Monday, January 19, 2009
Meta-analysis of Risk Reduction Estimates Associated With Risk-Reducing Salpingo-oophorectomy in BRCA1 or BRCA2 Mutation Carriers -- Rebbeck et al., 10.1093/jnci/djn442 -- JNCI Journal of the National
Meta-analysis of Risk Reduction Estimates Associated With Risk-Reducing Salpingo-oophorectomy in BRCA1 or BRCA2 Mutation Carriers -- Rebbeck et al., 10.1093/jnci/djn442 -- JNCI Journal of the National
In conclusion, the summary risk reduction estimates presented here confirm that BRCA1/2 mutation carriers who have been treated with RRSO have a substantially reduced risk of both breast and ovarian cancer. However, residual cancer risk remains after surgery. Therefore, additional cancer risk reduction and screening strategies are required to maximally reduce cancer incidence and mortality in this high-risk population.
The HPV Vaccine Controversy
The HPV Vaccine Controversy
"Gardasil was fast-tracked and received FDA approval before its final safety evaluation trials were complete, and its final safety evaluation trials won’g be concluded until September 2009. Despite this, the drug is being aggressively mass-marketed on TV and at the movies in adverts pitched to young girls, including preteens, and state legislators were heavily lobbied to make the drug mandatory for school girls ages 11 and up. Parents are understandably reluctant to give the shots to daughters who are not yet sexually active, and the long-term impacts of which are entirely unknown."
Sunday, January 18, 2009
Awards of excellence 2008 CANO: Pamela J. West
Awards of excellence
CANO/NOCA Award for Excellence in Gynecology-Oncology Nursing
Previous recipients of this award include:
2008 Pamela West
2007 Lynne Jolicoeur
2006 Joanne Brodeur
Australia What changes are needed to the current direction and interpretation of clinical cancer research to meet the needs of the 21st century?
Abstract
In this 21st century, we will need to better analyse the outcomes of our spending on newer and more expensive anticancer drugs, particularly through postmarketing assessment, to ensure that these investments are justified.
Evidence-based medicine is only as good as the evidence available, and we advocate for more independently designed and funded trials that concentrate on the minimum effective dose and duration of therapies to reduce toxicity to patients and to control costs. There is a place for governments to provide funding for these studies in the public good.
Although improving survival over standard care is the gold standard for proving the efficacy of a new therapy, surrogate endpoints such as early biological marker changes, functional imaging changes or earlier measures such as progression-free survival must be investigated to enable drug therapies to be discontinued earlier if they are ineffective.
Studies searching for the presence of biological targets must be funded to exploit the potential advantage of targeted therapies.
Treatment guidelines are best written by experts who are independent of the pharmaceutical industry.
Existing databases should be linked to better monitor the outcomes of new therapies. Privacy safeguards are important, but privacy legislation may need to be modified to serve the greater public good from the information gained from linking databases.
Friday, January 16, 2009
Medical News: Final Medicare Rule Shuts Off Payment for Erroneous Surgeries
Medical News: Final Medicare Rule Shuts Off Payment for Erroneous Surgeries - in Geriatrics, Medicare from MedPage Today
"The surgical mistakes join 12 categories of errors and preventable complications already on the CMS blacklist, which went into effect on Oct. 1:
* Objects left in after surgery
* Air embolisms
* Blood incompatibility
* Pressure ulcers
* Falls in the hospital
* Catheter-associated urinary tract infections
* Catheter-associated vascular infections
* Mediastinitis after CABG
* Inadequate glycemic control
* Surgical site infections
* Deep vein thrombosis and pulmonary embolism
* Drug-induced delirium
For those 12 errors, however, CMS is denying claims only for hospital inpatient reimbursements."
Thursday, January 15, 2009
Wednesday, January 14, 2009
Clinical Patterns and Biological Correlates of Cognitive Dysfunction Associated with Cancer Therapy
Clinical Patterns and Biological Correlates of Cognitive Dysfunction Associated with Cancer Therapy -- Dietrich et al. 13 (12): 1285 -- The Oncologist
ABSTRACT
Standard oncological therapies, such as chemotherapy and cranial radiotherapy, frequently result in a spectrum of neurocognitive deficits that includes impaired learning, memory, attention, and speed of information processing. In addition to classical mechanisms of neurotoxicity associated with chemo- and radiotherapy, such as radiation necrosis and leukoencephalopathy, damage to dynamic progenitor cell populations in the brain is emerging as an important etiologic factor. Radiation- and chemotherapy-induced damage to progenitor populations responsible for maintenance of white matter integrity and adult hippocampal neurogenesis is now believed to play a major role in the neurocognitive impairment many cancer survivors experience.
Tuesday, January 13, 2009
18F-FDG PET and PET/CT in the Evaluation of Cancer Treatment Response - The Journal of Nuclear Medicine
18F-FDG PET and PET/CT in the Evaluation of Cancer Treatment Response -- Ben-Haim and Ell 50 (1): 88 -- The Journal of Nuclear Medicine
Note: Ovarian Cancer is discussed under the Miscellaneous section.
