open access
Thursday, May 02, 2013
NIH: Study establishes basis for genomic classification of endometrial cancers (including similarities with breast/ovarian/colorectal)
Study establishes basis for genomic classification of endometrial cancers
A comprehensive genomic analysis of nearly 400 endometrial tumors suggests that certain molecular characteristics — such as the frequency of mutations — could complement current pathology methods and help distinguish between principal types of endometrial tumors, as well as provide insights into potential treatment strategies. In addition, the study, led by investigators in The Cancer Genome Atlas (TCGA) Research Network, revealed four novel tumor subtypes, while also identifying genomic similarities between endometrial and other types of cancers, including breast, ovarian, and colorectal cancers...........
Cancers Share Gene Patterns, Studies Affirm - NYTimes including commentaries
NYTimes.com
"Another finding was that many endometrial cancers had a mutation in a gene that had been seen before only in colon cancers. The mutation disables a system for repairing DNA damage, resulting in 100 times more mutations than typically occur in cancer cells....."
"....Jeff Boyd, executive director of the Cancer Genome Institute at Fox Chase Cancer Center, who was not involved with the new research, said the similarity among breast, ovarian and endometrial tumors was the best example yet of the idea that cancers are more usefully classified by their gene mutations than by where they originate. Though many scientists believe this view is correct, Dr. Boyd said, “It is very rewarding — I can’t overstate it” to see it validated with real data......
paywalled: Adverse Events Associated With Complementary and Alternative Medicine Use in Ovarian Cancer Patients
Abstract
Introduction. Many women with
ovarian cancer are choosing to include complementary and alternative
medicine (CAM) substances in conjunction
with their conventional treatment for ovarian
cancer. Many oncologists express concern that the adjunct use of CAM
substances
may be detrimental to the achievement of
therapeutic levels of chemotherapy leading to increases in drug
toxicity, under-treatment
of disease or other adverse events. In an effort to
ascertain the extent of the potential problem with simultaneous use of
CAM with conventional treatment we undertook
comprehensive systematic review of published case reports describing
CAM-related
adverse events among ovarian cancer patients. Study design. This article describes a systematic literature review. Methods.
The Natural Medicines Comprehensive Database (NMCD). PubMed, EMBASE®
and the Cochrane Central Register of Controlled Trials
(CCTR) were systematically reviewed for research
articles pertaining to case reports describing adverse events in
patients,
and clinical trials which examined the effects of
herbs and supplements used during cancer treatment.
Results. Only one case report and one clinical trial were identified which met our inclusion criteria and were relevant to the current
investigation.
Conclusion. Although there
are concerns about the potential for adverse events related to
concurrent use of CAM substances during conventional
treatment we found few case reports and clinical
trials in the literature which support this.
Vitamin D: More May Not Be Better (from Johns Hopkins media)
media
"People should consult with their doctors, Amer says, before starting vitamin D supplements and should have their blood levels checked. Still, he says, “most healthy people are unlikely to find that supplementation prevents cardiovascular diseases or extends their lives,” and there is no consensus among doctors on what is the right level of vitamin D in the blood for healthy people.
“There are a lot of myths out there and not enough data,” he concludes."
Surgical Techniques for Removing Problematic Mesh : Clinical Obstetrics and Gynecology
Abstract
"The use of mesh and graft in pelvic reconstructive surgery has
increased over the last decade. As the use of these products increased,
the frequency and complexity of mesh-related complications has also
increased. Management of complications resulting from mesh placement
requires a thoughtful, systematic approach. Although many mesh
complications can be managed nonsurgically, a significant proportion
will require surgical excision of some or all of the mesh. Mesh excision
is often successful in treating even serious complications, however a
notable portion of patients will require more than 1 operation and
complete symptom resolution is not always achieved."
A protocol for a systematic review on the impact of unpublished studies and studies published in the gray literature in meta-analyses
Open access
The complete article is available as a provisional PDF. The fully formatted PDF and HTML versions are in production.
Background
Meta-analyses are particularly vulnerable to the effects of publication bias. Despite
methodologists' best efforts to locate all evidence for a given topic the most comprehensive
searches are likely to miss unpublished studies and studies that are published in
the gray literature only. If the results of the missing studies differ systematically
from the published ones, a meta-analysis will be biased with an inaccurate assessment
of the intervention's effects.
