Sunday, January 17, 2016
Ovarian cancer in Lynch syndrome; a systematic review (Jan 2016)
abstract
OBJECTIVE:
The aim was to systematically review the characteristics of ovarian cancer in women with Lynch syndrome (LS) and evaluate the role of surveillance in detection of ovarian cancer in LS.METHODS:
All studies between 1979 and 2015 of women with ovarian cancer and LS or at 50% risk of LS were evaluated. Two reviewers independently evaluated eligible studies and extracted data on age at diagnosis, histological type, FIGO stage, and way of detection according to pre-specified criteria. The studies were assessed for quality using the Newcastle-Ottawa quality assessment scales.RESULTS:
The quality score of the 49 identified studies was at least 6 out of 8 and provide clinical information on 747 LS women with ovarian cancer. The mean age at diagnosis was 45.3 (range 19-82) years. Most frequent mutations were MSH2 (47%) and MLH1 (38%). Histopathological data were available for 445 women. The most frequently reported histological type was mixed type (mucinous/endometrioid/clear cell carcinomas) (n = 136; 31%). Most tumours (281, 65%) were diagnosed at an early stage (FIGO I/II). Six studies evaluating the effect of surveillance of ovarian cancer, reported that seven of 22 (32%) ovarian cancers were found during surveillance, 6/7 (86%) were detected at an early stage.CONCLUSION:
This systematic review describes that ovarian cancer in women with LS has a wide age-range of onset, is often diagnosed at an early stage with frequently endometrioid/clear cell histology. Data about the role of surveillance in detection of ovarian cancer in women with LS are scarce however detection at an early stage seems possible.Policy Statement on Site-Neutral Payments in Oncology (ASCO)
Policy Statement
American Society of Clinical Oncology⇑
- Corresponding author: American Society of Clinical Oncology
-
Presented to American Society of Clinical Oncology (ASCO) State Affiliate Council Executive Subcommittee Leadership: December 2015; ASCO Clinical Practice Committee Leadership: December 2015; ASCO Government Relations Committee: February 2015; ASCO Full Board of Directors (for final approval): May 2015.
INTRODUCTION
The phrase site neutrality is commonly
used to describe efforts to reconcile payment differentials for the same
or similar
health care services provided in different settings
of care. Under the fee-for-service Medicare program, the two dominant
payment systems for oncology services—the Medicare
physician fee schedule and the hospital outpatient prospective payment
system—are based on different rate-setting
methodologies. The differences in these rate-setting methodologies can
result in
different payment levels for similar or identical
health care services.
In response to these differences in
payment levels, some stakeholders and policymakers—including the
Medicare Payment Advisory
Commission (MedPAC), members of Congress, and the
Centers for Medicare and Medicaid Services (CMS)—have proposed but not
implemented
various options for establishing site neutrality.1-3
These site-neutrality proposals are focused on reducing Medicare
payment levels in one setting of care without examining
whether such modified payments would adequately
meet the needs of Medicare beneficiaries with cancer in that setting.
Furthermore,
these site-neutrality proposals are based on the
existing, outdated coding and reimbursement system, without accounting
for
the potential adverse impacts on the ongoing
efforts to fundamentally reform the oncology delivery system or the
overarching
trend toward value-based payment models in all
settings of care......
Financial Hardship Associated With Cancer in the United States: Findings From a Population-Based Sample of Adult Cancer Survivors
open access
In summary, we found that both material and psychological financial hardship is common in adult cancer survivors, especially among the working-age population. Ongoing increases in the cost of cancer treatment highlight the importance of identifying characteristics of cancer survivors more likely to experience financial hardship and efforts to improve provider communication about cancer care affordability, especially with changes in health care access due to ongoing implementation of the Affordable Care Act.
To RCT or Not to RCT: How to Change Practice for Rare Cancers?
open access
..........To take medicine-based evidence in oncology to the next level, larger, comprehensive registries and big data are needed desperately, with funding and support not only from government granting agencies and oncology societies but also from foundation, private sector, and industry sources. In this regard, the American Society for Radiation Oncology and the American Association of Neurologic Surgeons joined forces with corporate partners to develop a stereotactic radiosurgery registry for brain tumors and benign disorders.17 The ASCO-led development of CancerLinQ, a health information technology platform, will house a massive web of real-world cancer care data and uncover patterns that should lead to improved quality of care.18 Industry-led consortia are also now bringing together centers to share data for pooled analyses,19 and Google is supporting the Flatiron software platform to help connect cancer centers.20 Provided that issues of treatment quality/compliance, intellectual property, data access, and academic freedom can be transparently addressed, all of these initiatives hold great potential to influence our knowledge of how treatments either benefit or harm patients outside of clinical trials. Given that this represents more than 98% of our patients,21 being able to tap into such data would be helpful indeed, especially for rare cancers such as IHC
Ovarian Cancer Screening: Resist the Temptation -- For Now
medscape
Ovarian cancer continues to be the most lethal gynecologic malignancy. Currently, screening for this disease in average-risk women is not recommended owing to a high rate of false-positive test results that lead to unnecessary surgery.[1]
In an April 2009 commentary, I summarized initial findings from a British trial[2] of ovarian cancer screening in more than 200,000 postmenopausal women. Six years later, these UK investigators have reported their preliminary findings with respect to impact on mortality.[3]......Although the road forward continues to be challenging, this trial's findings bring us one step closer to routine screening for ovarian cancer.
