Sunday, March 25, 2007
Saturday, March 24, 2007
Gynecologic Oncology : A cost–effectiveness analysis of chemotherapy for patients with recurrent platinum-sensitive epithelial ovarian
ScienceDirect - Gynecologic Oncology : A cost–effectiveness analysis of chemotherapy for patients with recurrent platinum-sensitive epithelial ovarian cancer:
"Conclusions.
Second-line chemotherapy is cost-effective for patients with platinum-sensitive recurrent EOC. Due to minimal improvements in overall survival, third- and fourth-line chemotherapy are not cost-effective strategies."
Genentech: Avastin - Full Prescribing Information
Genentech: Avastin - Full Prescribing Information
Sandi's note: increased attention needs to be paid to nasal perforations ( Respiratory: nasal septum perforation) in patient populations
JAMA -- Abstract: Recommendations for the Care of Individuals With an Inherited Predisposition to Lynch Syndrome: A Systematic Review
JAMA -- Abstract: Recommendations for the Care of Individuals With an Inherited Predisposition to Lynch Syndrome: A Systematic Review, September 27, 2006, Lindor et al. 296 (12): 1507
CLINICIAN'S CORNER
Recommendations for the Care of Individuals With an Inherited Predisposition to Lynch Syndrome
A Systematic Review
JAMA. 2006;296:1507-1517.
Context About 2% of all colorectal cancer occurs in the context of the autosomal dominantly inherited Lynch syndrome, which is due to mutations in mismatch repair genes. Potential risk-reducing interventions are recommended for individuals known to have these mutations.
Objectives To review cancer risks and data on screening efficacy in the context of Lynch syndrome (hereditary nonpolyposis colorectal cancer) and to provide recommendations for clinical management for affected families, based on available evidence and expert opinion.
Data Sources and Study Selection A systematic literature search using PubMed and the Cochrane Database of Systematic Reviews, reference list review of retrieved articles, manual searches of relevant articles, and direct communication with other researchers in the field. Search terms included hereditary non-polyposis colon cancer, Lynch syndrome, microsatellite instability, mismatch repair genes, and terms related to the biology of Lynch syndrome. Only peer-reviewed, full-text, English-language articles concerning human subjects published between January 1, 1996, and February 2006 were included. The US Preventive Services Task Force's 2-tier system was adapted to describe the quality of evidence and to assign strength to the recommendations for each guideline.
Evidence Synthesis The evidence supports colonoscopic surveillance for individuals with Lynch syndrome, although the optimal age at initiation and frequency of examinations is unresolved. Colonoscopy is recommended every 1 to 2 years starting at ages 20 to 25 years (age 30 years for those with MSH6 mutations), or 10 years younger than the youngest age of the person diagnosed in the family. While fully acknowledging absence of demonstrated efficacy, the following are also recommended annually: endometrial sampling and transvaginal ultrasound of the uterus and ovaries (ages 30-35 years); urinalysis with cytology (ages 25-35 years); history, examination, review of systems, education and genetic counseling regarding Lynch syndrome (age 21 years). Regular colonoscopy was favored for at-risk persons without colorectal neoplasia. For individuals who will undergo surgical resection of a colon cancer, subtotal colectomy is favored. Evidence supports the efficacy of prophylactic hysterectomy and oophorectomy.
Conclusions The past 10 years have seen major advances in the understanding of Lynch syndrome. Current recommendations regarding cancer screening and prevention require careful consultation between clinicians, clinical cancer genetic services, and well-informed patients.
Author Affiliations: Departments of Medical Genetics (Drs Lindor and Petersen) and Health Sciences Research (Dr Petersen), Mayo Clinic College of Medicine, Rochester, Minn; Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Md (Mr Hadley); Department of Medicine and Huntsman Cancer Institute, University of Utah, and Veterans Affairs Medical Center, Salt Lake City (Dr Kinney); Medical Oncology, Maine Center for Cancer Medicine and Blood Disorders and Maine Medical Center, Portland (Dr Miesfeldt); Departments of Gynecologic Oncology (Dr Lu) and Gastrointestinal Medicine and Nutrition (Dr Lynch), M. D. Anderson Cancer Center, University of Texas, Houston; Department of Medical History and Ethics, University of Washington, Seattle (Dr Burke); and Schools of Nursing and Medicine, Oregon Health and Science University, Portland (Dr Press).
This Week in JAMA
JAMA. 2006;296:1437.
Prediction of MLH1 and MSH2 Mutations in Lynch Syndrome
Judith Balmaña, David H. Stockwell, Ewout W. Steyerberg, Elena M. Stoffel, Amie M. Deffenbaugh, Julia E. Reid, Brian Ward, Thomas Scholl, Brant Hendrickson, John Tazelaar, Lynn Anne Burbidge, and Sapna Syngal
JAMA. 2006;296:1469-1478.
