Outcome of BRCA1- compared with BRCA2-associated ovarian cancer: a nationwide study in the Netherlands

Abstract

Dr Kate O'Hanlan - Step by Step instructions for laparoscopic suturing - YouTube

 YouTube

JNCI memo to media: Estrogen Plus Progestin Use Linked With Increased Breast Cancer Incidence and Mortality

JNCI

paywalled: The Effect of Estrogen Plus Progestin Hormone Therapy on Breast Cancer Mortality: Still Unresolved

extract

paywalled: Editorial - Estrogen Plus Progestin and Breast Cancer Incidence and Mortality in the Women’s Health Initiative Observational Study

Abstract

New Analysis Says Evidence Lacking for HRT-Breast Cancer Link – WebMD

New Analysis Says Evidence Lacking for HRT-Breast Cancer Link

"...What is needed now, he said, is a clinical trial in which the hormone therapy in use today is compared with placebo, to evaluate the risks and benefits.
Another expert took a more middle-of-the-road view about the potential link.
"It would be hard to say the entire decline [in breast cancer rates] is due to the decline in HRT use," said Dr. Steven Narod, the Canada Research Chair in Breast Cancer at the University of Toronto.....

WHI: Combo HRT, Breast Cancer Risk Linked

WHI: Combo HRT, Breast Cancer Risk Linked

...."From a public health perspective, there should be reasonable caution in recommending a therapy for less than limiting climacteric symptoms," they stated.
In an editorial accompanying the study, Catherine Schairer, PhD, and Louise A. Brinton, PhD, of the National Cancer Institute in Rockville, Md., commented that "lingering questions" remain.
In particular, they noted that neither the WHI randomized trials nor this observational study considered the possible influence of duration of hormone therapy or current use at the time of diagnosis on the type or prognosis of the tumors.
They also suggested analyzing outcomes for the women excluded from this analysis because of not having had a recent negative mammogram.
"It might be informative to include these women in a future analysis to further determine the potential impact of screening on breast cancer survival and mortality associated with estrogen plus progestin use," wrote Schairer and Brinton.
An additional limitation of the analysis was the unavailability of information on breast cancer treatments used.

Will more finance reform improve quality in Ontario’s hospitals?

healthydebate

"...For payments to be effectively tied to quality, both processes and outcomes must be continuously measured in Ontario’s hospitals. But in many cases hospitals are not measuring relevant quality indicators. According to the clinical QBP guidebook from the COPD expert panel, the indicators of patient outcomes currently measured by hospitals, which include COPD admission rates and length of stvay, “do not measure the quality of care provided.”.....

Short-term single treatment of chemotherapy results in the enrichment of ovarian cancer stem cell-like cells leading to an increased tumor burden (in mice)

Blogger's Note: in mice

open access

"... These results suggest that a short-term single treatment of chemotherapy leaves residual cells that are enriched in CSClike (cancer stem cell) traits, resulting in an increased metastatic potential. The novel findings in this study are important in understanding the early molecular mechanisms by which chemoresistance and subsequent relapse may be triggered after the first line of chemotherapy treatment...."

Disparities in Ovarian Cancer Care Quality and Survival According to Race and Socioeconomic Status

abstract

Background The relationship between racial and socioeconomic status (SES) disparities and the quality of epithelial ovarian cancer care and survival outcome are unclear. 

Methods A population-based analysis of National Cancer Data Base (NCDB) records for invasive primary epithelial ovarian cancer diagnosed in the period from 1998 to 2002 was done using data from patients classified as white or black. Adherence to National Comprehensive Cancer Network (NCCN) guideline care was defined by stage-appropriate surgical procedures and recommended chemotherapy. The main outcome measures were differences in adherence to NCCN guidelines and overall survival according to race and SES and were analyzed using binomial logistic regression and multilevel survival analysis.

Research and Development for Botanical Products in Medicinals and Food Supplements Market

open access

"....For the present paper, we chose to describe shortly the most important regulatory issues being in force in EU and US, two of the largest markets for botanicals, and to highlight the most important steps to follow in the modern research and development of health botanical products.... 

" In conclusion, research and development on botanical products is today strongly influenced by the product destination in the market. For this reason, it is necessary that research is addressed and differentiated on the basis of the final market destination. Only in this way adequate safety and efficacy data can be provided for each product category."

Borrowing Information across Subgroups in Phase II Trials: Is It Useful?

