repost: Ten years' experience with centralized surgery of ovarian cancer in one health region in Norway

Abstract

BACKGROUND:

Better outcome of advanced ovarian cancer after centralized surgery has led to the recommendation for centralized surgery in a Norwegian health region. Whether the practice pattern has changed according to this recommendation has not been examined.

OBJECTIVE:

The objective of this study was to evaluate the referral practice and treatment of ovarian cancer in a Norwegian health region after the introduction of centralized surgery.

METHODS:

This was a retrospective, population-based study, including all women undergoing surgery for primary ovarian, tubal, and peritoneal cancer between 2000 and 2005, in Health Region IV of Norway. Clinical data and data regarding treatment and 5-year follow-up were analyzed.

RESULTS:

In total, 279 cases of ovarian, peritoneal, and tubal cancer were included. Eighty-four percent underwent primary surgery at the teaching hospital and 16% at the nonteaching hospitals. After an immediate rise in the number of cases undergoing primary surgery at the teaching hospital after the introduction of centralization in 1995, the percentage distribution between the teaching and nonteaching hospitals was stable during the study period. The women who underwent surgery at the nonteaching hospitals had a higher percentage of early-stage disease and were at higher risk of reoperation for comprehensive staging.

CONCLUSIONS:

Centralization of ovarian cancer surgery has been successfully accomplished in a health region in Norway. The referral practice of assumed advanced ovarian cancer cases shows satisfactory compliance with centralization at 10 years after the implementation of centralized surgery.

Oophorectomy in children. Who and why: 13-year experience in a single centre (China)

Abstract

AIM:

Oophorectomy performed in children is extremely uncommon. We aimed to investigate the disease pattern and the association between the underlying pathology and the clinical presentation among those patients who had their ovaries removed in their childhood.

CONCLUSION:

Although ovarian pathology is uncommon in children, a girl presenting with acute lower abdominal pain or progressive abdominal distension should raise the suspicion and prompt immediate investigation to rule out ovarian torsion or ovarian neoplasms.

Rates of risk-reducing surgery in Israeli BRCA1 and BRCA2 mutation carriers

Abstract

BACKGROUND:

The frequency of BRCA1 and BRCA2 mutations is higher in Israel than in almost all other countries. One strategy to reduce the burden of hereditary breast and ovarian cancers is to offer genetic testing followed by risk-reducing surgery (mastectomy and salpingo-oophorectomy) for mutation carriers. The extent to which Israeli women who carry mutations undergo these surgeries is not well characterized.

METHODS:

Israeli women who are BRCA1 or BRCA2 mutation carriers and followed at a single high-risk clinic were asked to complete a questionnaire detailing their clinical histories at the time of genetic results disclosure and a follow-up questionnaire was completed 18 or more months thereafter.

RESULTS:

A total of 205 mutation carriers completed the questionnaires. Of 170 women with no cancer history, 84 (49%) had a risk-reducing bilateral salpingo-oophorectomy and 22 (13%) had a risk-reducing mastectomy. Five of 35 (14.3%) women with breast cancer opted for contralateral mastectomy.

CONCLUSION:

Approximately one-half of Israeli women with a BRCA1 or BRCA2 mutation opt for risk reducing oophorectomy, but the rate of risk-reducing mastectomy is only 13%

Time trends in survival from cancer of unknown primary: Small steps forward

Abstract

BACKGROUND:

Cancer of unknown primary (CUP) is a fatal cancer for which incidence trends have changed but detailed survival trends remain unexplored. These could point out successful diagnostic and therapeutic approaches. We investigate survival trends in CUP according to histology, locations of metastases and site-specific causes of death.

RESULTS:

Survival for patients with CUP increased over the study period (HR=0.91 [95% confidence interval (CI): 0.78-0.84], p<0.001 for trend). Adenocarcinoma was the only histology associated with increased survival (0.78 [0.74-0.82], p<0.001 for trend). Survival was improved most clearly for CUP of the pelvis (0.55 [0.36-0.83]), peritoneum (0.58 [0.53-0.65]) and nervous system (0.46 [0.29-0.72]). Survival improved substantially in patients with ovarian (0.57 [0.46-0.70]), peritoneal (0.39 [0.24-0.65]) and biliary system cancers (0.67 [0.52-0.87]). Kaplan-Meier curves showed significant survival gains for all CUP and adenocarcinoma patients (p<0.001).