WHI Participant website
WHI Participant website
January 2009 New results from the Women’s Health Initiative Memory Study of Magnetic Resonance Imaging (WHIMS-MRI)
Monday, January 12, 2009
The effect of obesity on survival in patients with ovarian cancer (repost from 2008)
Conclusion
Although obesity has been reported as an independent prognostic factor for survival, this data demonstrates that survival rates are similar between obese and non-obese patients when optimal debulking statuses are the same. Therefore, maximal effort should be directed towards optimal debulking obese patients with EOC.
news item: Colonoscopy Fails to Identify Many Colorectal Cancers
Daily Cancer News - CancerConsultants.com
While researchers have long estimated that colonoscopy reduces colorectal cancer deaths by 90%, the results of this analysis indicate that the reduction might be closer to 60%. More research is needed to understand the implications of this analysis. In the meantime the researchers caution that the results of this study should not change the colonoscopy screening recommendations. A 60% reduction in mortality is still an important benefit; in comparison, mammography reduces breast cancer mortality by only 25%.
Globe and Mail: 2 articles: Obesity and Ovarian Cancer and McHealth stories leave us all hungry
globesports.com: McHealth stories leave us all hungry
Media articles of interest:In fact, the paper Body Mass Index and Risk of Ovarian Cancer (2009 American Cancer Society/Cancer Journal) as published:
Obesity / Ovarian cancer article: http://tinyurl.com/9ak8st
McHealth stories: http://tinyurl.com/7xmwsf
My online response as below: http://tinyurl.com/9554b6
(S Pniauskas, from Canada) wrote:
A prime example of the ethical, moral and professional duty of apparent
medical reporting is Andre's recent article: "Obesity raises risk of ovarian cancer".
"Conclusions: Based on the results of the current study, the authors SUSPECT that obesity....As observed in numerous previous investigations summarized in a recent meta-analysis of the available literature, BMI at baseline was associated with a modest but statistically NONSIGNIFICANT INCREASE IN RISK for ovarian cancer in our cohort as a whole... "
The whole article in the Globe regarding Obesity and Risk of Ovarian Cancer is significantly pathetic including the fact that the last sentence regarding risk of recurrence/higher rate of death is not accurate. What is accurate is the fact that if chemotherapy treatments are given according to BMI then the risk is Nil.
Ovarian Cancer and most cancers cannot simply be explained away by simple one page articles and to try to do so places additional burdens on our populations which are in fact fighting for and often losing the challenge of trying to live with life threatening cancers. Research communities publish their work as a 'work in progress' and not as the final solution to extremely complicated issues. Many factors influence the onset and risk of ovarian and other cancers and we simply are not there yet in understanding the full implications of any particular one or two potential issues.
It is an old lesson yet learned that medical reporting has a duty to understand the full context of the issues, as well as a duty to do no harm, which is not exclusively held to medical professionals but to also to medical reporting.
There are educational courses available to medical journalists and consumers, one being through the Cochrane Collaboration.
Diagnostic experience among 4,334 women reporting surgically diagnosed endometriosis
"...Sometime before diagnosis, 63% were told nothing was wrong with them."
(Editorial note: since there is a known connection between endometrioid and clear cell ovarian cancer cell types to endometriosis, it would be interesting to note followup on those subsequently diagnosed not only with endometriosis but also with ovarian cancer)
The government’s role in health care | Health Innovation Forum
The government’s role in health care | Health Innovation Forum
"More importantly, after nearly 30 years of overt attempts to manage provincial systems, they are still not stable or sustainable. This worrisome outcome results from the convergence of three probably uncontrollable and partially self-imposed factors I like to call the “Bermuda Triangle” of health care."
Sunday, January 11, 2009
Toronto Star: Disclose Charity Pay
Disclose charity pay
January 11, 2009
In these tough times, Canadian charities are working harder than ever to raise money for their good works.
But for charities, as for any business, it costs money to raise money.
To help maintain public confidence in charity work, the Canada Revenue Agency regulates fundraising by requiring the disclosure of what percentage of donations is spent on administration costs. Under proposed CRA guidelines released last year, charities should keep fundraising costs below 35 cents on the dollar. The goal is to reassure donors that most of their money is going to help deserving causes, rather than paying expenses and salaries.
Yet Ottawa is still lagging behind the U.S. in its regulation of the vital fundraising sector.
As the Star's Kevin Donovan reminded us in his recent story about a change of the guard at one of Toronto's biggest charities, most fundraisers won't say how much money they are paying their own top people. He reported that the departing president of SickKids Foundation, Michael O'Mahoney, earned a remarkable $624,103 in salary and benefits last year, more than the president of the Hospital for Sick Children for which he was raising money.
The Star discovered O'Mahoney's salary only because of disclosure documents filed with the Internal Revenue Service in the U.S., where SickKids Foundation arm does business, not the CRA.
Canada had long lagged behind the U.S. in disclosure of corporate salaries but, belatedly, shone a light on something shareholders have every right to know. Fundraising has become a big business, and the donors who have a stake in Canada's 83,000 charities deserve no less transparency than shareholders in big corporations.
Critical Care Canada Forum
Critical Care Canada Forum
Presentations
* 'Substitute Decision Making: Conflicts and Controversies in Practice' by Mark Handelman (Flash Movie)
* 'Unilateral Withdrawal: An 11th Commandment?' by Anand Kumar (Flash Movie)
* 'When is Enough Enough? An Ethical Perspective' by Robert Sibbald (Flash Movie)
* 'Legal Framework & Cases Affecting Critical Care in Ontario' by Joan Gilmour (Flash Movie)
Saturday, January 10, 2009
Journal of Ovarian Research | Full text | Can Subjective Global Assessment of Nutritional Status Predict Survival in Ovarian Cancer?
