- •Unplanned readmission rate is dependent on several modifiable patient and treatment related factors.
- •Three quarters of readmission happen within two weeks of discharge from the hospital
- •Surgical site infections are the leading cause of readmissions
Wednesday, March 02, 2016
Five daunting details you need to know from this new report on ovarian cancer - The Washington Post
The Washington Post
1) The term "ovarian cancer" is a misnomer, because the disease, in fact, is a "constellation of distinct types of cancer" involving the ovary -- all with different tumor types, distinctive molecular signatures and prognoses, the report says. Many of these cancers, scientists now know, don't start in the ovary at all, but arise from other areas, such as the fallopian tubes, and eventually spread to the ovary. Unfortunately, researchers don't yet understand even the basics on how the different subtypes develop and progress. The top research priority, the report said, should be understanding the most common and deadly type of ovarian cancer -- high-grade serous carcinoma, also known as HGSC.
Patients' Views of Adverse Events in Primary and Ambulatory Care
Medscape
In this systematic review, we aimed to produce a comprehensive summary of the published literature assessing patients' views on adverse events in primary and ambulatory care. As secondary objectives, we intended to (A) better characterize the methods used by the researchers; and (B) report the solutions proposed to increase the participation of patient in their own care.
Methods
Data Sources
This review was designed and reported according to the PRISMA statement "TRANSPARENT REPORTING of SYSTEMATIC REVIEWS and META-ANALYSIS –PRISMA.[13] We performed a systematic literature search on the databases: MEDLINE, OvidSP, CINAHL, Cochrane Library, PsycInfo and ScienceDirect, from the earliest available date to August, 2012. Publications in English, French or German-language were included. We used Medical Subject Headings (MeSH) terms and free text terms related to patient safety themes, as illustrated....(free) The National Academies Press: 2016 Ovarian Cancers: Evolving Paradigms in Research and Care
free download (need to register email)
Ovarian Cancers: Evolving Paradigms in Research and Care
The following files are available for free download. For more information about downloading files, please see the File Download FAQ
Full Book and Chapter PDFs
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The Biology of Ovarian Cancer
Recent evidence suggests that many ovarian carcinomas do not arise in
the ovary. Furthermore, researchers do not have a complete understanding
for each subtype of how the disease progresses or the effects of the microenvironment.
Without better model systems that replicate the manifestations
of the human disease, the answers to many key questions will remain
elusive. This research gap is further complicated by the significant degree
of heterogeneity of ovarian carcinomas, including within and between subtypes.
However, clinicians and researchers tend to combine them in many
types of research......
The Biology of Ovarian Cancer
Recent evidence suggests that many ovarian carcinomas do not arise in
the ovary. Furthermore, researchers do not have a complete understanding
for each subtype of how the disease progresses or the effects of the microenvironment.
Without better model systems that replicate the manifestations
of the human disease, the answers to many key questions will remain
elusive. This research gap is further complicated by the significant degree
of heterogeneity of ovarian carcinomas, including within and between subtypes.
However, clinicians and researchers tend to combine them in many
types of research......
Ovarian Cancer (news): The National Academies of Sciences, Engineering, and Medicine
Home - news
 |
|
New Report on Ovarian Cancer to Be Released March 2
Often
called a silent killer because of how difficult it is to diagnose in
its early stages, ovarian cancer is one of the deadliest cancers, with a
five-year survival rate of just under 46 percent. Although it is
relatively uncommon, more than 21,000 women in the U.S. are diagnosed
with ovarian cancer each year, and more than 14,000 die from the
disease.
A
new congressionally mandated report from the National Academies of
Sciences, Engineering, and Medicine examines current knowledge of
ovarian cancer and recommends research to advance understanding in order
to reduce the incidence of, and number of deaths from, ovarian cancer.
In particular, the report addresses distinctions in various subtypes of
ovarian cancer, challenges to early detection, the need for genetic
testing, disparities in standards of care, and how to improve treatment
of the disease and supportive care for its survivors.
Members
of the committee that conducted the study and wrote the report will
present their findings and recommendations at a public briefing
beginning at 11 a.m. EST on Wednesday, March 2, in the Lecture Room of
the National Academy of Sciences building, 2101 Constitution Ave., N.W.,
Washington D.C. Those who cannot attend may view a live webcast of the
event here.
Advance copies of Ovarian Cancers: Evolving Paradigms in Research and Care will be available to reporters only beginning at noon on Tuesday, March 1. The report is embargoed and not for public release before 11 a.m. EST on Wednesday, March 2.
To obtain a copy of the report or register to attend the briefing,
reporters should contact the Academies’ Office of News and Public
Information; tel. 202-334-2138 or email news@nas.edu.