Randomized Trial of Low-Dose Morphine Versus Weak Opioids in Moderate Cancer Pain
abstract/original
Purpose The WHO
guidelines on cancer pain management recommend a sequential three-step
analgesic ladder. However, conclusive data
are lacking as to whether moderate pain should
be treated with either step II weak opioids or low-dose step III strong
opioids.
Patients and Methods
In a multicenter, 28-day, open-label randomized controlled study, adults
with moderate cancer pain were assigned to receive
either a weak opioid or low-dose morphine. The
primary outcome was the number of responder patients, defined as
patients with
a 20% reduction in pain intensity on the
numerical rating scale.
Results A total of 240
patients with cancer (118 in the low-dose morphine and 122 in the
weak-opioid group) were included in the
study. The primary outcome occurred in 88.2% of
the low-dose morphine and in 57.7% of the weak-opioid group (odds risk,
6.18;
95% CI, 3.12 to 12.24; P < .001).
The percentage of responder patients was higher in the low-dose morphine
group, as early as at 1 week. Clinically
meaningful (≥ 30%) and highly meaningful (≥ 50%)
pain reduction from baseline was significantly higher in the low-dose
morphine
group (P < .001). A change in the
assigned treatment occurred more frequently in the weak-opioid group,
because of inadequate analgesia.
The general condition of patients, which was
based on the Edmonton Symptom Assessment System overall symptom score,
was better
in the morphine group. Adverse effects were
similar in both groups.
Conclusion In patients with cancer and moderate pain, low-dose morphine reduced pain intensity significantly compared with weak opioids,
with a similarly good tolerability and an earlier effect.
Original article:
Potential Simpson's Paradox in Multicenter Study of IP Chemotherapy for Ovarian Cancer (correspondence/manuscript-open access)
open access (3)
Potential Simpson's Paradox in Multicenter Study of Intraperitoneal Chemotherapy for Ovarian Cancer
To the Editor:
Wright et al1
used a propensity score matched sample approach to evaluate overall
survival and treatment-related toxicities of intraperitoneal
(IP)/intravenous (IV) relative to IV-only adjuvant
treatment protocols for ovarian cancer.
The authors found substantial differences
between institutions in raw IP usage rates. In addition, non-negligible
differences
between treatment groups were found even after
propensity score matching (compare Appendix Table A1 in Wright et al1)
in several variables, including institution at which patients received
treatment, Charlson comorbidity scale, age, primary
tumor site, and histology. IP treatment was
administered to a low percentage of patients in some institutions (4% at
institution
3), and to a high percentage in others (67% and 63%
at institutions 1 and 2, respectively). Is there a potential for
Simpson’s
paradox in the authors’ analysis?
Even with propensity matching, patients
who received IV-only treatment tended to be older and poorer and have
more comorbidities
than other patients. Did the matcher try
compensating for differences between institutions in percentage of IP
treatment by
assigning sicker, higher-risk patients receiving
IV-only treatment to match patients receiving IP treatment from low IP
rate
institutions?
Unfortunately, even percentage data on the
institutional distribution of propensity score matched patients
receiving IV-only
versus IP/IV treatment was not presented. More
broadly, can we be confident that the observed mortality differences
were not
largely attributable to differences between
institutions—unrelated to the selection of IP/IV versus IV-only
treatment? For
example, if institutions with a large number of
patients receiving IV-only treatment had an overall higher mortality
rate,
then might this pose a threat of distortion via
Simpson’s paradox?
I am concerned that there might have been
differences between institutions that were not directly related to the
choice of
treatment protocol; for example, differences in
surgical treatments, differences in patient selection, differences in
outpatient
and community factors, differences in monitoring
approaches, or other hospital factors.
It would be useful to see if there were
any substantial differences between centers in overall survival rates
(adjusted and/or
unadjusted) within a treatment protocol. For
example, were the overall survival rates in the IV-only treatment
condition comparable
across institutions? What was the range of overall
survival rates in the IV-only treatment condition across institutions?
Wright et al1
provide a useful examination of the clinical use of IP/IV chemotherapy
at six National Comprehensive Cancer Network institutions.
I am hopeful that additional data and analysis can
be provided by the authors to further clarify their findings.