Prediction of Germline Mutations and Cancer Risk in the Lynch Syndrome
Sining Chen, Wenyi Wang, Shing Lee, Khedoudja Nafa, Johanna Lee, Kathy Romans, Patrice Watson, Stephen B. Gruber, David Euhus, Kenneth W. Kinzler, Jeremy Jass, Steven Gallinger, Noralane M. Lindor, Graham Casey, Nathan Ellis, Francis M. Giardiello, Kenneth Offit, Giovanni Parmigiani, and for the Colon Cancer Family Registry
JAMA. 2006;296:1479-1487.
Predicting and Preventing Hereditary Colorectal Cancer
James M. Ford and Alice S. Whittemore
JAMA. 2006;296:1521-1523.
Colon Cancer
John L. Zeller, Cassio Lynm, and Richard M. Glass
JAMA. 2006;296:1552.
Friday, March 23, 2007
Thursday, March 22, 2007
Wednesday, March 21, 2007
Tuesday, March 20, 2007
Monday, March 19, 2007
March 2007 news item: What Couldn't Get Worse On the News Just Did
The Evening Bulletin - What Couldn't Get Worse On the News Just Did: "What Couldn't Get Worse On the News Just Did"
Saturday, March 17, 2007
this is not a singular issue - as reported in the Toronto Star: "The Unkindest Cut"
Here is what this particular article today (link at the end of this note)
does not say with respect to other gynecologists all working in my own
area in the past few years:
1) Centenary Hospital (Scarborough, Ontario) vs Armstrong: case before
the courts (I am not aware if the courts have made their final decision
on this one):
Hansard:
http://www.canlii.org/eliisa/simpleSearch.do?language=en&requestOrigin=requestSimpleOrAdvanced&defaultQuery=armstrong+vs+centenary&queryMethod=allQuery&Search=Search
http://www.canlii.org/on/cas/onca/2005/2005onca10427.html
Armstrong v. Centenary Health Centre
Citation : 2002 CanLII 42546 (ON S.C.) Date: December 20, 2002
Language: en
Ontario > Superior Court of Justice
Armstrong v. Centenary Health Centre
Citation : 2005 CanLII 20712 (ON C.A.) Date: June 13, 2005 Language: en
Ontario > Court of Appeal for Ontario
2) Whitby (Ontario) obstetrician-gynecologist Dr. Errol Wai-Ping
http://www.cbc.ca/fifth/donoharm.html
3) Dr. Richard Neale, a gynecologist and obstetrician, who worked in
Durham Region (Ajax/Pickering) and was prohibited from practicing in
Ontario before
he returned to England. (note: his licence was taken away while
practicing in England)
http://www.cmaj.ca/cgi/content/full/163/5/584-a
4) Toronto obstetrician and gynecologist Dr. Richard Austin
http://www.thestar.com/printArticle/193080
_*The unkindest cut TheStar.com - News - The unkindest cut*_
March 17, 2007
Tuesday, March 13, 2007
Saturday, March 10, 2007
2007 A new varian database for mismatch repair genes associated with Lynch Syndrome: Memorial University of Newfoundland - Faculty of Medicine
Memorial University of Newfoundland - Faculty of Medicine
Hum Mutat. 2007 Mar 8
A new variant database for mismatch repair genes associated with Lynch syndrome.
* Woods MO,
* Williams P,
* Careen A,
* Edwards L,
* Bartlett S,
* McLaughlin JR,
* Younghusband HB.
Discipline of Genetics, Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland, Canada.
Mutations in some mismatch repair (MMR) genes are associated with Lynch syndrome (LS; also called hereditary nonpolyposis colorectal cancer [HNPCC]), an autosomal dominant cancer susceptibility syndrome. Colorectal cancer (CRC) is the most frequent cancer observed in LS. However, tumors occur at a variety of extracolonic sites and individuals may have multiple primary cancers. LS is the most common hereditary form of CRC, accounting for approximately 1% of all CRC. Since the first account of mutations in MSH2 causing this cancer susceptibility syndrome in 1993, mutations in three additional MMR genes, MLH1, MSH6, and PMS2, have been shown to cause LS. More than 1,500 different variants have been identified in these four genes and approximately 80% of the alterations have been identified in MLH1 and MSH2. There have been a few previous attempts to systematically record MMR variants associated with LS patients; however, they were not complete nor were they continuously updated. Thus, it was our goal to generate and maintain a comprehensive catalogue of MMR variants from genes known to be mutated in LS (http://www.med.mun.ca/MMRvariants; last accessed 8 February 2007). Providing such a resource should aid investigators in understanding the significance of the variants. Hum Mutat 0, 1-5, 2007. (c) 2007 Wiley-Liss, Inc.