Journal of Ovarian Research | Full text | Can Subjective Global Assessment of Nutritional Status Predict Survival in Ovarian Cancer?
"Background
Malnutrition is a significant problem in patients with ovarian cancer. The goal of this study was to investigate the prognostic role of Subjective Global Assessment (SGA) in patients with ovarian cancer treated in an integrative cancer treatment setting."
Thursday, January 08, 2009
CSDH Conference 2008 video: Health as a Human Right (a Human Rights Report)
CSDH Conference
global inequality and discrimination and poverty - Universal Declaration of Human Rights
Readers as research detectives abstract + free full text
Abstract | Readers as research detectives
"Commentary - Readers as research detectives
Peter C Gøtzsche
Trials 2009, 10:2doi:10.1186/1745-6215-10-2
Published: 7 January 2009
Abstract (provisional)
Flaws in research papers are common but it may require arduous detective work to unravel them. Checklists are helpful, but many inconsistencies will only be revealed through repeated cross-checks of every little detail, just like in a crime case. As a major deterrent for dishonesty, raw data from all trials should be posted on a public website. This would also make it much easier to detect errors and flaws in publications, and it would allow many research projects to be performed without collecting new data. The prevailing culture of secrecy and ownership to data is not in the best interests of the patients."
Wednesday, January 07, 2009
Dietary patterns and ovarian cancer risk -- Kolahdooz et al. 89 (1): 297 -- American Journal of Clinical Nutrition
Dietary patterns and ovarian cancer risk -- Kolahdooz et al. 89 (1): 297 -- American Journal of Clinical Nutrition
"Conclusions: A diet characterized by high meat and fat intake may increase the risk of epithelial ovarian cancer. A diet high in fruit and vegetables was not associated with reduced risk."
Tuesday, January 06, 2009
Monday, January 05, 2009
Cytoreductive surgery for recurrent ovarian cancer: A meta-analysis
Conclusions
Among patients undergoing operative intervention for recurrent ovarian cancer, the proportion of patients undergoing complete cytoreductive surgery is independently associated with overall post-recurrence survival time. For this select group of patients, the surgical objective should be resection of all macroscopic disease.
Central East LHIN (Ontario)- Integration-Process slide/pdf file
Integration-Process_for_website.pdf (application/pdf Object)
There is no requirement of the LHIN or HSP provider to conduct a community engagement process
Sunday, January 04, 2009
Tragic results of suboptimal gynecologic cancer operations
Tragic results of suboptimal gynecologic cancer op...[Eur J Gynaecol Oncol. 2008] - PubMed Result
"CONCLUSION: If a gynecologist does not have enough experience or expertise about gynecological cancer operations, he or she must consider the possible harm that any surgical intervention might do, as the latin phrase 'primum non nocere' means and should refer patients to a gynecological oncology center without performing any surgery."
Prospective study of physical activity and the risk of ovarian cancer
Prospective study of physical activity and the ris...[Cancer Causes Control. 2008] - PubMed Result
"CONCLUSIONS: Neither moderate nor vigorous physical activity showed a statistically significant association with ovarian cancer in this large cohort of women."
Consideration of hereditary nonpolyposis colorectal cancer (HNPCC/Lynch Syndrome) in BRCA mutation negative familial ovarian cancers
Consideration of hereditary nonpolyposis colorecta...[Cancer. 2008] - PubMed Result
"CONCLUSIONS:: HNPCC should be considered when evaluating patients with suspected hereditary ovarian cancer who have had negative BRCA mutation testing"
Clinical trials in Canada: whose interests are paramount?
Clinical trials in Canada: whose interests are par...[Int J Health Serv. 2008] - PubMed Result
Clinical trials in Canada: whose interests are paramount?
More than 80 percent of clinical drug trials in Canada are funded by the pharmaceutical industry. This article evaluates the overall state of clinical trials in Canada and looks at the interplay between public and private interests. Health Canada has adopted standards developed by the International Conference on Harmonization, a body that is heavily influenced by industry. Commercial interests are increasingly involved in recruiting patients into clinical trials and in running these trials. It is in industry's interests to conduct drug tests on people for which it is easiest to see benefits. These interests are not fundamentally challenged by Health Canada's policy of issuing nonmandatory guidelines on who should and should not be included in clinical trials. The outcome of clinical trials is heavily influenced by commercial sponsorship, with the result that trials may favor corporate interests rather than the interests of the public. How Health Canada deals with that possibility is not known, because of its strict policy of treating clinical trial data as private property. If clinical trials are to serve the purpose for which they are designed, developing reliable and objective information about new drugs, then commercial interests cannot be allowed to take precedence over health interests.
Medical students' experiences with addicted patients: a web-based survey
Medical students' experiences with addicted patien...[Subst Abus. 2008] - PubMed Result
"Students reacted strongly to the psychosocial impact of addictions on patients, yet they viewed addiction as a personal choice, not an illness. Conclusion: Medical students are not being trained to diagnose addiction or provide advice and counseling. Medical schools need to provide students with positive clinical experiences supervised by physicians experienced in addictions."