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Evolving Approaches in Research and Care for Ovarian Cancers - Mar 2, 2016
JAMA Network - open access
Viewpoint
|
March 02, 2016
Evolving Approaches in Research and Care for Ovarian CancersA Report From the National Academies of Sciences, Engineering, and Medicine
JAMA. Published online March 02, 2016Most women with ovarian cancer present at an advanced stage, when the case-fatality rate is high. Approximately 22 280 women are diagnosed with ovarian cancer in the United States each year; 60% are classified as advanced stage, and the overall 5-year survival for these women is 28%.1 Reliable approaches for early detection of ovarian cancer have thus far been difficult to establish. The recently released report from the Institute of Medicine of the National Academies of Sciences, Engineering, and Medicine Committee on the State of the Science in Ovarian Cancer Research, titled Ovarian Cancers: Evolving Paradigms in Research and Care,2 highlights key gaps in the evidence base of ovarian cancer research and underscores opportunities that could affect many women.....
Most US cancer prevention guidelines don't provide information needed for decision-making
Medical News Today
The majority of cancer prevention and screening recommendations in the United States did not quantify benefits and harms or were unable to be presented in an even matter. These prevention and screening recommendations should be improved so that both clinicians and patients have better access to information so that they can make a more educated decision, according to a study published February 23 in the JNCI: Journal of the National Cancer Institute....
The researchers found 55 recommendations for using interventions to prevent or detect breast, prostate, colon, cervical, and lung cancer in 32 guidelines and that of those 55 recommendations, 39% received a comparable rating, while 14.5% received an incomplete rating. 54.5% received an asymmetric rating.
In an accompanying editorial, Michael Pignone, M.D., M.P.H., Professor of Medicine and Chief, UNC Division of General Internal Medicine, writes that the findings presented by Caverly and colleagues, "could be an important root cause of inadequate patient-provider communication and low patient knowledge about cancer screening services." "If we assume that guidelines are important sources of information for communication about cancer screening, we must then ask why the presentation of information about benefits and downsides in guidelines seems to be suboptimal."
Reference:
Cancer Prevention: Obstacles, Challenges, and the Road Ahead. Frank L. Meyskens Jr, Hasan Mukhtar, Cheryl L. Rock, Jack Cuzick, Thomas W. Kensler, Chung S. Yang, Scott D. Ramsey, Scott M. Lippman and David S. Alberts. Journal of the National Cancer Institute. DOI. 10.1093/jnci/djv309. Published February 23, 2016.
Source: Oxford University Press USA
Glasgow prognostic score is an independent marker for poor prognosis with all cases of epithelial ovarian cancer
open access
Discussion
The known prognostic factors for OC include residual tumor and chemotherapy response [4, 5].
Inflammatory markers such as GPS are important prognostic factors in
various cancers. This is the first study to evaluate whether high
pretreatment GPS predicts poor prognosis for patients with epithelial
OC, including those with early-stage disease.
Study population
This retrospective study reviewed medical records of 216 patients with different stages (stages I–IV) of epithelial OC who were treated at the Department of Obstetrics and Gynecology of Okayama University Hospital between January 2002 and July 2015.....
| Histology | |||||
| Serous adenocarcinoma | 113 | ||||
| Clear cell carcinoma | 31 | ||||
| Mucinous adenocarcinoma | 25 | ||||
| Endometrioid adenocarcinoma | 26 | ||||
| Other carcinoma | 5 | ||||
| Mixed type carcinoma | 16 | ||||
Extracting value from chaos: The promise of health information technology
ScienceDaily
"Getting to a desirable future where health IT is appropriately employed to benefit human health isn't a technical problem -- the technologies already exist. It's a health policy and a sociology problem,"
Paclitaxel Induced MDS and AML: A Case Report and Literature Review
open access
Therapy related acute myelogenous leukemia (AML) and myelodysplastic syndromes (MDS) have been classically linked to alkylating agents and topoisomerase inhibitors. They constitute about 1% of all AMLs. There is less evidence on association of taxanes (paclitaxel and docetaxel) with these myeloid neoplasms.
Fertility preservation in BRCA mutation carriers
abstract
Interest in fertility preservation for young women facing gonadotoxic therapies is increasing according to enhanced long-term survival rates of these patients. Women who carry a mutation in the BRCA1 or BRCA2 gene have a specifically increased lifetime risk of developing breast and tubo-ovarian cancer. Moreover, they are at high risk of undergoing premature infertility due to the medical interventions that are often performed in order to reduce cancer risk or treat an already existing malignancy. Fertility issues are relevant for healthy BRCA mutation carriers, whose family-planning decisions are often influenced by the need of prophylactic bilateral salpingo-oophorectomy at young age. In BRCA mutation carriers who have a breast cancer at young age, the oncostatic treatment is associated with a significant ovarian toxicity linked to chemotherapy as well as to the long lasting hormonotherapy and to the need of delaying pregnancy for several years. Prompt counselling about different fertility preservation options should be offered to all young girls and women at high risk of ovarian insufficiency and infertility. Validated techniques to preserve fertility include oocyte and embryo cryopreservation, while experimental techniques include ovarian suppression with GnRH-analogues during chemotherapy and ovarian tissue cryopreservation. The choice of the best strategy depends on age, type of chemotherapy, partner status, cancer type, time available for fertility preservation intervention and the risk of ovarian metastasis. All available options should be offered and can be performed alone or in combination. A crucial point is to avoid a significant delay to cancer treatment.