As part of the OPEN project (www.open-project.eu) we will conduct a systematic review
with the following objectives: To assess the impact of studies
that are not published or published in the gray literature on pooled effect estimates
in meta-analyses (quantitative measure);
To assess whether the inclusion of unpublished studies or studies
published in the gray literature leads to different conclusions in meta-analyses (qualitative
measure)
Methods
Inclusion criteria: Methodological research projects of a cohort of meta-analyses
(, which compare the effect of the inclusion or exclusion of unpublished studies or
studies published in the gray literature.
Literature search: To identify relevant research projects we will conduct electronic
searches in Medline, Embase and The Cochrane Library; check reference lists; and contact
experts.
Outcomes: 1) The extent to which the effect estimate in a meta-analyses changes with
the inclusion or exclusion of studies that were not published or published in the
gray literature; and 2) the extent to which the inclusion of unpublished studies impacts
the meta-analyses' conclusions.
Data collection: Information will be collected on the area of health care; the number
of meta-analyses included in the methodological research project; the number of studies
included in the meta-analyses; the number of study participants; the number and type
of unpublished studies; studies published in the gray literature and published studies;
the sources used to retrieve studies that are unpublished, published in the gray literature,
or commercially published; and the validity of the methodological research project.
Data synthesis: Data synthesis will involve descriptive and statistical summaries
of the findings of the included methodological research projects.
Discussion
Results are expected to be publicly available in the middle of 2013.
Case Reports - Vertebral artery dissection and cerebral infarction in a patient with recurrent ovarian cancer receiving bevacizumab
open access
Case Report
Highlights
- •
- Ovarian cancer patients receiving bevacizumab treatment can experience significant adverse events.
- •
- We report a case of vertebral artery dissection associated with bevacizumab treatment.
Case history
The
patient is a 60-year-old woman with stage IIIC ovarian cancer who
underwent primary optimal cytoreductive surgery, including total
abdominal hysterectomy, bilateral salpingo-oophorectomy, omentectomy and
lymphadenectomy in 2010. She was then randomized to Arm I of GOG 252
and received a total of six cycles of dose dense weekly intravenous (IV)
paclitaxel 80 mg/m2 with IV carboplatin Area under Curve
(AUC) 6.0 every 21 days and IV bevacizumab 15 mg/kg every 21 days
starting with cycle 2. She completed an additional six cycles of
bevacizumab maintenance but was subsequently removed from the study due
to disease progression by both CA125 and computed tomographic (CT)
imaging. She was then started on oral cyclophosphamide 50 mg daily with
bevacizumab 10 mg/kg IV every 2 weeks and had a great response as
indicated by serial CA125 monitoring. Of note, the patient had a history
of chronic hypertension which preceded her diagnosis of her ovarian
cancer and was not exacerbated by her treatment with bevacizumab; her
blood pressures remained well controlled on stable doses of enalapril
and hydrochlorothiazide (HCTZ)......
Wednesday, May 01, 2013
Prognostic value of ureteral location of upper tract urinary carcinoma (Lynch Syndrome patients)
Blogger's Note/Opinion: urothelial carcinoma of the ureter is a rare carcinoma but is part of the Lynch Syndome spectrum of cancers; most specifically it is not an uncommon cancer in Syndrome patients albeit the research is very lacking; this study is not specific to Lynch Syndrome patients but is critically important on the treatment/outcomes of patients determined by the location of the tumor in the ureter (typically one-sided in Lynch Syndrome patients - per research known to date); urothelial (ureter/renal pelvis - given stage, grade, surgery etc) can and does spread/recur/new primary in the bladder
~~~~~~~~~~~~~
Abstract
OBJECTIVES:
The aim of this study was to evaluate the prognostic significance of the ureteral location of the upper tract urinary carcinoma (UTUC).