In his letter, Holt1 expressed concern that the survival difference we observed in our study2 between intraperitoneal (IP)/intravenous (IV) chemotherapy and IV chemotherapy may be a result of residual confounding between the two groups (eg, differences between institutional practices) rather than because of the treatment itself....................As shown in Table 1, the overall survival was similar between institutions, and the central estimates were in favor of IP/IV for each institution, which is consistent with the aggregate results. In addition, we have included in Table 2 the raw percentages by institution that were omitted from Appendix Table A1 in our original article.2 Together, these results suggest that the survival benefit we observed was unlikely to be driven by differences in practices at any individual institution, particularly because the HR that we observed was similar to results from several prior randomized controlled trials.3-5
REFERENCES
Germline mutations in pancreatic cancer become better defined
open access
KEY POINTS
Germline mutations occur in approximately 15% of patients with PAC. These 2 studies suggest that genetic counseling and testing are appropriate for patients with early-onset PAC or a family history of PAC, those with one of several associated cancers, and those of Ashkenazi Jewish ancestry. Further study and guidelines are needed to integrate genetic testing for PAC into practice.
A total of 159 patients pursued the
recommended genetic testing, and a
germline cancer susceptibility mutation
was found in 24 patients (15%).
Mutations were detected in BRCA2
in 13 patients, BRCA1 in 4 patients,
p16 in 2 patients, PALB2 in 1 patient,
and the DNA mismatch repair genes
related to Lynch syndrome in 4
patients. The mean age of the
patients with a pathologic mutation
was 58.5 years compared with 64
years for those without mutations.
The researchers at MSKCC say they believe the results of this study suggest that it is reasonable for patients who are diagnosed with PAC at a young age or who are of Ashkenazi Jewish ancestry to be referred for genetic counseling and testing.“Additionally, it is important [to] advocate for coverage benefits of genetic counseling for patients with pancreatic cancer since many third-party payers primarily only focus on benefits for patients with breast, ovarian, and colorectal cancer,” says Dr. Stadler.
inherited cancer susceptibility genes and such syndromes as hereditary breast and ovarian cancer syndrome (BRCA1 and BRCA2), familial atypical mole syndrome (p16), Lynch syndrome (MLH1, mutS homolog [MSH]2, MSH6, PMS2, and EPCAM),
Peutz-Jeghers syndrome (STK11), and partner and localizer of BRCA2 (PALB2)-associated PAC. However, the prevalence of germline mutations in patients with pancreatic cancer is not well defined. Data that better define the prevalence of particular germline mutations are needed to make evidence-based recommendations and better select patients with pancreatic cancer for genetic testing......
Cancer statistics for Asian Americans, Native Hawaiians, and Pacific Islanders, 2016: Converging incidence in males and females
open access
Abstract
Cancer
is the leading cause of death among Asian Americans, Native Hawaiians,
and Pacific Islanders (AANHPIs). In this report, the American Cancer
Society presents AANHPI cancer incidence data from the National Cancer
Institute, the Centers for Disease Control and Prevention, and the North
American Association of Central Cancer Registries and mortality data
from the National Center for Health Statistics. Among AANHPIs in 2016,
there will be an estimated 57,740 new cancer cases and 16,910 cancer
deaths. While AANHPIs have 30% to 40% lower incidence and mortality
rates than non-Hispanic whites for all cancers combined, risk of stomach
and liver cancers is double. The male-to-female incidence rate ratio
among AANHPIs declined from 1.43 (95% confidence interval, 1.36-1.49) in
1992 to 1.04 (95% confidence interval, 1.01-1.07) in 2012 because of
declining prostate and lung cancer rates in males and increasing breast
cancer rates in females.
Routine Clinical Practice for Patients With Recurrent Ovarian Carcinoma: Results From the TROCADERO Study
open access (pdf)
Abstract
Objective: Treatment options for patients with recurrent
ovarian carcinoma are diverse, and different therapies are recommended
based on platinum-free interval (PFI). Data examining the association
between platinum sensitivity, treatment strategy, and outcomes are
limited, particularly for partially platinum-sensitive (PPS) patients.
This study characterized clinical features and outcomes in patients with
recurrent ovarian carcinoma in the context of sensitivity to
platinum-based therapy.
Methods: Anonymized case records were obtained from
eligible European medical sites. Eligible patients were 18 years or
older with epithelial ovarian carcinoma who had received 1 or more
platinum-based therapies and had 1 or more subsequent relapses. Patient
records were categorized by PFI and analyzed based on demographic and
clinical data using descriptive statistics.
Results: There was no difference between PFI in PPS
patients receiving platinum versus nonplatinum therapy (8.9 [range,
6.0-12.0] and 8.3 [range, 6.0-11.3] months, respectively). Overall
survival in patients with platinum-sensitive, PPS, platinum-resistant,
and platinum-refractory disease was 43.0 (95% confidence interval [95%
CI], 25.1-42.3), 20.5 (95% CI, 17.7-24.8), 12.7 (95% CI, 10.4-14.2), and
9.8 (95% CI, 6.6-14.9) months, respectively. Among PPS patients,
overall survival was 23.5 (95% CI, 18.4-37.3) and 18.7 (95% CI,
11.0-23.5) months for those who received platinum and nonplatinum-based
therapy, respectively. No demographic or clinical characteristics were
identified that indicated a difference between PPS patients who received
platinum-based therapy versus those who did not.