Nordic incidence rates of GCTs show stability over time/among different occupational categories 1953-2012
Abstract
Incidence and occupational variation of ovarian granulosa cell tumours in Finland, Iceland, Norway and Sweden during 1953-2012: a longitudinal cohort study.
OBJECTIVE:To determine the incidence and occupational variation of granulosa cell tumours (GCTs) in Finland, Iceland, Norway and Sweden over a 60-year period, 1953-2012.
DESIGN:
A longitudinal cohort study.SETTING AND POPULATION:
Finland, Iceland, Norway and Sweden and a total of 249 million women over a 60-year period (1953-2012). The NOCCA (Nordic Occupational Cancer Study) included 6.4 million women with 776 incident GCT cases diagnosed until the end of follow up.METHODS:
Incidence rates were calculated from the national cancer registries and compared using quasi-Poisson regression models. Occupation-specific standardised incidence ratios (SIRs) were calculated from the Nordic Occupational Cancer (NOCCA) database.MAIN OUTCOME MEASURES:
Incidence rates and standardised incidence ratios.RESULTS:
The age-adjusted (World Standard) incidence rates remained quite constant: about 0.6-0.8 per 100 000 for most of the study period. The age-specific incidence was highest at 50-64 years of age. There were no occupations with significantly increased risk of GCT. Major changes in the use of oral contraceptives, postmenopausal hormonal therapy, fertility rate and lifestyle in general during the study period and among different occupational categories do not appear to have a marked effect on the incidence of GCT.CONCLUSION:
Our findings support the concept of GCT as a primarily sporadic, not exposure-related, cancer.TWEETABLE ABSTRACT:
The Nordic incidence rates of GCTs show stability over time and among different occupational categories.Salpingectomy (fallopian tube)
abstract
Abstract
Salpingectomy
is the surgical excision of the fallopian tube. Traditionally the tubes
were preserved when undertaking a hysterectomy for benign reasons when
the intention is to conserve the ovaries. Recent evidence from
morphological, embryological, molecular biology and histopathology
points towards the fallopian tube; and in particular the fimbrial end,
being the origin for high-grade serous ovarian cancer. It is advocated
that bilateral salpingo-oopherectomy should be the method of choice for
risk-reducing surgery in patients with high risk of ovarian cancer,
namely those with BRCA1, BRCA2 and mismatch-repair gene
mutations. Increasingly, removal of the fallopian tubes as part of
hysterectomy for benign disease, with preservation of the ovaries, or as
a method for sterilisation in selected groups, has been shown to reduce
the risk of future development of ovarian cancer with minimal adverse
effects on the patient, a process that should be encouraged.
The ISRCTN Registry – Leaving No Trial Behind
On Medicine
Reported discrepancies between the information provided when the trial is registered and the data reported in publications is becoming a hot topic - especially with regards to outcome switching in randomised controlled trials. Updating the clinical trial record could be that missing link that differentiates between selective reporting and transparency of research.....
18F-FDG PET/CT and PET/MRI Perform Equally Well in Cancer
open access
18F-FDG PET/CT and PET/MRI Perform Equally Well in Cancer: Evidence from Studies on More Than 2,300 Patients
Gynecologic Cancer
Uterine, ovarian, and cervical cancer is initially diagnosed by ultrasound or biopsy. CT, MRI, and PET/CT are suggested for additional work-up if there is suspected or gross cervical involvement and suspected extrauterine disease (51,52).Diagnostic accuracy was similar between PET/CT and PET/MRI for detection of primary and recurrent pelvic malignancies in 3 studies that included a total of 69 patients (Table 4) (53–55). In the first study, on 19 patients with recurrent gynecologic cancer, both modalities correctly identified all 58 malignant lesions (57 of which were 18F-FDG–positive), including local and distant sites of recurrence (53). The diagnostic accuracy of PET/MRI and PET/CT on a patient basis was thus identical. The soft endpoint, interpreter confidence, appeared to be higher for PET/MRI than for PET/CT in both malignant (P < 0.01) and benign lesions (P < 0.05) (53).In the second study, on 26 patients, both modalities accurately identified all primary and recurrent tumors and abdominal metastases (54). Lesion conspicuity was better for PET/MRI (dedicated pelvic sequences) than for enhanced PET/CT.In the third study, Grueneisen et al. restaged 24 patients with a variety of gynecologic cancers (55). According to the reference standard (histopathology and imaging follow-up), 21 of those 24 patients (88%) had tumor recurrence. Both PET/CT and PET/MRI correctly identified 20 of 21 patients (95%) with tumor relapse.In summary, in the 69 patients with gynecologic cancer, diagnostic accuracy was comparable between the two modalities (Table 4).