PATIENTS AND METHODS:
Between January 1998 and December 2007, 161 patients with UTUC were operated in our center. Tumors were located on renal pelvis in 51% of cases, on the ureter in 34% of cases and in both locations in 15% of cases. Nephroureterectomy (surgical removal of kidney, renal pelvis and ureter) was performed in 79.5% of cases (128/161) whereas a conservative treatment was performed in 20.5% of cases (33/161).RESULTS:
In our series, 29.8% of patients had primary bladder cancer and 14.3% had synchronous bladder tumor. At a median follow-up of 42.5 months, 38.6% of patients developed bladder recurrence and 4.8% developed controlateral upper tract tumor. In multivariate analysis, ureteral location and existence of synchronous bladder tumor were independent prognostic factors of bladder recurrence (P=0.009 and P=0.025, respectively). Multivariate analysis retained T-stage and ureteral location as independent prognostic factors in both overall and disease-free survival (P=0.002 and P=0.0008 respectively for ureteral location).CONCLUSION:
Ureteral location was an independent prognostic factor of bladder recurrence and was associated with a poorer prognosis.Couples facing advanced cancer: examination of an interdependent relational system
Abstract
BACKGROUND:
The relational impact of advanced cancer on both patients and spouse caregivers has rarely been examined simultaneously. This study describes a framework for understanding distress in each partner as a consequence of psychosocial characteristics, burden of disease or of caregiving, and the distress of the other person. A model focusing on the protective value of social relatedness was tested to illustrate the interdependence of patients and spouses in their mutual adaptation to disease.METHODS:
A total of 278 advanced cancer patients and their spouse caregivers completed measures of psychological distress (e.g., depression), physical burden from cancer (e.g., symptom count), caregiving burden (i.e., time and task demand), and social relatedness (i.e., social support and attachment security). Structural equation modeling was used to extract latent factors associated with these constructs and to examine their interrelationships.RESULTS:
The model fit was adequate. Patient distress was related to disease burden (standardized path coefficient = 0.52) and patient social relatedness (-0.32). Caregiver distress was related to caregiving burden (0.21) and caregiver social relatedness (-0.51). Caregiving burden was related to patient disease burden (0.43) and caregiver social relatedness (-0.37). Reciprocal pathways between patient and caregiver distress indicated that caregiver distress was influenced by patient distress (0.30) but not vice versa (0.12).Self-Reported Conflicts of Interest of Authors, Trial Sponsorship, and the Interpretation of Editorials and Related Phase III Trials in Oncology
Abstract
PURPOSE Growing participation by industry in cancer
research has resulted in increased reporting of conflicts of interest
(COI). We aimed to test any association between authors' conclusions and
self-reported COI or trial sponsorship in cancer
studies.
METHODS Editorials and related phase III trials published in six clinical oncology journals in the last 3.5 years were analyzed independently by two investigators who classified study conclusions according to authors' endorsement of the experimental therapy. Logistic regression multivariable models were used to assess predictors of favorable conclusions of editorialists and of phase III authors. RESULTS: 150 phase III trials and 150 editorials were eligible. Among the phase III trials, 82 (54.7%) had positive results, and 78 (52.0%) were entirely or partially funded by industry. Any COI were disclosed in 103 phase III trials (68.7%) and in 71 editorials (47.3%). Multivariable analysis showed that phase III trial results were the only significant predictor for a positive conclusion by trial authors (odds ratio [OR], 92.2; 95% CI, 19.7 to 431.6; P < .001). Sponsorship did not predict for positive conclusion by phase III authors (OR, 0.86; 95% CI, 0.3 to 2.5; P = .788). The only factor associated with positive conclusions by editorial authors was a positive conclusion by phase III trial authors (OR, 36.3; 95% CI, 6.8 to 194.2; P < .001).
CONCLUSION
The interpretation of recently published phase III cancer trials by their authors or by editorialists was not influenced by financial relationships or industry sponsorship. Increased awareness of COI policies may have led to more integrity in cancer research reporting.
METHODS Editorials and related phase III trials published in six clinical oncology journals in the last 3.5 years were analyzed independently by two investigators who classified study conclusions according to authors' endorsement of the experimental therapy. Logistic regression multivariable models were used to assess predictors of favorable conclusions of editorialists and of phase III authors. RESULTS: 150 phase III trials and 150 editorials were eligible. Among the phase III trials, 82 (54.7%) had positive results, and 78 (52.0%) were entirely or partially funded by industry. Any COI were disclosed in 103 phase III trials (68.7%) and in 71 editorials (47.3%). Multivariable analysis showed that phase III trial results were the only significant predictor for a positive conclusion by trial authors (odds ratio [OR], 92.2; 95% CI, 19.7 to 431.6; P < .001). Sponsorship did not predict for positive conclusion by phase III authors (OR, 0.86; 95% CI, 0.3 to 2.5; P = .788). The only factor associated with positive conclusions by editorial authors was a positive conclusion by phase III trial authors (OR, 36.3; 95% CI, 6.8 to 194.2; P < .001).