Conclusions: Partially platinum-sensitive patients with
recurrent ovarian carcinoma who received platinum-based therapy had
improved outcomes compared with those who did not. No clear demographic
criteria for choosing platinum- versus nonplatinum-based therapy for PPS
patients were identified from patient records.
(pdf) .....Several clinical guidelines recommend the use of
platinum-based therapy for PPS patients. However, in the literature,
evidence supporting this treatment choice in PPS patients
specifically is limited. To date, no randomized study has
addressed this specific issue. The TROCADERO study shows
that PPS patients experience better outcomes when they receive
platinum-based therapy; these data lend support to administration
of platinum-based treatment to PPS patients. This study
also revealed that, following first-line therapy, a group of PPS
patients with recurrent disease received non-platinum-based
treatment. This is contrary to several clinical guidelines that
recommend a platinum-based treatment for this patient group.
No criteria were identified that appeared to influence physicians’
selection of a platinum/nonplatinum treatment regimen
in this setting. Further studies will be needed to elucidate criteria
that can be used to guide treatment decisions for patients
with recurrent ovarian carcinoma.
Health-related quality of life and health care use in cancer survivors compared with patients with chronic diseases - Netherlands
abstract
BACKGROUND
The
number of cancer survivors is steadily increasing and these patients
often experience long-lasting health problems. To make care for cancer
survivors sustainable for the future, it would be relevant to put the
effects of cancer in this phase into perspective. Therefore, the authors
compared health-related quality of life (HRQOL) and health care use
among cancer survivors with that of patients with chronic diseases.
METHODS
Patients
diagnosed at age >18 years with a cancer with a 5-year survival
rate > 20% and no distant metastases at the time of diagnosis and
patients aged >18 years with physician-diagnosed somatic chronic
diseases without cancer were sent a questionnaire. HRQOL was measured
with the RAND-36, a measure of HRQOL. Self-reported health care use was
measured for general practitioner care, specialist care, rehabilitative
care, physical therapy, ambulatory mental health care, and occupational
health care.
RESULTS
A
total of 601 cancer survivors and 1052 patients with chronic diseases
without cancer were included in the current study. Multimorbidity was
observed in 63% of the cancer survivors and 61% of the patients with
chronic diseases. The HRQOL of the cancer survivors was significantly
better than that of patients with chronic diseases after adjustment for
age and sex. For the mental functioning subscale, no significant
differences were found between the 2 groups. Cancer survivors were found
to be less likely to have visited a general practitioner or
cardiologist compared with patients with chronic diseases.
CONCLUSIONS
When
considering physical HRQOL and health care use, cancer survivors appear
to fare better than the average patient with chronic diseases. No
difference in mental functioning was observed in the current study.
Cancer care cost trends in the United States: 1998 to 2012
abstract
BACKGROUND
The
authors examine trends in spending on cancer from 1998 through 2012,
including cancer care costs, prevalence, and cases by payer, and discuss
the results within the context of a prior analysis and recent health
policy and programmatic changes.
METHODS
Condition-specific
distribution of expenditures from the Medical Expenditure Panel Survey,
supplemented with results from the National Nursing Home Survey and
other data sources, was used as the basis for allocating the Personal
Health Care components of the National Health Expenditure Accounts among
conditions.
RESULTS
Cancer
care expenditures grew at an annualized rate of 2.9% from 1998 to 2012.
The share of expenditures for hospital-based care declined to a low of
48% during 2007 through 2009. Professional and clinical services' shares
declined substantially between 2007 to 2009 and 2010 to 2012 when the
hospital share increased. Treated prevalence decreased for all payers
between the first and last study periods with the exception of private
payers (11.2% increase). Out-of-pocket expenditures declined to 4.7%,
whereas Medicare's share increased slightly. Medication expenditures
increased, notably within retail and mail order settings.