Editor's Choice: Lynch syndrome in the 21st century: clinical perspectives
open access (originally published 2015)
Summary
Lynch syndrome (LS) is the most common of all inherited cancer syndromes, associated with substantially elevated risks for colonic and extracolonic malignancies, earlier onset and high rates of multiple primary cancers. At the genetic level, it is caused by a defective mismatch repair (MMR) system due to presence of germline defects in at least one of the MMR genes- MLH1, MSH2, MSH6, PMS2 or EPCAM. An impaired MMR function during replication introduces infidelity in DNA sequence and leads to ubiquitous mutations at simple repetitive sequences (microsatellites), causing microsatellite instability (MSI).
Although previously, clinicopathological criteria such as Amsterdam I/II and Revised Bethesda Guidelines were commonly used to identify suspected LS mutation carriers, there has been a recent push towards universally testing, especially in case of colorectal cancers (CRCs), through immunohistochemistry for expression of MMR proteins or through molecular tests (polymerase chain reaction, PCR) for MSI, in order to identify LS mutation carriers and subject them to genetic testing to ascertain the specific gene implicated. In this review, we have discussed the latest diagnostic strategies and the current screening and treatment guidelines for colonic and extracolonic cancers in clinically affected and at-risk individuals for LS.
Urinary tract cancers
The lifetime risk of urinary tract cancers (transitional cell carcinoma
of bladder, renal pelvis and ureter) ranges from 0.2–25%
in LS patients and appears to be more prevalent with MSH2 mutations.
46 Urine cytology and urinalysis for microscopic hematuria
has not been shown to be sensitive or specific enough and
benefit of ultrasound screening is unclear. However, urinalysis
is inexpensive and usually a part of routine physical examination.
Therefore, consensus opinion is in favor of annual urinalysis
starting at age 30–35 years in individuals at risk for or
affected with LS.47
Gynecological (endometrial and ovarian) cancers
Endometrial cancer is the second most common cancer in LS
patients, with 20–60% lifetime risk depending upon specific
gene mutation. Fortunately, majority of symptomatic patients
with endometrial cancer have stage 1 disease with 5-year survival
rate in excess of 85%. Therefore, it is unlikely that screening
for endometrial cancer will offer any significant survival
benefit. However, consensus guidelines currently recommend
annual pelvic exam and endometrial sampling starting at age
30–35 years.40
The lifetime risk of ovarian cancer in women with LS ranges
from 0.3 to 20%. Although screening for ovarian cancer through
transvaginal ultrasound and CA-125 has not been shown to be
effective in any study (including patients with hereditary breast
cancer from mutation of BRCA1 or BRCA2), consensus opinion is
in favor of transvaginal ultrasound starting at age 30–35 years in
LS patients.36
Based upon cost-effectiveness analysis, current guidelines
recommend prophylactic hysterectomy and bilateral salpingooophorectomy at age 40 or after having finished childbearing.41
This option should be given to women in large part because of
the ineffectiveness of screening for gynecologic cancers, especially
ovarian cancer.42
Researchers With Opposing Views on Salt Intake Are Ignoring Each Other
Salt
Trinquart and colleagues reviewed 269 primary studies, analyses, clinical guidelines, consensus statements, comments and letters on salt intake and health published between 1979 and 2014. They sorted the papers based on whether or not they supported the link between reduced sodium intake and lower rates of heart disease, stroke, and death.
They found that 54% of papers supported the hypothesis, 33% refuted it, and 13% were inconclusive.
Those that supported the hypothesis tended to cite other papers that supported it, too, while those that refuted tended to cite others that refuted also, with little crossover between the camps.
Monday, February 29, 2016
Readmissions after Major Gynecologic Oncology surgery - Gynecologic Oncology
abstract
Highlights
Objectives
To examine the underlying indications, timing, and risk factors associated with unplanned hospital readmissions after major surgery for a gynecologic malignancy.Methods
This is a retrospective database cohort study utilizing the National Surgical Quality Improvement Program database (NSQIP). The association between risk factors with respect to 30-day unplanned readmission was modeled using logistic regression. Timing of readmission and the primary reason of readmission was abstracted from the database.Results
Overall, the unplanned readmission rate was 6.5% (832/12,804). On multivariate analysis, operative time ≥ 3 h (OR 1.39, p < 0.001), open abdominal surgery (OR 2.2, p < 0.001), any complication prior to discharge (OR 1.6, p < 0.001), two or more additional surgical procedures (OR 1.34, p = 0.003), or cervical cancer as the site of primary disease (OR 1.30, p = 0.05) were noted to be independent predictors of readmission. To provide a convenient calculation of overall probability of readmission, we developed a nomogram of factors significantly predicting readmission. Overall, infections were a cause of 45% of the readmissions. Surgical site infections were the most common reason, accounting for 29.2% of all readmissions. A majority of the readmissions (approximately 75%) were within two weeks of discharge from the hospital.Conclusions
Efforts to reduce readmission rates should focus on identifying patients at a high risk of readmission and reducing surgical site infections. Additionally, prospective evaluation of interventions targeted at reducing readmissions should focus on the first two weeks after discharge from the hospital.Biosimilars Webcasts
Biosimilars Webcast
Participants
in this video received financial support from Pfizer Inc. The opinions
or views expressed in this video are solely those of the participants
and do not necessarily reflect the opinions or recommendations of Pfizer
Inc.