PMID: 17347989
Thursday, March 01, 2007
Thursday, February 22, 2007
Wednesday, February 21, 2007
NO RESPONSE BY DECISION-MAKERS - sad! Ovarian Advocate - Caelyx for British Columbia Ovarian Cancer Women - funding vs life
FYI - Re: http://www.ovarianadvocate.ca/
February 17th, 2007
Sandi Pniauskas
117 Glen Hill Drive
Whitby, Ontario, Canada
L1N6Z8
Dear Madam/Sirs;
Re: Funding Caelyx for Treatment of Recurrent Ovarian Cancer in British
Columbia
I am writing to appeal to you to ensure that Caelyx is funded as a
treatment for recurrent ovarian cancer, or as deemed necessary, through
patient/physician decision-making. I do this because I have compassion,
understanding and intimate knowledge of the issues which ovarian cancer
women, their families and their friends face. From the initial
pre-surgery consultations to the last breath our ovarian cancer women
take. Research for decades is proof positive that ovarian cancer is the
most lethal of all gynecologic cancers. And yet, how far have we
actually progressed? 'Lethal' today is still the word used to describe
ovarian cancer. And yet, with our lack of decision-making, we actually
in fact consider our ovarian cancer women to be dispensable. They
deserve every chance and in light of extensive research, which you have
already received, the underlying issue of lack of actual access is not
comprehensible to me. I don't believe that I need to educate you on the
evidence-based research which provides sufficient criteria for simply
funding this chemotherapy for ovarian cancer women - today.
Further, it is irresponsible to confuse the economies of providing
Caelyx to ovarian cancer women in need. Confusion - because it is with
the hopes of remission or extension of life which no economies can ever
truly value in concrete terms. Further, recent reports indicate that
B.C.'s coffers are flush with funds. It therefore is a matter of
morality and quite simply the ability of the decision-makers to actually
make this decision.
Let us not continue to make mistakes of the past. The disparities in
access to either life-saving or life-extending therapies across
Provinces are well known. As a matter of fact, in the late 1990's,
Canadian ovarian cancer women experienced the very same issue between
Quebec and Ontario. Taxol was accessible to ovarian cancer women in
Quebec, and not in Ontario. It seems we have not yet learned our lessons
and are repeating the same mistakes but at the sacrifice of the valuable
women in our lives. The obvious lesson is that ovarian cancer does not
care where you live, but your survival does. How sad, in fact, that
while Health Care Ministers, Provincially and at the Federal level
discuss these issues, we simply are unable to recognize the deaths - the
actual realities while we wait for decisions. This is not acceptable and
our ovarian cancer women cannot wait. More importantly, the system which
you represent, has failed these women. It is a moral issue and only a
moral issue which stands in the way of ovarian cancer women in British
Columbia having access to this particularly effective chemotherapy.
Since my ovarian cancer diagnosis in 1999, I have been in the very
fortunate situation of surviving. But this survival comes at a price. It
is and has been typically a short term friendship, but one of value,
which words defy. It is and has been their absolute strength and will to
live and, yes, to suffer in silence, that alone deserves our respect by
doing the 'right thing'. You have the ability to give my ovarian cancer
women friends in British Columbia the will and the ability to improve
their life. This is a 'gift' through really a few strokes of the pen.
You can fund Caelyx for our ovarian cancer women in British Columbia. We
cannot wait, we should not have to wait.
Thank you.
Sincerely,
Sandi Pniauskas
email: sandipn@sympatico.ca
Tuesday, February 20, 2007
Saturday, February 17, 2007
Ovarian Cancer Advocate
Ovarian Cancer Advocate
"This webpage has been established by a group of women diagnosed with ovarian cancer in British Columbia. "
Friday, February 09, 2007
Thursday, February 08, 2007
July 11-13, 2007: Ovarian Cancer National Alliance 10th Anniversary Conference
The Ovarian Cancer National Alliance 10th Anniversary Conference (Washington, DC)
| |||||||||||||
A personal or family history of breast, colon or ovarian cancer may increase your risk for ovarian cancer
Family history includes both your mother and your father’s sides of the family
Friday, January 26, 2007
2007 January: Sunnybrook cancels some cancer surgery
Sunnybrook cancels some cancer surgeryGlobe and Mail - Toronto,Ontario,Canada
TORONTO -- Sunnybrook Health Sciences Centre is cancelling dozens of operations, including those of cancer patients....
2007 January: Wait times for cancer patients decreasing: report - Ontario - reference surgical waits Sunnybrook Regional Cancer Centre
".....Sunnybrook Health Sciences Centre is cancelling dozens of surgeries as it tries to deal with a patient backlog, and those waiting for cancer treatment...."
2007 UK - 3rd annual conference: "Where's the Patient's Voice in Health Professional Education?"
An exceptional opportunity for patients/carers and healthcare professionals.
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