CONCLUSIONS:

Over time, survival for patients with CUP increased for adenocarcinoma and for CUP of the pelvis, peritoneum and nervous system. Survival trends in CUP may be related to (1) similar trends in other common metastatic tumours, particularly pancreatic and hepatobiliary cancers, which are common 'hidden' primaries for CUP, (2) earlier detection and (3) advances in the management of metastatic cancers. The improvement in survival at specific locations suggests true therapeutic gains.

Expert Commentaries: Treat the System, Not the Error: Patient Safety in 2013

National Guideline Clearinghouse | Expert Commentaries

"....Despite these success stories, the sobering truth is that, overall, patient safety has not improved throughout the past decade. Landmark studies indicate that the prevalence of preventable harm likely has not changed over the past several years, (5) and some of the highest-profile efforts to improve safety thus far—such as restricting resident work hours (6) and investing in health information technology—have resulted in additional costs (in terms of manpower, time, and finances) without tangible benefits for patients or clinicians.....

"The publication of "Making Health Care Safer II" may, in Churchill's famous words, represent "the end of the beginning" for the patient safety movement. Just as clinicians should "treat the patient, not the disease," the patient safety field will need to prioritize redesigning systems over targeting individual error types in order to achieve the ultimate goal—the creation of a highly reliable health care system that minimizes preventable harm for all patients."

Epigenetic analysis of the Notch superfamily in high-grade serous ovarian cancer

Abstract

OBJECTIVES:

Gene methylation and other epigenetic modifications of gene regulation have been implicated in the growth of ovarian cancer, but the clinical significance of such modifications in the Notch pathway in high-grade serous ovarian cancer (HGS-OvCa) is not well understood. We used The Cancer Genome Atlas (TCGA) data to study the clinical relevance of epigenetic modifications of Notch superfamily genes.

METHODS:

We analyzed the interaction of DNA methylation and miRNAs with gene expression data for Notch superfamily members with the Spearman rank correlation test and explored potential relationships with overall survival (OS) with the log-rank test. We downloaded clinical data, level 3 gene expression data, and level 3 DNA methylation data for 480 patients with stage II-IV HGS-OvCa from the TCGA data portal. Patients were randomly divided into training and validation cohorts for survival analyses. In each set, patients were grouped into percentiles according to methylation and microRNA (miRNA) or messenger RNA (mRNA) levels. We used several algorithms to predict miRNA-mRNA interaction.

RESULTS:

There were significant inverse relationships between methylation status and mRNA expression for PPARG, CCND1, and RUNX1. For each of these genes, patients with a lower methylation level and higher expression level had significantly poorer OS than did patients with a higher methylation level and lower expression level. We also found a significant inverse relationship between miRNAs and mRNA expression for CCND1, PPARG, and RUNX1. By further analyzing the effect of miRNAs on gene expression and OS, we found that patients with higher levels of CCND1, PPARG, and RUNX1 expression and lower expression levels of their respective miRNAs (502-5p, 128, and 215/625) had significantly poorer OS.

CONCLUSIONS:

Epigenetic alterations of multiple Notch target genes and pathway interacting genes (PPARG, CCND1, and RUNX1) may relate to activation of this pathway and poor survival of patients with HGS-OvCa.

Taxane-sensitivity of ovarian carcinomas previously treated with paclitaxel and carboplatin - Online First - Springer

Abstract

Purpose

The aim of the present study was to investigate, in ovarian carcinoma cases, the predictive association between the treatment-free interval (TFI) after an initial paclitaxel plus carboplatin (TC) therapy and the subsequent effectiveness of a second-line taxane-containing chemotherapy.

Methods

Patients with a TFI < 6 months from the first-line TC therapy were treated with a combination chemotherapy using docetaxel and irinotecan; patients with a TFI ≥ 6 months were retreated with the same regimen as the initial TC therapy. The clinical data of these patients were retrospectively analyzed for this study.