Editorial support to prepare this video was provided by Phase Five Communications and funded by Pfizer Inc.
Editorial support to prepare this video was provided by Phase Five Communications and funded by Pfizer Inc.
Biosimilars
Extrapolating the Evidence. A Roundtable Discussion.
Patents for several biologics will soon expire, paving the way
for biosimilars—defined as highly similar versions of already licensed
or approved biological therapies. The aim of developing a biosimilar is
to establish similarity in terms of quality, safety, and efficacy rather
than to reestablish clinical benefit. This introduces a different way
of thinking about drug development for clinicians, who will ultimately
analyze and integrate biosimilars into existing treatment paradigms. As
such, oncologists across specialties need to understand the core
concepts of biosimilarity, including extrapolation—the approval of a
biosimilar for use in an indication held by the previously approved
biological therapy (deemed the reference product), but not directly
studied in a comparative clinical trial with the biosimilar.
Extrapolation is the highly scrutinized scientific rationale that
bridges data collected across indications and has important
implications in oncology, where biological anticancer therapies are
currently licensed for use across tumor types and in supportive care.
In this roundtable discussion, experts specializing in breast, lung, hematologic, and gynecologic cancers highlight the scientific rationale behind biosimilarity and extrapolation. They provide practical insight into the implications of biosimilars for clinical practices, including their potential to expand access to important medicines for patients and clinicians.
In this roundtable discussion, experts specializing in breast, lung, hematologic, and gynecologic cancers highlight the scientific rationale behind biosimilarity and extrapolation. They provide practical insight into the implications of biosimilars for clinical practices, including their potential to expand access to important medicines for patients and clinicians.
First-in-Class, First-in-Human Phase I Study of Selinexor, a Selective Inhibitor of Nuclear Export, in Patients With Advanced Solid Tumors
abstract
Purpose This trial
evaluated the safety, pharmacokinetics, pharmacodynamics, and efficacy
of selinexor (KPT-330), a novel, oral small-molecule
inhibitor of exportin 1 (XPO1/CRM1), and
determined the recommended phase II dose.
Patients and Methods In total, 189 patients with advanced solid tumors received selinexor (3 to 85 mg/m2)
in 21- or 28-day cycles. Pre- and post-treatment levels of XPO1 mRNA in
patient-derived leukocytes were determined by reverse
transcriptase quantitative polymerase chain
reaction, and tumor biopsies were examined by immunohistochemistry for
changes
in markers consistent with XPO1 inhibition.
Antitumor response was assessed according Response Evaluation Criteria
in Solid
Tumors (RECIST) version 1.1 guidelines.
Results The most
common treatment-related adverse events included fatigue (70%), nausea
(70%), anorexia (66%), and vomiting (49%),
which were generally grade 1 or 2. Most commonly
reported grade 3 or 4 toxicities were thrombocytopenia (16%), fatigue
(15%),
and hyponatremia (13%). Clinically significant
major organ or cumulative toxicities were rare. The maximum-tolerated
dose
was defined at 65 mg/m2 using a twice-a-week (days 1 and 3) dosing schedule. The recommended phase II dose of 35 mg/m2
given twice a week was chosen based on better patient tolerability and
no demonstrable improvement in radiologic response
or disease stabilization compared with higher
doses. Pharmacokinetics were dose proportional, with no evidence of drug
accumulation.
Dose-dependent elevations in XPO1 mRNA in
leukocytes were demonstrated up to a dose level of 28 mg/m2
before plateauing, and paired tumor biopsies showed nuclear accumulation
of key tumor-suppressor proteins, reduction of cell
proliferation, and induction of apoptosis. Among
157 patients evaluable for response, one complete and six partial
responses
were observed (n = 7, 4%), with 27 patients
(17%) achieving stable disease for ≥ 4 months.
Conclusion Selinexor is a novel and safe therapeutic with broad antitumor activity. Further interrogation into this class of therapy
is warranted.
(2015) Understanding RBC Indices (video 8:47 sec)
video
Description: Dr. Susan Leclair continues her living well series on understanding your lab reports, discussing red cell Indices, more commonly known as CBC. The CBC is an efficient and focused analysis of patients who have trouble with their red blood cells. One of the measurements that the red cell index quantifies is the mean cell volume (MCV) and Dr. Leclair explains why, what, and how the test helps your physician develop your specific plan of care.