CONCLUSIONS
The previous rapid growth of cancer prevalence and expenditures has now slowed, most remarkably since the 2007 recession. Out-of-pocket expenses for cancer treatment continue to decline, most recently reaching the lowest point in 25 years. In addition, the early effects of Affordable Care Act expansion can be observed in the decline of treated prevalence in the Medicaid population as the demographics of Medicaid enrollees change.Friday, January 15, 2016
Targeting AMPK signaling in combating ovarian cancers: opportunities and challenges
abstract
The development and strategic application of effective anticancer therapies have turned out to be one of the most critical approaches of managing human cancers. Nevertheless, drug resistance is the major obstacle for clinical management of these diseases especially ovarian cancer. In the past years, substantial studies have been carried out with the aim of exploring alternative therapeutic approaches to enhance efficacy of current chemotherapeutic regimes and reduce the side effects caused in order to produce significant advantages in overall survival and to improve patients' quality of life. Targeting cancer cell metabolism by the application of AMP-activated protein kinase (AMPK)-activating agents is believed to be one of the most plausible attempts. AMPK activators such as 5-aminoimidazole-4-carboxamide 1-β-d-ribofuranoside, A23187, metformin, and bitter melon extract not only prevent cancer progression and metastasis but can also be applied as a supplement to enhance the efficacy of cisplatin-based chemotherapy in human cancers such as ovarian cancer. However, because of the undesirable outcomes along with the frequent toxic side effects of most pharmaceutical AMPK activators that have been utilized in clinical trials, attentions of current studies have been aimed at the identification of replaceable reagents from nutraceuticals or traditional medicines. However, the underlying molecular mechanisms of many nutraceuticals in anticancer still remain obscure. Therefore, better understanding of the functional characterization and regulatory mechanism of natural AMPK activators would help pharmaceutical development in opening an area to intervene ovarian cancer and other human cancers.
“I Told Myself to Stay Positive” Perceptions of Coping Among Latinos With a Cancer Diagnosis Living in the United States
abstract
Purpose: This study
contributes to the sparse body of literature examining perceptions of
coping among Latino men and women with a
cancer diagnosis living in the United States.
There are currently 50 million Latinos in the United States and, by
2050, projected
to grow to 128 million. Although some research
indicates that Latinos have unique sociocultural beliefs that influence
their
cancer care, very little is known about their
perceptions of coping after being diagnosed with cancer. We examined
Latino
men and women’s perceptions of coping to
understand the meaning of their experience with cancer
Method: Using
criterion sampling technique, 60 immigrant and migrant Latino men and
women diagnosed with cancer within the past 5
years were recruited from community-based
organizations, clinics, and churches. The study consisted of 60- to
90-minute semistructured
interviews asking open-ended questions
pertaining to coping. The qualitative design facilitated an
understanding of coping
within the participants’ social and cultural
contexts.
Results: Median age of
the participants was 55 years. Among the women, 80% had breast cancer;
12% had ovarian cancer;
Physician trust moderates the relationship between intolerance of uncertainty and cancer worry interference among women with Lynch syndrome
abstract
This study investigated the extent to which intolerance of uncertainty was associated with cancer worry interference, anxiety and depression among women with Lynch syndrome (LS), and whether having greater trust in one's physician moderated those relationships. Women with confirmed LS (N = 128) were recruited from a high-risk of cancer registry and completed a one-time self-report questionnaire. Women who reported greater intolerance of uncertainty and more trust in their physician reported less cancer worry interference compared to women who had greater intolerance of uncertainty and less trust in their physician, who reported the highest worry interference, b = -1.39, t(99) = -2.27, p = .03. No moderation effect of trust in physician was found for anxiety or depression. Trust in one's physician buffered the impact of high intolerance of uncertainty on cancer worry interference, underscoring the need for supportive provider-patient relationships, particularly for LS patients.
FDA Strengthens Requirements for Surgical Mesh for the Transvaginal Repair of Pelvic Organ Prolapse to Address Safety Risks
FDA
....The take-home for the practicing urologist of this most recent guidance is that all pelvic organ prolapse meshes now have been upgraded to category 3, or most significant–risk, devices.....
Women Experience Long-Term Neuropathy After Chemotherapy, Leading to Falls
Long-Term Neuropathy
....The cohort for this comparative analysis was drawn from survivors enrolled in exercise clinical trials: 210 women reported symptoms of CIPN an average of six years after diagnosis (45 percent), and 252 did not. The average age of the participants was 62 years, and the majority (71 percent) had a diagnosis of breast cancer; the remaining diagnoses were lung, colorectal, ovarian or blood cancers.....
Nausea as a sentinel symptom for cytotoxic chemotherapy effects on the gut-brain axis among women receiving treatment for recurrent ovarian cancer
abstract
PURPOSE:
Nausea
is a common and potentially serious effect of cytotoxic chemotherapy
for recurrent ovarian cancer and may function as a sentinel symptom
reflecting adverse effects on the gut-brain axis (GBA) more generally,
but research is scant. As a first exploratory test of this GBA
hypothesis, we compared women reporting nausea to women not reporting
nausea with regard to the severity of other commonly reported symptoms
in this patient population.