Results

The response rate of those with a TFI equal to 6–12 months was greater than that of those with a TFI < 6 months (p = 0.014) and less than that of those with a TFI > 12 months (p = 0.012). The progression-free survival of the cases with TFI equal to 6–12 months was longer than that of those with TFI < 6 months (p = 0.012) and shorter than that of those with TFI > 12 months (p = 0.0011). Overall survival of cases with a TFI equal to 6–12 months was longer than that of those with TFI < 6 months (p = 0.012) and shorter than that of those with TFI > 12 months (p = 0.0005).

Conclusions

The effectiveness of using a second-line taxane-containing chemotherapy was shown to be predictable by the TFI after the first-line taxane-containing chemotherapy, implying that the theory of ‘taxane-sensitivity’ may be applied for second-line chemotherapy in the same way as that of ‘platinum-sensitivity’.

  

Undue industry influences that distort healthcare research, strategy, expenditure and practice: a review

Abstract

Conclusion

To serve its interests, the industry masterfully influences evidence base production, evidence synthesis, understanding of harms issues, cost-effectiveness evaluations, clinical practice guidelines and healthcare professional education and also exerts direct influences on professional decisions and health consumers. There is an urgent need for regulation and other action towards redefining the mission of medicine towards a more objective and patient-, population- and society-benefit direction that is free from conflict of interests.

Impact of family history on choosing risk-reducing surgery among BRCA mutation carriers

Abstract

Purchase $31.50

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Objective

Despite substantial survival benefits of risk-reducing mastectomy (RRM) and risk-reducing bilateral salpingo-oophorectomy (RRBSO) among BRCA mutation carriers, only a minority elect to undergo these procedures. This study investigates factors that might influence decision making regarding prophylactic surgeries among women with BRCA mutations.

Study Design

Unaffected BRCA mutation carriers who were counseled at our center and either underwent prophylactic surgery or participated in a high-risk surveillance program at our institution from 1998 through 2010 were included in the study. Medical records were reviewed and data collected included age, family history, parity, mutation type, history of breast biopsy or cosmetic surgery, and uptake of prophylactic surgeries.

New site - hospitalinspections.org - Health News Watchdog

New site - hospitalinspections.org

New site – hospitalinspections.org

Posted by Gary Schwitzer in Health care journalism, Medicare, Quality of care

The Association of Health Care Journalists launched a new website – hospitalinspections.org – that has something to offer not only journalists but the general public as well.....

Canadian Adverse Reaction Newsletter )eg. pico-salax/docetaxel...)

 January 2013 [Health Canada]

Health Products and Food Branch
Marketed Health Products Directorate
Canadian Adverse Reaction Newsletter Editorial Team

In this Issue:

• Pico-Salax (sodium picosulfate/magnesium citrate) and convulsions
• Risperidone and rhabdomyolysis independent of neuroleptic malignant syndrome
• Docetaxel and serious respiratory-related adverse reactions
• Case presentation: Ear drops containing peanut oil and suspected association with anaphylaxis
• Summary of advisories

(U.S.) Cancer leaders pinpoint key policy concerns for 2013

article

Advancing survivorship care through the National Cancer Survivorship Resource Center

open access

........The Survivorship Center began by identifying 10 priority cancer sites based on survivor prevalence and the severity of long-term or late effects, building on earlier publications designed to provide guidance to PCPs.18, 19 These 10 cancer sites are: breast, colorectal, prostate, lung, gynecologic (cervix, ovarian, endometrial, and uterine), and head and neck cancers, and melanoma. The process is a hybrid design that leverages practice-based evidence and expert consensus while incorporating a systematic review of existing evidence as emphasized in the American Cancer Society's process for developing prevention and early detection guidelines.20 Site-specific guidelines will be updated as additional evidence emerges.......

open access: A genome-wide search for common SNP x SNP interactions on the risk of venous thrombosis

BMC Medical Genetics

Conclusion

This study, the first genome-wide SNP interaction analysis conducted so far on VT risk, suggests that common SNPs are unlikely exerting strong interactive effects on the risk of disease.

