Sunday, November 30, 2008
Avoiding Drug Interactions
Avoiding Drug Interactions
There are three main types of drug interactions:
* Drugs with food and beverages
* Drugs with dietary supplements
* Drugs with other drugs
Saturday, November 29, 2008
Friday, November 28, 2008
Cancer researchers change focus to target the more stubborn killers - UK news item
Cancer researchers change focus to target the more stubborn killers - Health News, Health & Wellbeing - The Independent
"Mr Kumar said: 'Growing obesity cannot be the whole explanation [for the rise] because our rates are higher than in the US and obesity is a bigger problem there.'"
EvidenceUpdates - Risk of Venous Thromboembolism with the Angiogenesis Inhibitor Bevacizumab (Avastin) in Cancer Patients: A Meta-analysis
New Articles -- EvidenceUpdates
"CONCLUSION: The use of bevacizumab was significantly associated with an increased risk of developing venous thromboembolism in cancer patients receiving this drug."
Thursday, November 27, 2008
Ovarian cancer detection and treatment: current situation and future prospects - abstract
Ovarian cancer detection and treatment: current si...[Anticancer Res. 2008 Sep-Oct] - PubMed Result: "Ovarian cancer detection and treatment: current situation and future prospects.
Argento M, Hoffman P, Gauchez AS.
Pôle de Biologie, CHU Grenoble, BP217 38043 Grenoble cedex 9, France.
Between 70 and 75% of ovarian carcinomas are not discovered until they have reached an advanced stage III or later. Efforts should therefore be concentrated on earlier diagnosis. Ovarian cancer is not an entirely silent disease. Today, it is known that there are key symptoms which, depending on their frequency and intensity, can serve as warning signs to clinicians and patients. Mass screening for ovarian cancer is not currently possible because of a lack of specific markers for use in biological and imaging techniques, although new markers are now being developed. Screening every six or twelve months with the CA 125 blood test plus a transvaginal ultrasound is restricted to women at risk. Certain teams have proposed preventive bilateral adnexectomy for such women. The ovary is a complex organ subjected to a hormonal environment and affected by immune system dysfunctions. There now appears to be consensus on the influence of hormones in ovarian cancer, namely the beneficial role of pregnancy, breast feeding and in particular oral contraception, as well as the deleterious role of hormone replacement therapy(HRT).
However, the two main arguments put forward, incessant ovulation and exposure to gonadotropins, do not explain all the epidemiological data. It is through a better understanding of the etiology of ovarian cancer that new therapies can be developed. The theory of cancer immune surveillance, whereby lymphocytes have a sentinel role of recognizing and constantly suppressing malignant cells, provided a starting point for research into antitumoral immunotherapy. The first trials of vaccination by direct injection of tumor antigens or "loaded" dendritic cells today offer considerable hope for patients.
How Peer Review Failed at Redding Medical Center, Why It Is Failing Across the Country and What Can Be Done About It
While this is not specific to ovarian cancer, I expect it will be value for many:
redding-failure.pdf (application/pdf Object)
Wednesday, November 26, 2008
The withdrawal from oncogenetic counselling and testing for hereditary and familial breast and ovarian cancers
The withdrawal from oncogenetic counselling and te...[J Exp Clin Cancer Res. 2008] - PubMed Result
"CONCLUSIONS: The study revealed the importance to pay attention to the whole persona and their family system as well as provide information highlighting usefulness of early diagnosis."
Aggressive and complex surgery for advanced ovarian cancer: an economic analysis
Aggressive and complex surgery for advanced ovaria...[Gynecol Oncol. 2008] - PubMed Result
"CONCLUSIONS: Complex surgery for ovarian cancer cytoreduction carries a survival benefit at increased direct medical cost. However, preliminary cost-effectiveness results suggest complex surgery provides good value for money spent. Future research on the cost and quality of life implications of surgical morbidity during follow-up is warranted to formally assess the cost-effectiveness of complex vs. simple surgical procedures."