METHODS:
A secondary analysis of data systematically collected from women in active chemotherapy treatment for recurrent ovarian cancer (n = 158) was conducted. The Symptom Representation Questionnaire (SRQ) provided severity ratings for 22 common symptoms related to cancer and chemotherapy. Independent sample t tests and regression analyses were used to compare women with and without nausea with regard to their experience of other symptoms.RESULTS:
Nausea was reported by 89 (56.2 %) women. Symptoms that were significantly associated with nausea in bivariate and regression analyses included abdominal bloating, bowel disturbances, dizziness, depression, drowsiness, fatigue, headache, lack of appetite, memory problems, mood swings, shortness of breath, pain, sleep disturbance, urinary problems, vomiting, and weight loss. Symptoms that were not associated with nausea included hair loss, numbness and tingling, sexuality concerns, and weight gain.CONCLUSIONS:
Nausea experienced during chemotherapy for recurrent ovarian cancer may be an indicator of broader effects on the gut-brain axis. A better understanding of the mechanisms underlying these effects could lead to the development of novel supportive therapies to increase the tolerability and effectiveness of cancer treatment.Interval debulking surgery for advanced epithelial ovarian cancer
abstract: The Cochrane Library
Published Online: 9 JAN 2016
Assessed as up-to-date: 1 JUN 2015
Background
Interval debulking surgery (IDS), following induction or neoadjuvant chemotherapy, may have a role in treating advanced epithelial ovarian cancer (stage III to IV) where primary debulking surgery is not an option.
Objectives
Search methods
Selection criteria
Data collection and analysis
Main results
Authors' conclusions
Plain language summary
Interval debulking surgery for advanced epithelial ovarian cancer
Investigation of exomic variants associated with overall survival in ovarian cancer
abstract
Background: While numerous susceptibility loci for epithelial ovarian cancer (EOC) have been identified, few associations have been reported with overall survival. In the absence of common prognostic genetic markers, we hypothesize that rare coding variants may be associated with overall EOC survival and assessed their contribution in two exome-based genotyping projects of the Ovarian Cancer Association Consortium (OCAC).
Methods: The primary patient set (Set 1) included 14 independent EOC studies (4293 patients) and 227,892 variants, and a secondary patient set (Set 2) included six additional EOC studies (1744 patients) and 114,620 variants. Because power to detect rare variants individually is reduced, gene-level tests were conducted. Sets were analyzed separately at individual variants and by gene, and then combined with meta-analyses (73,203 variants and 13,163 genes overlapped).
You Can’t Trust What You Read About Nutrition
blog
.....The U.S. Dietary Guidelines Advisory Committee recently released its latest guidelines, which define a healthy diet as one that emphasizes vegetables, fruits, whole grains, low- or nonfat dairy products, seafood, legumes and nuts while reducing red and processed meat, refined grains, and sugary foods and beverages.1 Some cardiologists recommend a Mediterranean diet rich in olive oil, the American Diabetes Association gives the nod to both low-carbohydrate and low-fat diets, and the Physicians Committee for Responsible Medicine promotes a vegetarian diet. Ask a hard-bodied CrossFit aficionado, and she may champion a “Paleo” diet based on foods our Paleolithic ancestors (supposedly) ate. My colleague Walt Hickey swears by the keto diet.
Who’s right? It’s hard to say. When it comes to nutrition, everyone has an opinion. What no one has is an airtight case......
Researchers kill drug-resistant lung cancer with 50 times less chemo (Taxol)
Paclitaxel is a potent drug used in the United States as a first- and second-line treatment for breast, lung and pancreatic cancers. (blogger's note - and ovarian cancer)
Science news (in research)
The cancer drug paclitaxel just got more effective. For the first time, researchers from the University of North Carolina at Chapel Hill have packaged it in containers derived from a patient's own immune system, protecting the drug from being destroyed by the body's own defenses and bringing the entire payload to the tumor.....
Date: 2016-01-15 Carter v. Canada (Attorney General) - Supreme Court of Canad
SCC Cases
January
15, 2016 le
15 janvier 2016
ORDER ORDONNANCE
MOTION
REQUÊTE
LEE CARTER, HOLLIS JOHNSON, WILLIAM
SHOICHET, BRITISH COLUMBIA CIVIL LIBERTIES ASSOCIATION AND GLORIA TAYLOR v.
ATTORNEY GENERAL OF CANADA – and between – LEE CARTER, HOLLIS JOHNSON, WILLIAM
SHOICHET, BRITISH COLUMBIA CIVIL LIBERTIES ASSOCATION AND GLORIA TAYLOR v.