Saturday, January 03, 2009
Can the preoperative Ca-125 level predict optimal cytoreduction in patients with advanced ovarian carcinoma? A single institution cohort study
Can the preoperative Ca-125 level predict optimal ...[Gynecol Oncol. 2009] - PubMed Result: "Can the preoperative Ca-125 level predict optimal cytoreduction in patients with advanced ovarian carcinoma? A single institution cohort study"
A contemporary analysis of ability of pre-op serum CA-125 to predict primary cytoreductive outcome in patients advanced ovarian, tubal & peritoneal
A contemporary analysis of the ability of preopera...[Gynecol Oncol. 2009] - PubMed Result
"A contemporary analysis of the ability of preoperative serum CA-125 to predict primary cytoreductive outcome in patients with advanced ovarian, tubal and peritoneal carcinoma"
Wednesday, December 31, 2008
Tuesday, December 30, 2008
Monday, December 29, 2008
Message from Gilles Frydman, ACOR founder
| From Gilles Frydman, ACOR founder | |
Dear list member,
Today I am going to ask you to support ACOR with a donation. If this sounds unusual, read on! Why does one of the world's largest cooperative of patient-run medical online communities ask for financial support from its users?
ACOR, which I founded in 1996, is built differently from almost every other cancer advocacy organization. We exist only online. We have a number of volunteer staff, just over 100. ACOR content is free to use by anyone. Our annual expenses are currently less than $350,000 dollars. We do a lot with very little money! But we should be doing more!
At its core, ACOR is driven by a global community of cancer patients and caregivers (more than 50,000 of you) - all dedicated to sharing knowledge freely. Over almost thirteen years, listmembers have contributed countless email messages, many of them of great value to other community members. More than 75,000 people come to our website/ listservs every day to access information, free of charge, free of bias and free of advertising.
But ACOR is more than a website. We share a common cause: Imagine a world in which every single cancer patient is given free and immediate access to valid, current and accurate knowledge to help them understand their disease, assess all available treatments and understand the long-term impact of a cancer diagnosis. That's our commitment. Day after day, we push a little more to make sure no one becomes another victim of the opaque medical world.
Your donation helps us in several ways. Most importantly, you will help us cover the increasing cost of managing global traffic to one of the most popular cancer websites on the Internet. Funds also will help us improve the software that runs the ACOR communities -- making it easier to search the archives, easier to read and to classify messages from others, and easier to organize the information you need to become a truly engaged and empowered patient/caregiver. We want to build new services that will help all of you meet others socially in more engaging ways than is possible with plain listservs. We want to give you new tools to tell your story and share with others pictures and videos. We would like to build the largest gallery of art from cancer patients, including visual art, moving images, poetry, etc. Finally we are committed to growing the free knowledge access world-wide, by recruiting new volunteers, developing communities in many languages and geared to minorities, and building strategic partnerships with foreign medical institutions.
ACOR is different. It's probably the largest cancer support system in history, run by volunteers and with content entirely generated by patients and caregivers. Like any real public health service, we don't believe advertising should have any place in an ACOR community or anywhere on our website(s). We want to keep all of these free and strong, but in order to make it happen we need the support of thousands of people like you.
I invite you to join us, at any level you feel comfortable: Your donation will help keep ACOR free for all those who need and will need access to support and information.
Come visit http://www.acor.org/donate/now/
Thank you,
Gilles Frydman
Founder, ACOR.org
ICES 2008: Cancer surgery in Ontario
Cancer surgery in Ontario
Overview [2.62 MB PDF]
Chapter 1: Introduction [2.38 MB PDF]
Chapter 2: Surgery for Breast Cancer [3.79 MB PDF]
Chapter 3: Surgery for Prostate Cancer [3.25 MB PDF]
Chapter 4: Surgery for Colorectal Cancer [4.22 MB PDF]
Chapter 5: Surgery for Lung Cancer [3.45 MB PDF]
Chapter 6: Surgery for Uterine Cancer [3.03 MB PDF]
Chapter 7: Surgery for Ovarian Cancer [3.00 MB PDF]
Chapter 8: Surgery for Cervical Cancer [3.79 MB PDF]
Chapter 9: Surgery for Vulvar Cancer [2.37 MB PDF]
Chapter 10: Reflections and Recommendations [2.05 MB PDF]
Technical Appendix (full version) [2.44 MB PDF]
Sunday, December 28, 2008
Patients with a history of epithelial ovarian cancer presenting with a breast and/or axillary mass
Patients with a history of epithelial ovarian canc...[Gynecol Oncol. 2008] - PubMed Result
CONCLUSION:
The interval between EOC diagnosis and the breast and/or axilla event, an elevated CA125 level, and a family history of breast and/or ovarian cancer may help differentiate patients with metastatic EOC to the breast and/or axilla from those patients with a second primary breast cancer. The presence of a metastatic EOC portends a poor prognosis.
(Note: EOC = Epithelial Ovarian Carcinoma)
Challenges in multidisciplinary cancer care among general surgeons in Canada
Abstract | Challenges in multidisciplinary cancer care among general surgeons in Canada:
"Conclusions
General surgeons appear to use a wide range of information resources but they may not address the complex needs of many cancer patients. Decision-making is challenged by informational and logistical issues related to the coordination of multidisciplinary care. This suggests that limitations in system capacity may, in part, contribute to variable guideline compliance. Further research is required to evaluate the appropriateness of information seeking, and both concurrent and consecutive mechanisms by which to achieve multidisciplinary care."