CONCLUSION
The interpretation of recently published phase III cancer trials by their authors or by editorialists was not influenced by financial relationships or industry sponsorship. Increased awareness of COI policies may have led to more integrity in cancer research reporting.
Preserving fertility in female cancer patients: A snapshot of the options
open access
Key points
- Chemotherapy and radiotherapy are toxic to the ovaries, although the damage can be attenuated in some cases.
- The standard option for preserving fertility has been oocyte retrieval after controlled ovarian stimulation, followed by in vitro fertilization and subsequent cryopreservation of the resulting embryos.
- Unfortunately, controlled ovarian stimulation takes time, may delay needed cancer therapy, and may worsen estrogen-dependent cancers. Alternatives are being explored.
- Cryopreservation of unfertilized oocytes is an option for women who do not have a partner, although oocytes are more susceptible to damage during freezing than embryos are.
Genomics to Reshape Endometrial Cancer Treatment
Blogger's Note: while there is no reference to Lynch Syndrome in this abstract it will be of interest to those with dual malignancies (endometrial (uterine)/ovarian
press release
Newswise — The most in-depth look yet at endometrial cancer shows that adding genomics-based testing to the standard diagnostic workup could change the recommended course of treatment for some women.
The new research, involving nearly 400 women with endometrial cancer, is published May 2 in the journal Nature. The endeavor is part of The Cancer Genome Atlas project, funded by the National Institutes of Health (NIH).
The study also indicates that some endometrial tumors are genetically similar to subtypes of ovarian cancer (eg. endometrioid) and deadly basal-like breast cancer. Future clinical trials should evaluate whether some endometrial cancers could be treated with drugs typically used for the other cancers
Harnessing Technology to Improve Clinical Trials: Study of Real-Time Informatics to Collect Data, Toxicities, Image Response Assessments, and Patient-Reported Outcomes in a Phase II Clinical Trial
Abstract
Purpose In clinical
trials, traditional monitoring methods, paper documentation, and
outdated collection systems lead to inaccuracies
of study information and inefficiencies in the
process. Integrated electronic systems offer an opportunity to collect
data
in real time.
Patients and Methods
We created a computer software system to collect 13 patient-reported
symptomatic adverse events and patient-reported Karnofsky
performance status, semi-automated RECIST
measurements, and laboratory data, and we made this information
available to investigators
in real time at the point of care during a phase
II lung cancer trial. We assessed data completeness within 48 hours of
each
visit. Clinician satisfaction was measured.
Results Forty-four
patients were enrolled, for 721 total visits. At each visit,
patient-reported outcomes (PROs) reflecting toxicity
and disease-related symptoms were completed
using a dedicated wireless laptop. All PROs were distributed in batch
throughout
the system within 24 hours of the visit, and
abnormal laboratory data were available for review within a median of 6
hours
from the time of sample collection. Manual
attribution of laboratory toxicities took a median of 1 day from the
time they
were accessible online. Semi-automated RECIST
measurements were available to clinicians online within a median of 2
days from
the time of imaging. All clinicians and 88% of
data managers felt there was greater accuracy using this system.
Conclusion Existing
data management systems can be harnessed to enable real-time collection
and review of clinical information during
trials. This approach facilitates reporting of
information closer to the time of events, and improves efficiency, and
the
ability to make earlier clinical decisions.