The complete article is available as a provisional PDF. The fully formatted PDF and HTML versions are in production.

open access: Pathology Reporting of Neuroendocrine Tumors: Essential Elements for Accurate Diagnosis, Classification, and Staging

Pathology Reporting of Neuroendocrine Tumors

".... Epithelial neuroendocrine tumors (NETs) can arise in most epithelial organs of the body but are particularly well-recognized in the lung, tubular gastrointestinal tract, and pancreas. Oberndorfer proposed the term “carcinoid tumor” for well-differentiated NETs more than a century ago,¹ and for many years this term was employed for most entities in the family, although those arising in the pancreas were designated “islet cell tumors.”², ³, ⁴, ⁵ Since Oberndorfer's time, it has become clear that NETs comprise a diverse group of neoplasms in terms of origin, mechanism of development, functional status, histologic patterns, and biological behavior. Most studies have focused on subsets of tumors restricted to one organ or organ system,⁶, ⁷, ⁸ resulting in many different diagnostic terms and classification systems. For example, “neuroendocrine tumor,” “carcinoid tumor,” “endocrine neoplasm,” and “neuroendocrine carcinoma” have all been applied to small intestinal primary tumors.³, ⁹, ¹⁰, ¹¹, ¹² These varied approaches have obscured some of the commonalities among NETs of different sites, and comparison of data among studies employing different nomenclature and classification parameters has been difficult.^13......

open access: Systemic Therapeutic Options for Carcinoid

open access

"...In a retrospective analysis including 33 NENs, the objective response rate was 25% with a three-drug regimen of streptozotocin/5-FU and cisplatin.⁸² Although this study is small and based on heterogeneous primary tumor sites (lung [n = 8], gastrointestinal [n = 9], ovarian [n = 1], unknown primary [n = 15])....

open access: Recent Advances in the Genetics, Diagnosis, and Treatment of Neuroendocrine Tumors

 Blogger's Note: this paper does not include ovarian neuroendocrine tumors but may help those with this rare type of cancer

Neuroendocrine Tumors

open access: Ireland - A prospective investigation of predictive and modifiable risk factors for breast cancer in unaffected BRCA1 and BRCA2 gene carriers

BMC Cancer 

Background

Breast cancer is the most common female cancer worldwide. The lifetime risk of a woman being diagnosed with breast cancer is approximately 12.5%. For women who carry the deleterious mutation in either of the BRCA genes, BRCA1 or BRCA2, the risk of developing breast or ovarian cancer is significantly increased. In recent years there has been increased penetrance of BRCA1 and BRCA2 associated breast cancer, prompting investigation into the role of modifiable risk factors in this group. Previous investigations into this topic have relied on participants recalling lifetime weight changes and subjective methods of recording physical activity. The influence of obesity-related biomarkers, which may explain the link between obesity, physical activity and breast cancer risk, has not been investigated prospectively in this group. This paper describes the design of a prospective cohort study investigating the role of predictive and modifiable risk factors for breast cancer in unaffected BRCA1 and BRCA2 gene mutation carriers.

Methods

Participants will be recruited from breast cancer family risk clinics and genetics clinics. Lifestyle risk factors that will be investigated will include body composition, metabolic syndrome and its components, physical activity and dietary intake. PBMC telomere length will be measured as a potential predictor of breast cancer occurrence. Measurements will be completed on entry to the study and repeated at two years and five years. Participants will also be followed annually by questionnaire to track changes in risk factor status and to record cancer occurrence. Data will be analysed using multiple regression models. The study has an accrual target of 352 participants.

Discussion

The results from this study will provide valuable information regarding the role of modifiable lifestyle risk factors for breast cancer in women with a deleterious mutation in the BRCA gene. Additionally, the study will attempt to identify potential blood biomarkers which may be predictive of breast cancer occurrence.

The complete article is available as a provisional PDF. The fully formatted PDF and HTML versions are in production.