Clinical Patterns and Biological Correlates of Cognitive Dysfunction Associated with Cancer Therapy
Clinical Patterns and Biological Correlates of Cognitive Dysfunction Associated with Cancer Therapy -- Dietrich et al. 13 (12): 1285 -- The Oncologist
"Adult patients typically report cognitive symptoms, such as difficulties with memory and attention, soon after initiating treatment. Frequently, these symptoms persist after completion of therapy and are a cause of considerable distress for individuals who are unable to return to their previous academic, occupational, or social activities, or are able to do so only with significant additional mental effort. Long-term evaluation of cancer survivors has raised concerns that cancer and cancer therapy may result in persistent and late emerging cognitive dysfunction [25–27]. This observation has been supported by recent experimental studies. Both radiation and commonly used chemotherapy agents have been shown to cause acute and delayed injury to the CNS"
Saturday, December 27, 2008
Health 2.0 & The Widening Digital Divide: A Call to Action | e-Patients.net
Health 2.0 & The Widening Digital Divide: A Call to Action | e-Patients.net
"Too many years witnessing the same thing. First in the ACOR system. Then in many conferences about eHealth, e-Patients and now Health 2.0 and the Connected Health symposium at Harvard Medical School. Why is an entire segment of the US population almost completely absent from the fast evolving world of Health 2.0 and Participatory Medicine?............And if we do not force a change there is no reason this sad situation should change."
Friday, December 26, 2008
Influence of Intraoperative Capsule Rupture on Outcomes in Stage I Epithelial Ovarian Cancer.
- Obstet Gynecol. 2009 Jan;113(1):11-17.
-
Influence of Intraoperative Capsule Rupture on Outcomes in Stage I Epithelial Ovarian Cancer.
From the 1Division of Gynecologic Oncology, Mayo Clinic, Rochester, Minnesota; 2Division of Gynecologic Oncology, the Ohio State University College of Medicine, Columbus; and 3Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota.
OBJECTIVE:: To evaluate the effect of tumor capsule rupture on disease prognosis in stage I epithelial ovarian cancer.
METHODS:: All patients with International Federation of Gynecology and Obstetrics stage I epithelial ovarian cancer operated on at the Mayo Clinic and The Ohio State University between January 1991 and December 2007 were identified. Relevant tumor characteristics, procedures performed, adjuvant therapies, and follow-up were recorded and analyzed. Inclusion criteria included comprehensive staging. Cox proportional hazards, Kaplan-Meier estimation, log rank test, and chi test were used for statistical analyses.
RESULTS:: There were 161 cases that met inclusion criteria. Seventy-four (46%) patients had intact capsules without positive cytology or surface involvement; 61 (38%) had capsule rupture; 33 (20%) had positive cytology; and 22 (14%) had surface involvement. Overall, 22 of 161 (14%) patients recurred and 12 of 161 (7%) patients died of their disease. In univariable analysis, both intraoperative capsule rupture and positive cytologic washings portended worse disease-free survival (hazard ratio [HR] 3.6, 95% confidence interval [CI] 1.5-8.9; P=.004 and HR 5.2, 95% CI 2.1-12.3; P<.001, respectively) and disease-specific survival (HR 4.1, 95% CI 1.3-15.4; P=.018 and HR 5.9, 95% CI 1.8-19.3; P=.005, respectively). In multivariable analysis, capsule rupture (HR 4.2, 95% CI 1.8-10.9; P=.001) and positive cytologic washings (HR 6.4, 95% CI 2.5-16.0; P<.001) remained independent predictors of worse disease-free survival. Disease-free survival and disease-specific survival were shortest for stage IC cases with positive cytology, surface involvement, or both, that also had intraoperative rupture.
CONCLUSION:: In stage I epithelial ovarian cancer, intraoperative capsule rupture portends a higher risk of disease recurrence and death from disease. Careful intraoperative removal of ovarian masses is important, and recognizing the higher-risk nature of such cases is imperative. LEVEL OF EVIDENCE:: III.
Monday, December 22, 2008
Research Summary: Australia - blood test for ovarian cancer OvPlex
Bloodtest-ovariancancer
"On 28 October 2008, OvPlex™ was released to the Australian market as a diagnostic test for women suspected of having ovarian cancer. The test is initially available through general practitioners in Melbourne at a cost of $200 to the patient. Healthlinx Limited plans to roll the availability of the test out across the country. OvPlex™ is not being marketed for use as a population screening test."
Sunday, December 21, 2008
Relapse and survival in early-stage ovarian cancer
Relapse and survival in early-stage ovarian cancer. [Arch Gynecol Obstet. 2008] - PubMed Result
CONCLUSION:
Patients with early ovarian cancer stage pT1c and pT2a or low grade tumor have to be
monitored closely in oncologic follow-up as they bare a significant risk for disease recurrence.
Ascites at primary diagnosis, pT1c or pT2a tumor stage or recurrent disease are associated
with a poor survival even in early ovarian cancer.
Patient satisfaction with quality of life as a prognostic indicator in ovarian cancer patients treated in an integrative treatment setting
Patient satisfaction with quality of life as a pro...[J Soc Integr Oncol. 2008] - PubMed Result
"Our study has demonstrated no statistically significant prognostic association of patient satisfaction with QoL, as measured by the QLI, with survival in ovarian cancer."