Abstract

"Because of the heterogeneity of human tumors, cancer patient populations are usually composed of multiple subgroups with different molecular and/or histologic characteristics. In screening new anticancer agents, there might be a scientific rationale to expect some degree of similarity in clinical activity across the subgroups. This poses a challenge to the design of phase II trials assessing clinical activity: Conducting an independent evaluation in each subgroup requires considerable time and resources, whereas a pooled evaluation that completely ignores patient heterogeneity can miss treatments that are only active in some subgroups. It has been suggested that approaches that borrow information across subgroups can improve efficiency in this setting. In particular, the hierarchical Bayesian approach putatively uses the outcome data to decide whether borrowing of information is appropriate. We evaluated potential benefits of the hierarchical Bayesian approach (using models suggested previously) and a simpler pooling approach by simulations. In the phase II setting, the hierarchical Bayesian approach is shown not to work well in the simulations considered, as there appears to be insufficient information in the outcome data to determine whether borrowing across subgroups is appropriate. When there is strong rationale for expecting a uniform level of activity across the subgroups, approaches using simple pooling of information across subgroups may be useful."

open access: 2012 Pharmaceutical care for patients with breast and ovarian cancer

open access

Purpose
Individualized patient care may help reduce the
incidence of adverse drug events in systemic cancer therapy.
This study was conducted to explore the feasibility and
potential of additional pharmaceutical care for breast and
ovarian cancer patients.

Conclusions
In conclusion, our results suggest that pharmaceutical care for
patients with breast and ovarian cancer is feasible and may
have an impact on PROs as particularly indicated by significant
improvements of the antiemetic response and patient
satisfaction. Although there is no doubt that a higher awareness
of drug-related problems is beneficial, final conclusions
on the effectiveness of a new health care intervention can only
be drawn when studied in a randomized trial. Therefore,
our data may serve as a valuable basis for planning a
large randomized multicenter trial.

Caffeine, is Associated with Reduced Estrogen Receptor Negative and Postmenopausal Breast Cancer Risk with No Effect Modification by CYP1A2 Genotype

abstract

Associations between caffeine and coffee consumption and breast cancer risk are uncertain, with studies suggesting inverse and null associations. Variation in cytochrome P450 1A2 (CYP1A2), a gene responsible for caffeine metabolism, may modify these associations. Cases (n = 3,062) were recruited through the Ontario Cancer Registry and controls (n = 3,427) through random digit dialing. Logistic regression was used to evaluate associations between breast cancer risk and intakes of 7 caffeine-containing items and total caffeine, and examine whether a genetic variant in CYP1A2 (rs762551) modified these associations. Analyses were stratified by estrogen receptor (ER), menopausal, and smoking status. Generally, coffee and caffeine were not associated with breast cancer risk; however, a significant reduction in risk was observed with the highest category of coffee consumption [≥5 cups per day vs. never, multivariate-adjusted odds ratio (MVOR) = 0.71, 95% confidence interval (CI): 0.51, 0.98]. Variant rs762551 did not modify associations. In stratified analyses, high coffee intake was associated with reduced risk of ER- (MVOR = 0.41, 95% CI: 0.19, 0.92) and postmenopausal breast cancer (MVOR = 0.63, 95% CI: 0.43, 0.94). High coffee consumption, but not total caffeine, may be associated with reduced risk of ER- and postmenopausal breast cancers, independent of CYP1A2 genotype. Further studies are needed to replicate these findings.

Barriers and Approaches to the Successful Integration - U.S. of Palliative Care and Oncology Practice

abstract

"As management of patients with cancer is evolving, an increased focus is being placed on individualized patient-centered care. Early integration of palliative care into the overall management of patients with cancer can help achieve this paradigm shift. Despite recommendations for earlier integration of palliative care by national and international societies, several barriers remain to achieving this goal. Survey studies have indicated a significant need for increased education regarding palliative care for both medical undergraduates and postgraduate physicians. Key issues in the early integration of palliative care include relationship-building across multiple health systems and specialties; development of a standardized definition of palliative care, making clear that it should be fully integrated with cancer-directed therapy; identification of physician and nonphysician champions; standardization of tools for patient assessment; education programs designed to meet the needs of health care professionals; and ongoing evaluation to assess program benefits and limitations."

Provision of palliative care and pain management services for oncology patients - Germany

requires subscription ($$$) to view full paper

 Abstract
Early initiation of palliative care to address pain and other symptoms offers the potential to improve quality of life for patients with cancer. The approaches to implementing and delivering palliative care and pain management services vary depending on patient needs, available resources, provider training, and clinical setting. This article describes the experiences in developing programs in which the need for early palliative care or pain management services for patients with cancer was recognized. In each case, collaborative efforts, careful planning, administrative support, and ample time were needed to implement such services.....