2013 open access BJC - New perspectives on molecular targeted therapy in ovarian clear cell carcinoma - see Blogger's comments regarding Lynch Syndrome/clear cell ovarian cancer
Blogger's Note: repost/re-review; specific references to clear cell ovarian cancer as it relates to Lynch Syndrome mutations (MLH1; MSH2)
~~~~~~~~~~~~~~~~~~~~~
Loss of mismatch repair genes (hMLH1 and hMSH2;
(Cai et al, 2004; Pal et al, 2008; Ketabi et al, 2011) 7–18% MSI
"Targeting mismatch repair (MMR) defects in OCCCs. Microsatellite
instability (MSI), caused by defects in the DNA MMR
genes, has been observed at high levels (i.e., MSI-high) and low
levels (i.e., MSI-low) in 14% and 7% of OCCCs, respectively, with a
strong correlation between alterations in the expression of hMLH1
and hMSH2 and the presence of MSI in these tumours (Cai et al,
2004). Further evidence that a subset of OCCCs are associated with
MMR defects was observed in a study of Swedish and Danish
Lynch syndrome ovarian cancer patients of which 17% had
OCCCs (Ketabi et al, 2011). A meta-analysis of various histological
subtypes of MMR-deficient EOC has also reported that OCCCs
represent about 18% of these tumours (Pal et al, 2008). The
therapeutic relevance of MMR deficiency has recently been
elucidated in a study demonstrating that methotrexate induces
oxidative DNA damage and is selectively lethal to tumour cells
with MMR defects via inhibition of dihydrofolate reductase (Martin et al, 2009)."
"The distinct molecular features of OCCC and serous ovarian cancer
serve to emphasise the need to develop subtype-specific therapeutic
approaches in the management of EOC. Furthermore, despite
displaying histologically uniform features, OCCCs do not constitute
a single entity and may be classified into distinct molecular
genetic subtypes that also appear to be associated with clinical
outcome (Tan et al, 2011). Additionally, a question which remains
unanswered is whether OCCCs observed in Asian and Western
populations are molecularly distinct entities, which might require
different therapeutic approaches."
Specific references:
- Cai KQ, Albarracin C, Rosen D, Zhong R, Zheng W, Luthra R, Broaddus R, Liu J (2004) Microsatellite instability and alteration of the expression of hMLH1 and hMSH2 in ovarian clear cell carcinoma. Hum Pathol 35(5): 552–559
- Ketabi Z, Bartuma K, Bernstein I, Malander S, Gronberg H, Bjorck E, Holck S, Nilbert M (2011) Ovarian cancer linked to Lynch syndrome typically presents as early-onset, non-serous epithelial tumors. Gynecol Oncol 121(3): 462–465.
Mesh cancer: long-term mesh infection leading to squamous-cell carcinoma of the abdominal wall
Mesh
Purpose
It is recognized that
chronic inflammation can cause cancer. Even though most of the
available synthetic meshes are considered non-carcinogenic, the
inflammatory response to an infected mesh plays a constant aggression to
the skin. Chronic mesh infection is frequently the result of misuse of
mesh, and due to the challenging nature of this condition, patients
usually suffer for years until the infected mesh is removed by surgical
excision.
Methods
We report two cases of squamous-cell carcinoma (SCC) of the abdominal wall, arising in patients with long-term mesh infection.
Results
In both patients, the
degeneration of mesh infection into SCC was presumably caused by the
long-term inflammation secondary to infection. Patients presented with
advanced SCC behaving just like the Marjolin’s ulcers of burns. Radical
surgical excision was the treatment of choice. The involvement of the
bowel played an additional challenge in case 1, but it was possible to
resect the tumor and the involved bowel and reconstruct the abdominal
wall using polypropylene mesh as onlay reinforcement, in a single stage
operation. He is now under adjuvant chemotherapy. The big gap in the
midline after tumor resection in case 2 required mesh bridging to close
the defect. The poor prognosis of case 2 who died months after the
operation, and the involvement of the armpit, groin and mesenteric nodes
in case 1 shows how aggressive this disease can be.
Conclusion
Infected mesh must be
treated early, by complete excision of the mesh. Long-standing mesh
infection can degenerate into aggressive squamous-cell carcinoma of the
skin.
Fatigue: A Systematic Review of Complementary and Alternative Medicine Interventions for the Management of Cancer-Related Fatigue
Abstract
Fatigue, experienced by patients during
and following cancer treatment, is a significant clinical problem. It is
a prevalent
and distressing symptom yet pharmacological
interventions are used little and confer limited benefit for patients.