Canadian Doctors for Medicare-Position on Activity-based funding in Canadian Hospitals and other Surgical Facilities (references intl sources)
ABF-final-9.8.8.pdf (application/pdf Object)
What is activity-based funding?
Widespread confusion exists around the jargon used to describe different ways of funding
hospitals.
Activity-based funding (ABF) is also known in the UK as payment-by-results
(PbR), as patient-focused funding (PFF) by the Canadian Medical Association, as servicebased
funding or case-mix funding by the Kirby Commission, as prospective payment
system (PPS) in the US, and elsewhere as payment-for-volume, or volume-based funding.
We use the relatively neutral term of activity-based funding, because the focus is not
necessarily on the patient, but rather on the type and volume of service delivered.
Health and QOL Outcomes: How do medical students value health - evaluation of hypothetical health states compared to the general population
1477-7525-6-111.pdf (application/pdf Object)
In a recent European survey on the acceptance of quality of life measurement between 72-90% of
the physicians accepted quality of life (QoL) as an outcome measure, however with less than 50%
accepting the concept of quality adjusted life years (including utility measurement) [2]. In a similar
survey in the United States and Canada only about one third of the physicians had ever collected
data on quality of life or had taken it systematically into account in clinical decision making [3].
Medical students gain a different perspective on health problems during their medical education by developing the role of a medical doctor. The participation in a health state
valuation task potentially allows them to reflect on a patients’ perspective on decision making when
being confronted with hypothetical health states. Further it has been acknowledged that there is a
need for health related quality of life education in medical school [4]......Futures studies should investigate the change of health states valuations of health care professionals over the period of their medical training.
SABCS: Breast Cancer Risk No Higher for BRCA1/2-Negative Women from Mutation-Positive Families - Meeting Coverage
Medical News: SABCS: Breast Cancer Risk No Higher for BRCA1/2-Negative Women from Mutation-Positive Families - in Meeting Coverage, SABCS from MedPage Today
Action Points
* Explain to patients that women who are not carriers of BRCA1/2 mutations do not have an increased risk of breast cancer, even if they come from a mutation-positive family.
* Note that this study was published as an abstract and presented orally at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.
Saturday, December 20, 2008
Associations between p53 overexpression and multiple measures of clinical outcome in high-risk, early stage or suboptimally-resected, advanced stage..
Associations between p53 overexpression and multip...[Gynecol Oncol. 2008] - PubMed Result
"Associations between p53 overexpression and multiple measures of clinical outcome in high-risk, early stage or suboptimally-resected, advanced stage epithelial ovarian cancers A Gynecologic Oncology Group study."
Treatment of the peritoneal carcinomatosis by cytoreductive surgery and intraperitoneal hyperthermic chemotherapy (IHPC): postoperative morbidity.....
[Treatment of the peritoneal carcinomatosis by cyt...[Ann Ital Chir. 2008 Jul-Aug] - PubMed Result
"Treatment of the peritoneal carcinomatosis by cytoreductive surgery and intraperitoneal hyperthermic chemotherapy (IHPC): postoperative morbidity and mortality and short-term follow-up"
September 2008: Tips for consultants - "Here's How to Fool Most of the People Most of the Time"
Canadian Centre For Policy Alternatives - Septmeber 2008: Tips for consultants
"If you are planning a consultation, you must first ensure that control of the process stays in corporate and government hands. Minimal public notice, short time frames, distant or expensive venues, and hired guns (process consultants) are all techniques that have been used successfully. It is also important to restrict citizen participation to the smallest number you can get away with. This may or may not include whatever segment of the public poses the greatest threat to the policy or development being proposed."
The Cancer Epidemic as a Social Event
cancer.pdf (application/pdf Object)
"Critics of the war on cancer argue that it has largely been a failure. The widespread belief that
we are making progress against cancer is an illusion. The vaunted increases in five year survival
rates are misleading according to the critics because they now count things that are not
cancer and because they are able to diagnose real cancer at an earlier stage, people appear to
survive longer."
"We can win the war against cancer. The best available research is necessary, but not sufficient,
for our victory. Cancer research is designed and undertaken, and the results published and acted
upon, in a deeply political context. The social, political and economic changes necessary to win
the war against cancer will require more than research alone. It will also require collective action,
the uniting of movements that have operated for the most part independently."
Social Watch Canada2008 - Centre for Policy Alternatives: "Rights, budgets and building alternatives"
Social_Watch_Canada2008.pdf (application/pdf Object)
"The Government of Canada, as a signatory to several key UN treaties, including the Covenant on Economic
Social and Cultural Rights and the Convention on the Elimination of All Forms of Discrimination against
Women (CEDAW), has committed to ensure that Canada respects its human rights commitments
to all its citizens. These rights include but are not exclusive to access to justice, affordable housing,
access to education and employment as well as the appropriate provisions to ensure women’s equality
and implement “appropriate measures” to fulfill Canada’s obligations under CEDAW.
Canadian federal budgets from the last decade have ignored these obligations and have, indeed,
made things worse for women and vulnerable populations. While Canada does hold limited open
pre-budget consultations with non-governmental organizations and claims to do a high level of gender
budgeting, the focus of federal governments have moved away from sustained social and strategic
investments towards an aggressive tax cut agenda."