ATTORNEY GENERAL OF CANADA AND ATTORNEY GENERAL OF BRITISH COLUMBIA
(B.C.) (35591)
[1]
The Attorney General of Canada applies for a
six-month extension of the suspension of this Court’s declaration that
ss. 241(b) and 14 of the Criminal Code, R.S.C. 1985,
c. C-46, “are of no force or effect to the extent that they prohibit
physician‑assisted death for a competent adult person who (1) clearly
consents to the termination of life and (2) has a grievous and
irremediable medical condition (including an illness, disease or disability)
that causes enduring suffering that is intolerable to the individual in the
circumstances of his or her condition”. The declaration of invalidity of
ss. 241(b) and 14 was suspended for 12 months, until February 6,
2016. The appellants oppose the Attorney General’s application. Should
an extension of the suspension be granted, the Attorney General of Quebec asks that
legislation regulating end‑of‑life assistance adopted in Quebec be
exempted from the suspension, to avoid uncertainty as to whether the Quebec
regime conflicts with the federal prohibition preserved by any extension of the
suspension. Finally, the appellants and certain interveners ask this Court to
grant a constitutional exemption for individuals who wish to seek assistance in
ending their life during the period of any extension......The Emergency Department Point of Palliative Care Access for Patients With Advanced Cancer (open access)
EMA Updates HRT Warning on Ovarian Cancer Risk
European Regulatory Roundup
Posted 14 January 2016
Welcome to our European Regulatory Roundup, our weekly overview of the top EU regulatory news.
EMA Updates HRT Product Information to Clarify Ovarian Cancer Risk
EMA has updated the product information for hormone-replacement therapy (HRT). The changes follow a review by the Pharmacovigilance Risk Assessment Committee (PRAC) late last year, which concluded EMA should strengthen the warning about the link between HRT and ovarian cancer.In the previous product information, ovarian cancer was described as a slight risk for people who took HRT for five to 10 years. However, since EMA drafted that version, a meta-analysis published in The Lancet has found shorter-term use of HRT is also associated with a slightly increased risk of the development of ovarian cancer. The publication of data against the hypothesis that only long-term use of HRT puts people at risk of ovarian cancer prompted PRAC and EMA to reassess their position.
Whereas the old text read “long-term (at least 5-10 years) use of oestrogen-only HRT products has been associated with a slightly increased risk of ovarian cancer,” the revised document states: “Epidemiological evidence from a large meta-analysis suggests a slightly increased risk in women taking oestrogen-only or combined oestrogen-progestagen HRT, which becomes apparent within 5 years of use and diminishes over time after stopping.”
EMA has also revised a section detailing the number of extra cases of ovarian cancer it would expect to see among people receiving HRT. The regulator now advises that two in every 2,000 women aged 50 to 54 years old who are not taking HRT will develop ovarian cancer over a five-year period. Among women who have been taking HRT for five years, the rate increases to three in 2,000, one extra case per 2,000 people.
Monday, December 28, 2015
(U.S.) FDA Grants Multi-Epitope Vaccine Orphan Designation for Ovarian Cancer
science news
Published Online:5:41 AM, Mon December 28, 2015
An orphan drug designation has been granted to the multi-epitope folate receptor alpha (FRα) vaccine TPIV 200 as a treatment for patients with ovarian cancer by the FDA.
According to a statement from the drug's developer, TapImmune, the designation was based on findings from a phase I study, which were electronically published in conjunction with the 2015 ASCO Annual Meeting.
"Ovarian cancer is highly aggressive, clinically evasive, and, with current treatment modalities, time to recurrence is relatively short and prognosis upon recurrence is poor," Patrick Yeramian, MD, vice president and chief medical officer at TapImmune, said in a statement. "The FDA's decision to grant TPIV 200 orphan designation underscores the need for additional therapeutic options and validates the scientific rationale of TapImmune's approach."
Treatment with the vaccine was associated with FRα-specific T-cell response that persisted beyond the completion of the study for a majority of patients. In total, FRα is expressed on nearly 90% of ovarian cancer cells.
In the phase I study, 22 patients with breast or ovarian cancer were enrolled following surgery and adjuvant therapy. Prior to receiving the vaccine, patients were treated with 1 cycle of cyclophosphamide on days 1 to 7 and 15 to 22, to reduce immunosuppressive T regulatory cells (Tregs). The vaccine, which contained the 5 peptides FR30, FR56, FR76, FR113, and FR238, was administered intradermally at three sites on the first day of each subsequent cycle following cyclophosphamide for a maximum of 6 cycles......
Sunday, December 27, 2015
Drug fever after cancer chemotherapy is most commonly observed on posttreatment days 3 and 4
abstract
Conclusion
The febrile
episodes that occurred on posttreatment days 3 and 4 were considered to
represent adverse drug reactions after cancer chemotherapy. Physicians
should be aware of this feature of chemotherapy-associated fever and
avoid unnecessary examination and treatments including prescribing
antibiotics.
Can pregabalin prevent paclitaxel-associated neuropathy?
abstract - An ACCRU pilot trial
Conclusions
The results of this pilot trial do not support that pregabalin is helpful for preventing P-APS or paclitaxel-associated CIPN.
Double-booked Surgeries Roil Medicine (article including comments)
Medscape
A recent Boston Globe investigation into overlapping or double-booked elective surgeries at the venerable Massachusetts General Hospital (MGH) in Boston has provoked debate and soul-searching in the medical profession.