A doctor shares the secrets of cancer survivors
blog
Disclaimer: I have never had cancer. Therefore, at the most basic level, I do not have the right to pontificate about dealing with the dread disease. Rather, I have been the servant and support of those that struggle with cancer. I thought it might be of some assistance to share my observations from the other side of the bed rail. Perhaps, their secrets of survival may help you.
Cancer is a team sport; do not do this alone.....
The association between socioeconomic status and tumour stage at diagnosis of ovarian cancer
(abstract) A pooled analysis of 18 case-control studies
Highlights
•
The association between socioeconomic status (level of education) and tumour stage at diagnosis of ovarian cancer was investigated.
•
Data were obtained from 18 case-control studies that provided individual level measures of level of education.
•
Lower level of education was associated with an increased risk of advanced tumour stage at diagnosis.
•
The results persisted when taking BMI and smoking status into account.
•
The results calls for further studies on how to reduce this diagnostic delay.
Abstract
Purpose
Socioeconomic status (SES) is a known predictor of survival for several cancers and it has been suggested that SES differences affecting tumour stage at diagnosis may be the most important explanatory factor for this. However, only a limited number of studies have investigated SES differences in tumour stage at diagnosis of ovarian cancer. In a pooled analysis, we investigated whether SES as represented by level of education is predictive for advanced tumour stage at diagnosis of ovarian cancer, overall and by histotype. The effect of cigarette smoking and body mass index (BMI) on the association was also evaluated.
Methods
From 18 case-control studies, we obtained information on 10,601 women diagnosed with epithelial ovarian cancer. Study specific odds ratios (ORs) with corresponding 95% confidence intervals (CI) were obtained from logistic regression models and combined into a pooled odds ratio (pOR) using a random effects model.
Results
Overall, women who completed ≤high school had an increased risk of advanced tumour stage at diagnosis compared with women who completed >high school (pOR 1.15; 95% CI 1.03–1.28). The risk estimates for the different histotypes of ovarian cancer resembled that observed for ovarian cancers combined but did not reach statistical significance. Our results were unchanged when we included BMI and cigarette smoking.
Conclusion
Lower level of education was associated with an increased risk of advanced tumour stage at diagnosis of ovarian cancer. The observed socioeconomic difference in stage at diagnosis of ovarian cancer calls for further studies on how to reduce this diagnostic delay.
Personal and professional use of menopausal hormone therapy among gynecologists (multinational - Latin America)
(abstract) A multinational study (REDLINC VII)
Highlights
- •
- MHT use and perceived related risks were assessed among gynecologists (personal and partner use).
- •
- Main perceived risks related to MHT according to gynecologists were thromboembolism and breast cancer.
- •
- Gynecologists are mostly supporters of MHT use for themselves or their spouses.
- Background
- Previously, the REDLINC VI study showed that the main reason for not using menopausal hormone therapy (MHT) was a lower prescription by doctors.
- Objective
- To determine the use of MHT and perceived related risks among gynecologists.
- Methods
- A self-administered and anonymous questionnaire was delivered to certified gynecologists of 11 Latin American countries that included personal data and that related to MHT use and related risks.
- Results
- A total of 2,154 gynecologists were contacted of which 85.3% responded to the survey (n = 1,837). Mean age was 48.1 ± 11.4 years, 55.5% were male, 20.3% were faculty members and 85% had a partner (men or women). An 85.4% of gynecologists responded that they would use MHT if they had menopausal symptoms (81.8% in case of female) or prescribe it to their spouses (88.2% in case of men; p < 0.001). Perceived risk related to MHT use (scale from 0 to 10) was higher among female as compared to male gynecologists (4.06 ± 2.09 vs. 3.83 ± 2.11, p < 0.02). The top two perceived reported risks were: thromboembolism (women 33.6% vs. men 41.4%, p < 0.009) and breast cancer (women 38.5% vs. men 33.9%, p < 0.03). Overall, gynecologists reported prescribing MHT to a 48.9% of their symptomatic patients (women 47.3% vs. men 50.2%, p<0.03) and 86.8% currently prescribed non hormonal and 83.8% alternatives therapies for the management of the menopause. Older and University member gynecologists prescribed more MHT.
- Conclusion
Although this Latin American survey showed that gynecologists are mostly supporters of MHT use (for themselves or their spouses), this behavior is not reflected in their clinical practice.
Subjective assessment versus ultrasound models to diagnose ovarian cancer
(abstract) A systematic review and meta-analysis
INTRODUCTION:
Many national guidelines concerning the management of ovarian cancer currently advocate the risk of malignancy index (RMI) to characterise ovarian pathology. However, other methods, such as subjective assessment, International Ovarian Tumour Analysis (IOTA) simple ultrasound-based rules (simple rules) and IOTA logistic regression model 2 (LR2) seem to be superior to the RMI. Our objective was to compare the diagnostic accuracy of subjective assessment, simple rules, LR2 and RMI for differentiating benign from malignant adnexal masses prior to surgery.