Cause-Specific Survival for Women Diagnosed With Cancer During Pregnancy or Lactation: A Registry-Based Cohort Study
Cause-Specific Survival for Women Diagnosed With C...[J Clin Oncol. 2008] - PubMed Result
"CONCLUSION: In general, the diagnosis of most cancer types during pregnancy or lactation does not increase the risk of cause-specific death. Breast and ovarian cancer diagnosed during lactation represents an exception."
Tuesday, November 25, 2008
Monday, November 24, 2008
news item regarding Commonwealth Fund publication Nov 2008
excerpts:
Only one-quarter (26%) of U.S. and Canadian patients reported same-day access to doctors when they were sick—and one-fourth or more reported long waits. In contrast, about half or more of Dutch (60%), New Zealand (54%), and U.K. (48%) patients were able to get a same-day appointment.
In the past two years, 59 percent of U.S. patients visited an emergency room; only Canada had higher rates (64%). In both countries, one in five said they went to the ER for a condition that could have been cared for by a regular doctor if one had been available.
Interval debulking surgery for advanced epithelial...[Gynecol Oncol. 2008] - PubMed Result
Interval debulking surgery for advanced epithelial...[Gynecol Oncol. 2008] - PubMed Result
"CONCLUSIONS: Our review could not conclude whether IDS would improve the survival of women with advanced EOC compared with conventional treatment. IDS appeared to yield benefit only in the patients whose primary surgery was not performed by expert surgeons."
Oophorectomy as a risk factor for coronary heart disease
Conclusion
The existing evidence is inconclusive to determine the effect of BSO on risk of CHD.
Sunday, November 23, 2008
The Role of Antioxidants and Vitamin A in Ovarian Cancer: Results From the Women's Health Initiative - Nutrition and Cancer
The Role of Antioxidants and Vitamin A in Ovarian Cancer: Results From the Women's Health Initiative - Nutrition and Cancer
"The results from this prospective study of well-nourished, postmenopausal women suggest that intake of dietary antioxidants, carotenoids, and vitamin A are not associated with a reduction in ovarian cancer risk."
Uptake of clinical genetic testing for ovarian cancer in Ontario: a population based study
Uptake of clinical genetic testing for ovarian can...[Gynecol Oncol. 2008] - PubMed Result:
"CONCLUSIONS: Genetic testing is available in Ontario to all women with invasive ovarian cancer. However, only a small proportion of women are being referred for testing. This study suggests that increased public awareness directed at physicians and at women with cancer may expand the use of genetic testing."
ICES - search results "ovarian"
| 1 | Health care delivery in Canada and the United States: are there relevant differences in health care outcomes? | 5% | Investigative Reports | September, 2003 |
| At a Glance | ||||
| 2 | At A Glance - October 2008 | 39% | At a Glance | October, 2008 |
| Journal Publications | ||||
| 3 | Outcomes in surgery for ovarian cancer | 12% | Journal Publications | September, 2003 |
| 4 | Surgical outcomes in women with ovarian cancer | 10% | Journal Publications | October, 2008 |
| Other | ||||
| 5 | Chapter 7: Surgery for Ovarian Cancer | 100% | Other | November, 2008 |
| 6 | Egg race | 16% | Other | April, 2006 |
| 7 | More than skin deep | 12% | Other | December, 2003 |
| 8 | Overview | 3% | Other | November, 2008 |
| 9 | Technical Appendix (abbreviated version) | 2% | Other | November, 2008 |
| 10 | Chapter 1: Introduction | 2% | Other | November, 2008 |
| 11 | Chapter 10: Reflections and Recommendations | 2% | Other | November, 2008 |
| 12 | HC 2008 - Urbach - Cancer surgery services | 2% | Other | February, 2008 |
Cancer Surgery in Ontario, Chapter 7, Surgery for Ovarian Cancer 2008 December report
Cancer Surgery in Ontario, Chapter 7, Surgery for Ovarian Cancer.pdf (application/pdf Object)
Implications:
More research is needed to better
understand why the use of cancer
staging procedures—such as
omentectomy and lymph node
excision—varied among women in
the study cohort who underwent
surgery for ovarian cancer.
Plans for expanding surgical services
related to the treatment of ovarian
cancer in Ontario should factor in the
existing referral patterns among Local
Health Integration Networks (LHINs).