A Plan To Fix Cancer Care - NYTimes.com

A Plan To Fix Cancer Care - NYTimes.com

Online Dietary Recommendations For Cancer Patients Inconsistent

medical news

open access: Patient self-appraisal of change and minimal clinically important difference on the European organization for the research and treatment of cancer quality of life questionnaire core 30 before and during cancer therapy

Blogger's Note: included gyn cancer patients; Harvard researchers

Open access

 Background

Clinical interpretation of health related quality of life (HRQOL) scores is challenging. The purpose of this analysis was to interpret score changes and identify minimal clinically important differences (MCID) on the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (QLQ-C30) before (T1) and during (T2) cancer treatment. 

"We also observed decreases in QLQ-C30 scores among patients reporting “about the same” in the SSQ for the PF and global QOL domains. This finding suggests a potential response shift in scoring of HRQOL. Response shift is known as the change in internal standards,
values, and the conceptualization of HRQOL after the start of cancer treatment [21]. Patients may report a better health condition even though their actual physical condition has deteriorated when they perceive a greater survival benefit from cancer treatment [21,22].
Further exploration and conceptual work are necessary to better understand the effect of response shift on patient-reported HRQOL scores."

open access: Diabetes and Risk of Cancer

Open access

Tumor Inhibition by DepoVax-Based Cancer Vaccine Is Accompanied by Reduced Regulatory/Suppressor Cell Proliferation and Tumor Infiltration

open access

"... Immunization of tumor-bearing HLA-A2 transgenic mice with human vaccine DPX-0907, a peptide-based vaccine for breast/ovarian/prostate cancers, showed efficient induction of immune response to cancer peptides despite the presence of suppressor cells. Thus, this study provides the rationale for using DPX-based cancer vaccines in immune-suppressed cancer patients, to induce effective anticancer immunity.....

Dr. Frederick Provides Expert Opinion About Ovarian Cancer Study Results | Mission: Roswell Park Cancer Institute

Expert Opinion

In a recent interview with WBFO’s Eileen Buckley, RPCI’s Dr. Peter Frederick commented on a study from the University of California,* which revealed that only about 37% of women with ovarian cancer get care consistent with the National Comprehensive Cancer Network (NCCN) guidelines. Dr. Frederick, Assistant Professor of Oncology within Roswell Park’s Department of Gynecologic Oncology, called this statistic a “wakeup call” for health care providers and patients.
Conclusions drawn from the study can be summed as follows:

• Adherence to NCCN guidelines for treatment of ovarian cancer is correlated with overall survival.
• High-volume providers are significantly more likely to provide NCCN guideline-adherent care associated with improved survival outcomes. (A provider is considered to be "high-volume" when they treat 20 ovarian cancer patients per year. More than 100 women with ovarian cancer are treated at Roswell Park each year. )

Empowering Women to be Self-Advocates
Ovarian cancer is a particularly difficult cancer to treat because there are no good screening approaches, and it's often detected at advanced stages when treatment options are limited. So what can women do to ensure not only adequate, but exceptional ovarian cancer care? Dr. Frederick recommended to:

• ask questions about how experienced your surgeon is;
• get a second opinion; and
• seek specialized ovarian cancer care from high-volume gynecologic oncology providers.

Visit WBFO’s website to read the full news article or study abstract, and listen to an audio clip featuring Dr. Frederick. 
* Abstract presented by Robert Bristow, MD, MBA, FACS, Director of Gynecologic Oncology Services at the University of California, Irvine, on March 11, 2013 at the Society of Gynecologic Oncology’s Annual Meeting on Women’s Cancer.

Cancer survivors: Managing your emotions after cancer treatment - MayoClinic.com

MayoClinic

open access: Involving patients in quality indicator development – a systematic review

Involving patients

 Conclusion: 
Although there is a large body of literature on QI, publications that describe approaches to patient involvement in QI development are scarce. In principle, indirect and direct methods of patient involvement can be distinguished, and it seems most promising to combine different approaches. However, the limited number of publications identified clearly shows that further research in this field is overdue and that the quality of reporting found in studies within this field needs to be improved.

Cancer statistics, 2013 (U.S.)

Cancer statistics, 2013

Ovary

estimated new cases    22,240

estimated deaths

14,030