MATERIALS AND METHODS:
MEDLINE, EMBASE and CENTRAL were searched (January 1990-August 2015). Eligibility criteria were prospective diagnostic studies designed to preoperatively predict ovarian cancer in women with an adnexal mass.
RESULTS:
We analysed 47 articles, enrolling 19,674 adnexal tumours; 13,953 (70.9%) benign and 5721 (29.1%) malignant. Subjective assessment by experts performed best with a pooled sensitivity of 0.93 (95% confidence interval [CI] 0.92-0.95) and specificity of 0.89 (95% CI 0.86-0.92). Simple rules (classifying inconclusives as malignant) (sensitivity 0.93 [95% CI 0.91-0.95] and specificity 0.80 [95% CI 0.77-0.82]) and LR2 (sensitivity 0.93 [95% CI 0.89-0.95] and specificity 0.84 [95% CI 0.78-0.89]) outperformed RMI (sensitivity 0.75 [95% CI 0.72-0.79], specificity 0.92 [95% CI 0.88-0.94]). A two-step strategy using simple rules, when inconclusive added by subjective assessment, matched test performance of subjective assessment by expert examiners (sensitivity 0.91 [95% CI 0.89-0.93] and specificity 0.91 [95% CI 0.87-0.94]).
CONCLUSIONS:
A two-step strategy of simple rules with subjective assessment for inconclusive tumours yielded best results and matched test performance of expert ultrasound examiners. The LR2 model can be used as an alternative if an expert is not available
Saturday, February 27, 2016
Advances in Genomic Medicine 'Unstoppable' - February 26, 2016 report
LA JOLLA, California — Gene editing, liquid biopsies for cancer, and the latest moves by industry leaders driving the democratization of genomic information will be among the highlights of the Future of Genomic Medicine (FOGM) IX conference.
And each day of the 2-day event will start with a patient story. "The patient stories are compelling and they really set the stage for this program and what genomic medicine is all about," said course director Eric Topol, MD, from the Scripps Translational Research Institute in La Jolla, California, who is editor-in-chief of Medscape.
Another patient who will tell her story at the conference is Elisa Long, PhD, from the University of California, Los Angeles, who was diagnosed with breast cancer at the age of 33. She had no family history or other major risk factors, but turned out to carry the BRCA mutation.
The irony, Dr Topol explained, is that she is an assistant professor of decisions, operations, and technology management, and her research is focused on the way people make medical decisions when faced with uncertainty.
"Genomics, gradually, is getting into medicine in a big way, but there are still major hurdles to overcome. We'll get into those from the patient perspective," said Dr Topol.
Cancer MoonShot
An update on the newly formed Cancer MoonShot 2020 initiative will be presented by Patrick Soon-Shiong, MD, chief executive officer of NantHealth. Accelerating the collaboration among researchers working to activate the immune system in the fight against cancer is central to the mission of the initiative.
Cancer genomics will be looked at from many different perspectives, particularly the liquid biopsy, "which is the hottest topic of all in cancer," Dr Topol reported.
science news: Every-3-Week vs. Weekly Paclitaxel and Carboplatin for Ovarian Cancer
ScienceDaily (per prior science report - easier to read version)
Research led by a Dignity Health St. Joseph's Hospital and Medical Center physician on ovarian cancer was published in the Feb. 24, 2016 issue of New England Journal of Medicine. The research was directed by Bradley J. Monk, M.D. and researchers at 12 other medical facilities around the nation.
The featured research titled "Every-3-Week vs. Weekly Paclitaxel and Carboplatin for Ovarian Cancer" unveils that the standard front-line treatment for advanced ovarian cancer should either be every three week chemotherapy with carboplatin, paclitaxel plus bevacizumab (an antibody than inhibits blood vessels from feeding the cancer) or every three week chemotherapy with carboplatin and weekly dose intense paclitaxel. The latter does not involve expensive bevacizumab known as Avastin but is more inconvenient......
Procoagulant activity in gynaecological cancer patients; the effect of surgery and chemotherapy
abstract
Highlights
- •
- Thrombin generation is increased in ovarian and endometrial cancer.
- •
- •
- Thrombin generation is higher in patients who subsequently develop thrombosis post-surgery.
Abstract
Background
Gynaecological cancers are associated with high rates of venous thromboembolism (VTE). Studies on ambulatory cancer patients do not support thromboprophylaxis during chemotherapy. Approximately 6–7% of gynaecological cancer patients suffer a postoperative VTE despite Low Molecular Weight Heparin prophylaxis (LMWH). Large cancer studies have shown that Calibrated Automated Thrombogram (CAT) and Microparticles (MP) assays may be useful in predicting VTE but data on gynaecological cancer patients is scarce.