Surgical treatment of hereditary nonpolyposis colorectal cancer (HNPCC, Lynch syndrome)+ gyn surgery at the same time

Abstract

The surgical management of the Lynch syndrome patient with colorectal cancer needs to be individualized. Because of the increased incidence of synchronous and metachronous colorectal neoplasms, most favor an extended resection at the time of diagnosis of colorectal cancer. Age of diagnosis, stage of the tumor, co-morbidities, surgical expertise, surgical morbidity, and patient wishes (must?) should be taken into account when considering a surgical procedure. There are no prospective randomized trials or retrospective trials suggesting that patients undergoing an extended procedure have a survival advantage compared to those undergoing segmental resection. In retrospective studies it has been demonstrated that patients undergoing extended procedures will develop less metachronous colorectal neoplasms and will undergo less subsequent surgical procedures related to colorectal cancer. In females abdominal hysterectomy and bilateral salpingoophorectomy should be considered at the time of surgery for colorectal cancer.

GOG publications index 1975-2013

 Blogger's Note: according to pubsearch results; not all are cross-referenced

Publication Search Engine - Page 2

SGO conference: Delaying Chemo Ups Mortality in Ovarian Cancer

Medpage

"......Investigators found that 450 patients (>25%) started chemotherapy more than 40 days after surgery.
Comparison of the interval to chemotherapy and log hazard ratio for survival showed that the hazard began to increase after 25 days.....

Action Points

• This study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.
• Women with advanced ovarian cancer had significantly worse survival when they started chemotherapy more than 25 days after surgery.
• Note that patients with microscopic residual disease after surgery faced a greater mortality risk compared with the overall population of women with ovarian cancer.

".....Previous studies of the relationship between delay to chemotherapy and survival in ovarian cancer involved retrospective data, single institutions, and heterogeneous patient populations and treatment. The analysis of GOG 218 used prospectively collected data from a large population of patients who received standardized care and contemporary therapy, including a targeted agent, Eskander noted.
During the discussion that followed, a SGO attendee referred to studies reported more than 20 years ago, documenting rapid regrowth of ovarian cancer cells during the first 4 to 7 days after cytoreductive surgery.
The European Organization for Treatment and Research in Cancer (EORTC) tried without success to develop a study of early chemotherapy, within 4 days after surgery. The EORTC subsequently did identify day 20 after surgery as the "D Day" for chemotherapy.....

Women's Health Matters - Ovarian Cancer: An Advocate's Journey

Blogger's Note: I have forgotten about this item until someone mentioned it to me today; time has passed including a Lynch Syndrome mutation diagnosis (MSH2) as well as a second recent primary of urothelial (ureter) carcinoma. That latter and most recent cancer event, in all honesty, was a surprize even though I would believe myself to be well-informed. But then again, it surprized the medical professionals involved as well, so we are in good company. Words of wisdome (mine) - pay attention to rare cancers. The research obviously focuses on the more well known cancers to the demise of many patients.
When first beginning the very long journey in 1999, it is sad to say,obviously in my opinion and in general terms, women still are not receiving the best care possible. The latter is recently and once again re-confirmed by the U.S. recent study during the SGO conference this year (access to care).  Whether women are living in the U.S., Canada or elsewhere, it is safe to assume the stats would remain relative. There are a number of postings on this blog brought to light really by the article in the NY Times and I believe, Reuters.

Women's Health Matters - Ovarian Cancer: An Advocate's Journey

Newswise | Latest News - SGO abstracts 2013 (media recap)

Newswise

press release: SGO | Dr. Barbara Goff assumes SGO and Foundation presidency

press release

.....“SGO and the Foundation are at the forefront of initiatives to redefine what it means to deliver high quality, cost-effective health care for women with gynecologic cancers,” said Dr. Goff.
“The Society’s recent report, ‘Creating a New Paradigm in Gynecologic Cancer Care: Policy Proposals for Delivery, Quality and Reimbursement,’ provides the roadmap to achieve that on a national level. And the Foundation’s new Outcomes Research Institute will invest in the research necessary to get there.” ....

We need a new paradigm in gynecologic cancer care: SGO proposes solutions for delivery, quality and reimbursement policies

universally available (??)

Meeting Report from SGO Practice Summit