However,
many cancer patients use some form of complementary
and alternative medicine (CAM), and some evidence suggests it may
relieve
fatigue. A systematic review was conducted to
appraise the effectiveness of CAM interventions in ameliorating
cancer-related
fatigue. Systematic searches of biomedical,
nursing, and specialist CAM databases were conducted, including Medline,
Embase,
and AMED. Included papers described interventions
classified as CAM by the National Centre of Complementary and
Alternative
Medicine and evaluated through randomized
controlled trial (RCT) or quasi-experimental design. Twenty studies were
eligible
for the review, of which 15 were RCTs. Forms of CAM
interventions examined included acupuncture, massage, yoga, and
relaxation
training. The review identified some limited
evidence suggesting hypnosis and ginseng may prevent rises in
cancer-related
fatigue in people undergoing treatment for cancer
and acupuncture and that biofield healing may reduce cancer-related
fatigue
following cancer treatments. Evidence to date
suggests that multivitamins are ineffective at reducing cancer-related
fatigue.
However, trials incorporated within the review
varied greatly in quality; most were methodologically weak and at high
risk
of bias. Consequently, there is currently
insufficient evidence to conclude with certainty the effectiveness or
otherwise
of CAM in reducing cancer-related fatigue. The
design and methods employed in future trials of CAM should be more
rigorous;
increasing the strength of evidence should be a
priority.
Narrative medicine as a means of training medical students toward residency competencies
Abstract
Objective
This
study sought to explore the perceived influence of narrative medicine
training on clinical skill development of fourth-year medical students,
focusing on competencies mandated by ACGME and the RCPSC in areas of
communication, collaboration, and professionalism.
Methods
Using
grounded-theory, three methods of data collection were used to query
twelve medical students participating in a one-month narrative medicine
elective regarding the process of training and the influence on clinical
skills. Iterative thematic analysis and data triangulation occurred.
Results
Response
rate was 91% (survey), 50% (focus group) and 25% (follow-up). Five
major findings emerged. Students perceive that they: develop and improve
specific communication skills; enhance their capacity to collaborate,
empathize, and be patient-centered; develop personally and
professionally through reflection. They report that the pedagogical
approach used in narrative training is critical to its dividends but
misunderstood and perceived as counter-culture.
Conclusion/Practice implications
Participating
medical students reported that they perceived narrative medicine to be
an important, effective, but counter-culture means of enhancing
communication, collaboration, and professional development. The authors
contend that these skills are integral to medical practice, consistent
with core competencies mandated by the ACGME/RCPSC, and difficult to
teach. Future research must explore sequelae of training on actual
clinical performance.
MicroRNAs and Recent Insights into Pediatric Ovarian Cancers | Frontiers in Pediatric Oncology
open access
Introduction
Adnexal masses are a common cause for the medical
evaluation of young women and girls. Approximately 5–10% of all women in
the United States undergo surgery for an adnexal mass at some point in
their lives (Barakat et al., 2009).
In most cases, adnexal masses in young women are benign cystadenomas
that arise either from the ovary or developmental remnants of paratubal
tissue. However, 2–8% pediatric adnexal masses are ultimately diagnosed
as cancer (Barakat et al., 2009).
Clinical Spectrum
In contrast to adult ovarian cancers, pediatric
ovarian cancers typically originate in germ cells or stroma rather than
epithelia lining the ovarian surface, distal fallopian tube, or
peritoneal implants of endometriosis. Approximately 40% of ovarian
tumors are germ cell tumors whereas 25% are sex cord-stromal tumors (Barakat et al., 2009).
Germ cell ovarian cancers are a diverse category of tumors that include
both benign and malignant disease. Ovarian teratomas (“dermoids”) are
the most common and perhaps best-known example of a benign ovarian germ
cell tumor. While their true incidence in the general population is
unknown, dermoids account for approximately 65% of adnexal masses in
pediatric patients presenting for treatment (Ehren et al., 1984).
Malignant ovarian germ cell tumors are much less common than their
benign counterparts. Histologically, malignant germ cell tumors
recapitulate rudimentary tissues observed during normal human
development (Table 1). The most common malignant ovarian germ cell tumor is dysgerminoma (Chieffi et al., 2012).
Other germ cell tumors observed in the ovary include immature teratomas
and endodermal sinus tumors. Combinations of different histologic
elements are frequently observed in the same ovarian tumor. These
“mixed” tumors frequently contain elements of dysgerminoma (Chieffi et al., 2012)......