Objective
Our objective was to identify whether the CAT assay and MP functional assays have potential as biomarkers predictive of VTE in gynaecological cancer patients.
Patients and methods
Gynaecological cancer patients were investigated before surgery (n = 146) and at 5, 14 and 42 days post-surgery (n = 78). Fourteen additional patients were investigated before chemotherapy and after 3 and 6 cycles of therapy. Thrombin generation was measured before and after addition of thrombomodulin.
Results
Patients with clear cell cancer (CCC) of the ovary and patients with endometrial cancer had higher ETP and peak thrombin compared with patients with benign disease. Patients who developed VTE (n = 8) following surgery had enhanced thrombin generation prior to surgery which persisted during the post-operative period despite LMWH prophylaxis. Both neoadjuvant and adjuvant chemotherapy showed increased thrombin generation following addition of thrombomodulin. There were no differences in MP levels during the study.
Conclusions
CAT assay shows potential as a promising biomarker for the prediction of VTE in gynaecological cancer patients. The identification of high risk patients combined with individualised LMWH prophylaxis might reduce VTE in this high risk group.
Analgesic medication use and risk of epithelial ovarian cancer in African American women
Blogger's Note: abstract does not indicate risks/adverse events
Abstract
Background:
Existing literature examining analgesic medication use and epithelial ovarian cancer (EOC) risk has been inconsistent, with the majority of studies reporting an inverse association. Race-specific effects of this relationship have not been adequately addressed.
Methods:
Utilising data from the largest population-based case–control study of EOC in African Americans, the African American Cancer Epidemiology Study, the relationship between analgesic use (aspirin, non-aspirin nonsteroidal anti-inflammatory drugs (NSAIDs), and acetaminophen) and risk of EOC was estimated by multivariate logistic regression. The association of frequency, duration, and indication of analgesic use on EOC risk was also assessed.
Results:
Aspirin use, overall, was associated with a 44% lower EOC risk (OR=0.56; 95% CI=0.35–0.92) and a 26% lower EOC risk was observed for non-aspirin NSAID use (OR=0.74; 95%CI=0.52–1.05). The inverse association was strongest for women taking aspirin to prevent cardiovascular disease and women taking non-aspirin NSAIDs for arthritis. Significantly decreased EOC risks were observed for low-dose aspirin use, daily aspirin use, aspirin use for <5 years, and occasional non-aspirin NSAID use for a duration of 
5 years. No association was observed for acetaminophen use.
5 years. No association was observed for acetaminophen use.
Conclusions:
Collectively, these findings support previous evidence that any NSAID use is inversely associated with EOC risk.
Cediranib, a pan-VEGFR inhibitor, and olaparib, a PARP inhibitor, in combination therapy for high grade serous ovarian cancer - Expert Opinion on Investigational Drugs -
abstract
Introduction:
An estimated 22,000 women are diagnosed annually with ovarian cancer in the United States. Initially chemo-sensitive, recurrent disease ultimately becomes chemoresistant and may kill ~14,000 women annually. Molecularly targeted therapy with cediranib (AZD2171), a vascular endothelial growth factor receptor (VEGFR)-1, 2, and 3 signaling blocker, and olaparib (AZD2281), a poly(adenosine diphosphate [ADP]-ribose) polymerase (PARP) inhibitor, administered orally in combination has shown anti-tumor activity in the treatment of high grade serous ovarian cancer (HGSOC). This combination has the potential to change the treatment of HGSOC.
Areas covered:
Preclinical and clinical studies of single agent cediranib and olaparib or their combination are reviewed. Data are presented from peer-reviewed published manuscripts, completed and ongoing early phase clinical trials registered in ClinicalTrials.gov, National Cancer Institute-sponsored clinical trials, and related recent abstracts.
Expert opinion:
Advances in the treatment of HGSOC that improve progression-free and overall survival have proven elusive despite examination of molecularly targeted therapy. HGSOC patients with deleterious germline or somatic mutations in BRCA1 or BRCA2 (BRCAm) are most responsive to PARP inhibitors (PARPi). PARPi combined with angiogenesis inhibition improved anti-cancer response and duration in both BRCAm and BRCA wild type HGSOC patients, compared to olaparib single agent treatment, demonstrating therapeutic chemical and contextual synthetic lethality.
Friday, February 26, 2016
Family Grieves Tragic Loss of Third Child to Genetic Condition - Lynch Syndrome
News
A Pennsylvania family is mourning the loss of their daughter after she died of a genetic syndrome that also took the lives of her brother and sister.
Erin Mading of Pittsburgh told ABC News that her daughter Isabella, 10, died on Feb. 6 from a brain cancer that was caused by the genetic condition Lynch Syndrome 3, also known as Constitutional Mismatch Repair Deficiency, or CMMRD.
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