Financing the Health Care System: Is Long-term Sustainability Possible?
Financing_Health_Care_Dec_11.pdf (application/pdf Object)
"This analysis focuses on expenditures for health care as a determinate of sustainability. The first
part looks at historical trends in spending, followed by estimated cost drivers and the
expected influence these will have on total health care spending. Finally, financing options
will be reviewed for their impact on public spending."
Canada’s aging population will not create a crisis in health
care costs, but will remain a variable to be managed into the future.
Thursday, December 18, 2008
Surprised by Hope -- JCO When the Tumor is Not the Target series
Surprised by Hope -- Francis 26 (36): 6001 -- Journal of Clinical Oncology
"I never lied to my patient at any point about the potential benefits of therapy, but appropriately tempered my approach to avoid beating her over the head with poor prognosis talk at every juncture along the way. I believe that my patient had her eyes wide open, but preferred to wear rose-colored glasses."
Practical Model for Prognostication in Advanced Cancer Patients: Is Less More? -- Bruera and Hui 26 (36): 5843 -- Journal of Clinical Oncology
Practical Model for Prognostication in Advanced Cancer Patients: Is Less More? -- Bruera and Hui 26 (36): 5843 -- Journal of Clinical Oncology
"Thus, it is imperative for oncologists not only to refine the science of prognostication, but also to further the art of communication, gently guiding patients and families through times of uncertainty."
Dr. Daniel Gallahan, First Transatlantic Workshop on Multi-scale Cancer Modelling on ecancer tv
Watch Dr. Daniel Gallahan, First Transatlantic Workshop on Multi-scale Cancer Modelling on ecancer tv. Cancer journal: online cancer news, clinical oncology research, cancer information and latest
Dr. Daniel Gallahan
First Transatlantic Workshop on Multi-scale Cancer Modelling
First Transatlantic Workshop on Multi-scale Cancer Modelling: Dr. Daniel Gallahan, Deputy Director, Division of Cancer Biology, National Cancer Institute discusses the role of in-silico modelling in understanding the complexities of cancer
Tuesday, December 16, 2008
Association of Colonoscopy and Death from Colorectal Cancer
0000605-200901060-00306v1.pdf (application/pdf Object)
Conclusion:
In usual practice, colonoscopy is associated with fewer
deaths from CRC. This association is primarily limited to deaths
from cancer developing in the left side of the colon.
Flawed Inferences About Screening Mammography Benefit Based on Observational Data (Correspondence)
JCO.2008.17.9341v1.pdf (application/pdf Object)
"The article by Badgwell et al1 might have had minimal impact on
women were it not for the news media picking up the story. Coverage
was predictable and considerable. The media painted stronger conclusions
than the authors may have intended. The American Society of
Clinical Oncology fanned the flames with its totally inaccurate and
misleading press release entitled, “Women 80 and Older Benefit from
Mammography, but Few Are Screened.”
The Journal of Clinical Oncology erred in publishing this article. It
was a disservice to women, young as well as old. Such publication
reveals a seriously defective editorial process at the journal."
Hanging in the Balance: Making Decisions - Benefits/Harms of Breast Cancer Screening Amongst the Oldest Old Without Safety Net of Scientific Evidence
JCO.2008.19.4928v1.pdf (application/pdf Object)
"...The intensity about the controversy that followed this publication reflects the fact that we are
ill-prepared from a scientific knowledge perspective to provide health care rationally, ethically, equitably, and humanely to the “booming” older population."
Monday, December 15, 2008
The Cochrane Collaboration (International Consumer video)
The Cochrane Collaboration:
"A nine-minute video featuring members of the Cochrane Consumer Network describing how they work together and contribute to improve health care in communities around the world."
Cancer Surgery in Ontario, Chapter 7, Surgery for Ovarian Cancer
Cancer Surgery in Ontario, Chapter 7, Surgery for Ovarian Cancer.pdf (application/pdf Object)
Key Findings:
• Nearly three quarters (73 percent) of women
diagnosed with ovarian cancer in 2003/04 received
surgery within a year of diagnosis.
• Almost all procedures (96 percent) were done in an
inpatient hospital setting.
• Some Local Health Integration Networks (LHINs)
appeared to serve as referral centres for women with
ovarian cancer. For example, 223 surgical procedures
for the disease were done in facilities located in the
Toronto Central LHIN during the study period.
However, only 56 of these (25 percent) were for
patients who resided in the Toronto Central LHIN at
the time they were diagnosed.
• The most common surgical procedure performed
on women with ovarian cancer was unilateral or
bilateral salpingo-oophorectomy (USO/BSO) with
omentectomy; this was undergone by 58 percent
of women in the study cohort. Other procedures
included USO/BSO alone (27 percent) and USO/BSO
with pelvic or para-aortic lymph node excision
(8.1 percent). (blogger's comment: not standard of care)
• While gynecologic oncologists comprised just 6.5
percent of surgeons who performed surgery for
ovarian cancer in Ontario during the study period,
these sub-specialists did 49 percent of all procedures.
• Six out of 10 surgeries for ovarian cancer (60 percent)
were done in academic (teaching) hospitals.
