Alberta): Alberta Health Services, Cancer Care; 2012 Apr. 12 p. (Clinical practice guideline; no. GYNE-001). [27 references] |
Guideline Status
This is the current release of the guideline.
press release: Novogen shares soar on the potential of its experimental anti ovarian cancer drug - CS-6 - financial news
Novogen shares soar on the potential of its experimental anti ovarian cancer drug - Proactiveinvestors (AU)
"......Cancer stem cells have been identified in a range of cancers including ovarian, brain cancers and leukaemia and are almost completely resistant to radiotherapy and standard anti-cancer drugs.
With CS-6 showing dual activity, it would mark the drug as having significant potential as a comprehensive chemotherapy, targeting both the minority cancer stem cell as well as the majority non stem cells.
The study was done by Mazor Oncology, a spin off company of Yale Universtiy that has expertise in cancer stem cells.
Studies performed in the laboratory of Dr. Gil Mor at Yale University have identified and characterized ovarian cancer stem cells as the source of ovarian cancer recurrence....."
"....In laboratory tests conducted since Novogen acquired its new Triaxial drug technology, CS-6 has proved highly effective at stopping the growth of these cancer stem cells, eventually causing them to die.
The initial studies at Mazor Oncology show a highly effective cytotoxic effect on ovarian cancer stem cells, at low concentrations and within a short period of time....."
Prevalence and Incidence of Comorbidities in Elderly Women With Ovarian Cancer
Prevalence and Incidence of Comorbidities in Elderly Women With Ovarian Cancer
Objective
Studies
suggest comorbidity plays an important role in ovarian cancer. We
characterized the epidemiology of comorbid conditions in elderly U.S.
women with ovarian cancer.
Methods
Women
with ovarian cancer age ≥ 66 years, and matched cancer-free women, were
identified using the National Cancer Institute's Surveillance,
Epidemiology, and End Results registry linked to Medicare claims.
Prevalence before diagnosis/index date and 3- and 12-month incidence
rates (per 1,000 person-years) after diagnosis/index date were estimated
for 34 chronic and acute conditions across a broad range of diagnostic
categories.
Highlights
►
Comorbidities were common among elderly U.S. women with or without
ovarian cancer.
► The incidence of most comorbidities was higher in cancer than cancer-free patients.
► The incidence of most comorbidities was higher in cancer than cancer-free patients.
abstract: Prognostic role of cyclooxygenase-2 in epithelial ovarian cancer: A meta-analysis of observational studies
Prognostic role of cyclooxygenase-2 in epithelial ovarian cancer: A meta-analysis of observational studies
Highlights
► We performed a meta-analysis to evaluate the prognostic role of cyclooxygenase-2 (COX-2) in patients with ovarian cancer.► This study showed that higher COX-2 expression was significantly associated with poor overall survival.
► Among studies which controls for covariates, a more prominent association was found between COX-2 expression and poor overall survival.
abstract: Oncologic outcomes obtained after neoadjuvant and adjuvant chemotherapy for the treatment of urothelial carcinomas of the upper urinary tract: a review
Blogger's Note: of interest to Lynch Syndrome patients
Oncologic outcomes obtained after neoadjuvant and adjuvant chemotherapy for the treatment of urothelial carcinomas of the upper urinary tract: a review
Conclusion
No definite recommendations for peri-operative chemotherapy in UTUC can be derived from the current literature. Current therapy is largely based on extrapolation from the bladder cancer literature. Prospective studies dedicated to UTUC (upper tract urinary carcinoma eg. ureter) are neededopen access: Synthesis and Anticancer Activity of Mono-Carbonyl Analogues of Curcumin
Blogger's Note: a highly technical paper with references to ovarian cancer but also to the unstable nature of metabolic activities in Curcumin
Sunday, February 17, 2013
Frequency and clinical implications of incidental new primary cancers detected on true whole-body 18F-FDG PET/CT studies
Abstract
OBJECTIVE:
To determine the frequency of additional primary
malignancies in patients undergoing staging/restaging with PET/computed
tomography (CT) and to determine the frequency with which these
unsuspected findings change clinical management.
METHODS:
This is a retrospective review of 556 patients who had
undergone a total of 804 PET/CTs for staging/restaging. Lesions that
were at an atypical location for a metastasis from the primary
malignancy (indication for the study) and had a maximum standardized
uptake value (SUV) greater than 2.5 were considered suspicious. Suspicious
lesions were followed up by a combination of clinical examination,
biopsy, and additional and/or follow-up imaging.
RESULTS:
Forty-three (7.7%) patients had lesions that were suspicious
for a newly discovered primary malignancy that was different from the
known/suspected malignancy (indication for study). Eight (1.4% of 556)
of these patients had biopsy confirmation of an additional synchronous
or metachronous primary malignancy. However, these suspicious lesions
changed the clinical management for 18 (3.2% of 556) patients. Patients
with early-stage disease (stages 1 and 2) based on the malignancy for
which the study was conducted were three times more likely to have these
suspicious lesions biopsied, evaluated by clinical examination or by
additional immediate imaging than were patients with advanced-stage
disease (stages 3 and 4); however, this difference was not statistically
significant (P=0.08).
CONCLUSION:
Unsuspected additional primary malignancies are rarely
identified in patients undergoing staging/restaging with PET/CT but have
the potential to significantly impact clinical management.
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