There are relatively few gynecologic
oncologists in Ontario; these subspecialists
provide care to a large
number of women with ovarian cancer.
Further evaluation is required—both
in terms of the role of gynecologic
oncologists in treating women with
ovarian cancer, and also whether the
supply of these specialists will be
sufficient to meet future demand.
Findings
• While the incidence of ovarian cancer among Ontario women increased with age in 2003/04, the probability of surgical treatment decreased. About three-quarters (73 percent) of women in the Overall Ovarian Cancer Cohort underwent a surgical procedure related to the diagnosis and treatment of their disease.
• There was no clear relationship between women’s socioeconomic status and whether they had surgery for ovarian cancer. However, those living in regions with the lowest neighbourhood income were less likely than all others to have ovarian cancer-related surgery. (duh?)
• Rates of ovarian cancer-related surgery ranged across Local Health Integration Networks (LHINs) of patient residence—from a low of 58 percent among women living in the North West LHIN to a high of 88 percent among those residing in the Erie St. Clair LHIN.
Lymph node excision was done in just eight percent of women with ovarian cancer
During the study period, gynecologic oncologists comprised about seven percent of all physicians performing ovarian cancer
surgery in Ontario. Yet these sub-specialists performed nearly half (49) percent of all the surgeries among women in the
Ovarian Cancer Surgery Cohort.
Obstetrician/gynecologists performed 40 percent of surgeries on women in this study cohort; the remaining 12 percent of
procedures were done by physicians with other specialties.
Gynecologic oncologists were more likely than obstetrician/gynecologists to perform omentectomy (70 percent vs. 44 percent respectively) and lymph node excision (13 percent vs. six percent
Canadian Medicine: New study adds weight to call for boys to get HPV vaccine too
Canadian Medicine: New study adds weight to call for boys to get HPV vaccine too
"The study’s failure to demonstrate the vaccine’s effect on cancer is a function of the same problem that some critics of the HPV vaccine identified in the trials on girls: the trials’ follow-up periods aren’t long enough to determine whether there will actually be a drop in cancers, and, if so, how long the vaccine’s protection will last."
Note: nor long-term side effects
Commentary: Hormone Receptor Testing in Breast Cancer: A Distress Signal from Canada
Commentary: Hormone Receptor Testing in Breast Cancer: A Distress Signal from Canada -- Allred 13 (11): 1134 -- The Oncologist
Note: this response addresses the clinical aspects but not the political landscape and lack of transparency.
original article:
Breast Cancer Testing Scandal Shines Spotlight on Black Box of Clinical Laboratory Testing
http://jnci.oxfordjournals.org/cgi/content/full/100/12/836?ijkey=bfa78dfa42fd694d7cd597c944b59f7b421076d4&keytype2=tf_ipsecshaFriday, November 21, 2008
Macleans.ca - The angry breast cancer survivors
Macleans.ca - The angry breast cancer survivors
Women with post-treatment maladies find no one really wants to hear ‘downbeat’ stories
Thursday, November 20, 2008
AFP: European patent office restores breast cancer gene patent
AFP: European patent office restores breast cancer gene patent
"Only a handful of countries -- including Brazil and Chile -- do not allow patents on genes in any form."
Wednesday, November 19, 2008
The impact of positron emission tomography (PET) on expected management during cancer treatment: findings of the National Oncologic PET Registry.
http://www.ncbi.nlm.nih.gov/pubmed/19016303?dopt=AbstractPlus"
Tuesday, November 18, 2008
[Bowel Perforation Associated with Bevacizumab Therapy in Recurrent Ovarian Cancers without Bowel Obstruction or Bowel Involvement
http://www.ncbi.nlm.nih.gov/pubmed/19011357?dopt=AbstractPlus
Rare Appendix Tumor - Pseudomyxoma Peritonei (PMP)
http://www.cancerwise.org/april_2007/display.cfm?id=119563e8-6f93-48bd-9c3f22598df717dc&method=displayfull&color=green
"How is PMP diagnosed?
The disease is challenging to diagnose. A lot can be hidden inside the abdomen, and it develops slowly over time. Many patients are originally misdiagnosed with ovarian cancer (women) or metatastatic colon cancer."