The newspaper reported in October that MGH patients routinely were not told that their attending surgeon would be in charge of two operations at the same time, which is an informed consent issue. Surgical residents and fellows sometimes performed entire operations while a double-booked attending surgeon was elsewhere, according to the Boston Globe......
Peritoneal carcinomatosis from unusual cancer origins: Is there a role for HIPEC?
abstract
INTRODUCTION:
Complete cytoreductive surgery (CCRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) is the gold standard for curative treatment of peritoneal carcinomatosis (PC) arising from colorectal cancer, peritoneal mesothelioma and peritoneal pseudomyxoma peritonei (PMP). The results of HIPEC remain controversial in PC that originates from ovarian cancer, stomach cancer, neuroendocrine tumors, or sarcoma. HIPEC has also been used, although very rarely, for other malignant carcinomatoses. Its use has been exceptional due either to the rarity of the tumor or because such disease is usually widespread and rarely confined to the peritoneum. The aim of this study was to evaluate the results of CCRS plus HIPEC in patients with PC of unusual origin.Novel MSH2 Mutation in the First Report of a Vietnamese–American Kindred with Lynch Syndrome
open access (pdf)
Case Histories: Proband Medical History
Patient #1 is a 57 year-old female who fled Vietnam in 1980. In
February 2010 she was found to have an 8 cm complex right adnexal
mass on ultrasound. She did not report any postmenopausal vaginal
bleeding or gastrointestinal symptomatology. A pre-operative computed
tomography (CT) scan demonstrated the pelvic mass and a mid-colonic
lesion. The patient underwent open hysterectomy, bilateral salpingo-oophorectomy,
omentectomy, pelvic/para-aortic lymphadenectomy and transverse colectomy with primary anastomosis. Pathology was consistent with 3 synchronous lesions: FIGO stage IA grade 1 endometrial carcinoma, FIGO IC clear cell ovarian carcinoma, and stage I adenocarcinoma of the colon. She received adjuvant platinum- plus taxane-based intravenous chemotherapy.
In October 2012, the proband's sister Patient #2 reported menorrhagia
and was diagnosed with grade 2 endometrioid adenocarcinoma. She
was referred to the same Gynecologic Oncologist that cared for her
sister and provided a more detailed family history (colon cancer in her
brother (age 49) and maternal pancreatic cancer (deceased age 48).
She underwent a robotic hysterectomy with bilateral salpingooophorectomy
and lymphadenectomy. Final pathology revealed a FIGO stage IA, grade 2 endometrioid adenocarcinoma with no lymphovascular space invasion. IHC screening of the tumor for MLH1, MSH2, MSH6, and PMS2 was positive for LS. Both sisters and their brother were referred for genetic counseling.
Genetic characterization of early onset ovarian carcinoma - Gynecologic Oncology
abstract
We sequenced germline DNA from forty-seven women diagnosed with OC at age 40 or younger ascertained through a gynecologic oncology tissue bank or referred from outside providers using BROCA
Highlights
Thursday, December 24, 2015
Impact of Age at Primary Breast Cancer on Contralateral Breast Cancer Risk in BRCA1/2 Mutation Carriers
open access
Conclusion Age at first breast cancer is a strong risk factor for cumulative CBC risk in BRCA1/2 mutation carriers. Considering the available evidence, age-specific risk estimates should be included in counseling......
In our unselected cohort of patients with breast cancer , we found 10-year cumulative CBC risks of 21.1% for BRCA1 mutation carriers and 10.8% for BRCA2 mutation carriers, which were two to three times higher than for noncarriers (HR, 3.31 for BRCA1; and HR, 2.17 for BRCA2 mutation carriers).
Painful Hands and Feet After Cancer Treatment: Inflammation Affecting the Mind-Body Connection
Editorial
With the growing number of cancer survivors, it is critical for us to consider toxicities that arise during treatment and do not resolve after treatment ends. Some symptoms continue to burden patients for many years after the cancer has been cured, and chemotherapy-induced peripheral neuropathy (CIPN) is a conspicuous example.....
..... We must be clinically attuned to the complaints our patients voice, and we must make a serious effort to develop prevention and treatment strategies that will reduce the burden of cancer treatment–associated toxicities.
Wednesday, December 23, 2015
Patterns and functional implications of rare germline variants across 12 cancer types
open access -
- Published
We observed several significant associations in specific cancer types: RAD51C in AML, ATM in PRAD and PALB2 in STAD. Across cancer types, a higher percentage of breast and ovarian cancer cases were identified as having rare truncation variants in cancer genes versus other cancer types, due predominantly to high frequencies in BRCA1/2. The percentage of breast and ovarian cancer cases carrying BRCA1/2 germline truncation variants in the TCGA cohort was 4.4% and 11.6%, respectively, consistent with previous reports39, 40, 41, 42. Interestingly, stomach cancer has the second highest percentage of rare truncations
Subscribe to:
Comments
(
Atom
)