New Doubts About Ginkgo Biloba - NYTimes.com
NYTimes.com
".... The results of the study do not confirm that ginkgo biloba is dangerous to humans, but it is disturbing that the laboratory animals all tended to suffer the same sorts of injuries, said Cynthia Rider of the National Toxicology Program and the lead scientist of the ginkgo biloba study.....
open access: Development and preliminary testing of the psychosocial adjustment to hereditary diseases scale (in Lynch Syndrome patients)
open access
BMC Psychology 2013, 1:7 doi:10.1186/2050-7283-1-7
Published: 30 April 2013
Published: 30 April 2013
"Three large pedigrees with MSH2 mutations on intron 5, exon 8 or exon 4 to 16 have been identified with 272 carriers and 295 non-carriers confirmed and entered into a Cancer Screening Data Base."
Background
The presence of Lynch syndrome (LS) can bring a lifetime of uncertainty to an entire
family as members adjust to living with a high lifetime cancer risk. The research
base on how individuals and families adjust to genetic-linked diseases following predictive
genetic testing has increased our understanding of short-term impacts but gaps continue
to exist in knowledge of important factors that facilitate or impede long-term adjustment.
The failure of existing scales to detect psychosocial adjustment challenges in this
population has led researchers to question the adequate sensitivity of these instruments.
Furthermore, we have limited insight into the role of the family in promoting adjustment.
Methods
The purpose of this study was to develop and initially validate the Psychosocial Adjustment
to Hereditary Diseases (PAHD) scale. This scale consists of two subscales, the Burden
of Knowing (BK) and Family Connectedness (FC). Items for the two subscales were generated
from a qualitative data base and tested in a sample of 243 participants from families
with LS.
Results
The Multitrait/Multi-Item Analysis Program-Revised (MAP-R) was used to evaluate the
psychometric properties of the PAHD. The findings support the convergent and discriminant
validity of the subscales. Construct validity was confirmed by factor analysis and
Cronbach's alpha supported a strong internal consistency for BK (0.83) and FC (0.84).
Conclusion
Preliminary testing suggests that the PAHD is a psychometrically sound scale capable
of assessing psychosocial adjustment. We conclude that the PAHD may be a valuable
monitoring tool to identify individuals and families who may require therapeutic interventions.
The complete article is available as a provisional PDF. The fully formatted PDF and HTML versions are in production.
" Although most individuals seemed well adjusted, a subgroup
had elevated distress levels, compromised family functioning and lower quality of life."
Intraperitoneal chemo superior in low-volume residual ovarian cancer : OBGYN News
OBGYN News
"Patients with
resected advanced ovarian cancer and low-volume residual disease fare
better in the long term with intraperitoneal chemotherapy instead of
intravenous chemotherapy.
A team led by Dr. Devansu Tewari assessed outcomes
in 876 women from two key Gynecologic Oncology Group trials: GOG 114 and
GOG 172. Combined median follow-up in those trials approached 11 years.
Compared with their peers given intravenous
chemotherapy, women given intraperitoneal (IP) chemotherapy had a 16%
lower risk of progression or death and a 17% lower risk of death,
according to results reported at the annual meeting of the Society of
Gynecologic Oncology.
Benefit was evident regardless of the extent of
residual disease. Also, each additional cycle of IP chemotherapy reduced
the risk of death by 12%.
|
|
"A
strength of this study is that it is a combined analysis of these two
major IP trials that looked at long-term follow-up and showed survival
outcomes that are quite significant. The defining difference between the
two groups is that one received IP therapy and one did not, as it is
very unlikely that IP therapy would have been administered in the
recurrent setting," Dr. Tewari commented.
Although more than 7 years have elapsed since the
National Cancer Institute recommended consideration of IP chemotherapy
for advanced-stage low-volume ovarian cancer, uptake of this therapy has
been limited given lingering questions about efficacy, safety, and
issues such as the ideal regimen, noted Dr. Tewari, who is director of
gynecologic oncology for the Southern California Permanente Medical
Group in Orange County, California, and assistant professor of ob.gyn.
at the University of California, Irvine.
"We have now updated the results of GOG 172 and GOG
114. But we also acknowledge that in the last 7 years, a lot has changed
in the treatment of ovarian cancer in which these advantages may be
further enhanced," he noted, for example, through use of bevacizumab
(Avastin) and dose-dense therapy.
In particular, oncologists are awaiting results of the recently completed GOG 262
trial (assessing the role of bevacizumab and dose-dense paclitaxel) and
the GOG 252 trial (assessing the role of IP carboplatin, bevacizumab,
and dose-dense paclitaxel)......
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