Monday, November 17, 2008
Family history can trump breast cancer gene test - Yahoo! News
http://news.yahoo.com/s/ap/20081117/ap_on_he_me/med_breast_cancer_3
Family history can trump breast cancer gene test
By LAURAN NEERGAARD, AP Medical Writer Lauran Neergaard, Ap Medical Writer Mon Nov 17, 3:28 pm ET
WASHINGTON – If breast cancer runs in the family, women can be at high risk even if they test free of the disease's most common gene mutations, sobering new research shows. The genes BRCA1 and BRCA2 are linked with particularly aggressive hereditary breast cancer, and an increased risk of ovarian cancer, too.
When a breast cancer patient is found to carry one of those gene mutations, her relatives tend to breathe a sigh of relief if they test gene-free.
But those headline-grabbing genes account for only about 15 percent of all breast cancer cases. Even in families riddled with breast cancer, a BRCA gene is the culprit only in roughly one family of every five that gets tested, said University of Toronto cancer specialist Dr. Steven Narod.
So clearly members of those families remain at risk from other yet-to-be-found genes, but how much risk?
Narod tracked nearly 1,500 women from 365 breast cancer-prone families, who tested negative for BRCA1 and BRCA2 mutations.
After five years, those women had a fourfold higher risk than average women of developing breast cancer, Narod reported Monday at a meeting of the American Association for Cancer Research.
This is crucial information for women considering gene testing, said Georgetown University genetics counselor Beth Peshkin, who wasn't part of the study.
"This is contrary to what I think the common perception is," Peshkin said. "Unless a mutation is identified in the family, a negative test result doesn't provide reassurance."
The good news: Narod's study showed these women didn't have an increased risk of ovarian cancer, like BRCA1- and BRCA2-carriers do.
While the $3,000 BRCA tests are well-accepted, newer tests for other genes linked to breast cancer are coming on the market.
But "the family history is a much stronger predictor," stressed Narod. He recommends that such women take the anti-cancer drug tamoxifen and undergo MRI cancer checkups instead of easier mammograms "regardless of what other gene tests showed."
Oncology: percentage of visits for patients, regardless of age, with a diagnosis of cancer currently receiving chemotherapy or radiation therapy ....
http://www.qualitymeasures.ahrq.gov/summary/summary.aspx?ss=1&doc_id=12046
Oncology: percentage of visits for patients, regardless of age, with a diagnosis of cancer currently receiving chemotherapy or radiation therapy who report having pain with a documented plan of care to address pain.
Cancer in Canada in 2008 -- Marrett et al. 179 (11): 1163 -- Canadian Medical Association Journal
http://www.cmaj.ca/cgi/content/full/179/11/1163?etoc#T122
Pandora's box: ethics of PGD for inherited risk of late-onset disorders
http://www.ncbi.nlm.nih.gov/pubmed/18983739?ordinalpos=8&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum
Metabolic syndrome after risk-reducing salpingo-oophorectomy in women at high risk of hereditary breast ovarian cancer
A controlled observational study:
http://www.ncbi.nlm.nih.gov/pubmed/19008092?ordinalpos=2&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum
A serum based analysis of ovarian epithelial tumorigenesis
http://www.ncbi.nlm.nih.gov/pubmed/19007974?dopt=Abstract
Helping Doctors and Patients Make Sense of Health Statistics
http://www.psychologicalscience.org/journals/pspi/pspi_8_2_article.pdf">pspi_8_2_article.pdf
SUMMARY
We show that information pamphlets,
Web sites, leaflets distributed to doctors by the pharmaceutical
industry, and even medical journals often report
evidence in nontransparent forms that suggest big benefits
of featured interventions and small harms. Without understanding
the numbers involved, the public is susceptible
to political and commercial manipulation of their anxieties
and hopes, which undermines the goals of informed consent
and shared decision making.
Methods of consumer involvement in developing healthcare policy and research, clinical practice guidelines and patient information material -Cochrane
http://mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD004563/frame.html
"Two studies, which compared using consumer interviewers with staff interviewers as data collectors for patient satisfaction surveys, found small differences in satisfaction survey results, with less favourable results obtained when consumers were the interviewers."
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