Cancer surgery in Ontario
Cancer surgery in Ontario
Cancer surgery in Ontario
 | Urbach D, Simunovic M, Schultz S. December 2008
This atlas gives Ontario health service providers, policy makers, and the public new information on patterns of surgical care for Ontarians with cancer including regional distribution of services, types of providers and their scope of practice. This research was undertaken to support ongoing improvements in quality and accessibility of care for Ontarians being treated for cancer with a special focus on cancer related surgery. See Backgrounder, See Media Advisory
Hard copies of the Atlas will be available on Tuesday, December 2, 2008. |
Overview [2.62 MB PDF]
Chapter 1: Introduction [2.38 MB PDF]
Chapter 2: Surgery for Breast Cancer [3.79 MB PDF]
Chapter 3: Surgery for Prostate Cancer [3.25 MB PDF]
Chapter 4: Surgery for Colorectal Cancer [4.22 MB PDF]
Chapter 5: Surgery for Lung Cancer [3.45 MB PDF]
Chapter 6: Surgery for Uterine Cancer [3.03 MB PDF]
Chapter 7: Surgery for Ovarian Cancer [3.00 MB PDF]
Chapter 8: Surgery for Cervical Cancer [3.79 MB PDF]
Chapter 9: Surgery for Vulvar Cancer [2.37 MB PDF]
Chapter 10: Reflections and Recommendations [2.05 MB PDF]
Technical Appendix (abbreviated version) [2.38 MB PDF]
2008 Office of the Auditor General of Ontario report
ar_en08.pdf (application/pdf Object)
Wait times reported on the Ministry’s website
combined in-patient and out-patient wait
times, even though in-patients generally
received their scan within a day. At one hospital,
for example, the Ministry-reported wait
time for a CT was 13 days, but out-patients
actually waited about 30 days.
Elsewhere:
"....Wait times (MRI) are from five to six months...."
Central East LHIN report (2008)
http://www.centraleastlhin.on.ca/uploadedFiles/Home_Page/Board_of_Directors/Board_Meeting_Submenu/CEO_Report(1).pdf
Saturday, December 13, 2008
Thursday, December 11, 2008
National Invitational Workshop: Towards an agenda for Cancer Survivorship
slide set eg: LiveStrong, Canada vs U.S. etc
Survivorship_Linda E. Carlson.pdf (application/pdf Object)
Oral Sodium Phosphate (OSP) Products for Bowel Cleansing Information U.S. FDA warning
Oral Sodium Phosphate (OSP) Products for Bowel Cleansing Information
FDA ALERT [12/11/2008]
FDA has become aware of reports of acute phosphate nephropathy, a type of acute kidney injury, associated with the use of oral sodium phosphate products (OSP) for bowel cleansing prior to colonoscopy or other procedures. These products include the prescription products, Visicol and OsmoPrep, and OSPs available over-the-counter without a prescription as laxatives (e.g., Fleet Phospho-soda). In some cases when used for bowel cleansing, these serious adverse events have occurred in patients without identifiable factors that would put them at risk for developing acute kidney injury. We cannot rule out, however, that some of these patients were dehydrated prior to ingestion of OSPs or they did not drink sufficient fluids after ingesting OSP.
Tuesday, December 09, 2008
JAMA -- Randomized Trials of Antioxidant Supplementation for Cancer Prevention: First Bias, Now Chance--Next, Cause
although this Editorial and related research is specific to Prostate Cancer there are lessons to be learned:
JAMA -- Randomized Trials of Antioxidant Supplementation for Cancer Prevention: First Bias, Now Chance--Next, Cause, December 9, 2008, Gann 0 (2008): 2008.863
Intraepithelial T cells and prognosis in ovarian c...[Mod Pathol. 2008] - PubMed Result
Intraepithelial T cells and prognosis in ovarian c...[Mod Pathol. 2008] - PubMed Result
"The presence of intraepithelial CD8(+) T cells was not associated with improved survival in endometrioid or clear cell carcinomas."
Whole-body hyperthermia (WBH) in combination with carboplatin in patients with recurrent ovarian cancer - a phase 11 study
Whole-body hyperthermia (WBH) in combination with ...[Gynecol Oncol. 2008] - PubMed Result
"....There is no evidence yet, that whole-body hyperthermia contributes to any clinical improvement beyond chemotherapy alone. This question can only be addressed in a randomized phase III trial."
The effect of obesity on survival in patients with ovarian cancer
The effect of obesity on survival in patients with...[Gynecol Oncol. 2008] - PubMed Result
"CONCLUSION: Although obesity has been reported as an independent prognostic factor for survival, this data demonstrates that survival rates are similar between obese and non-obese patients when optimal debulking statuses are the same. Therefore, maximal effort should be directed towards optimal debulking obese patients with EOC."
UICC's Reel Lives: Bringing truths about cancer to new audiences
getStaticModFile.aspx (application/pdf Object)
"Jan knew little about cancer but a lot about friendship."
Physicians' Experiences With BRCA1/2 Testing in Community Settings
Physicians' Experiences With BRCA1/2 Testing in Community Settings -- Keating et al. 26 (35): 5789 -- Journal of Clinical Oncology
"Conclusion: Community-based physicians seem to be successfully incorporating BRCA1/2 testing into their practices. Physicians’ recommendations for surveillance of mutation carriers are generally consistent with practice guidelines, yet recommendations for preference-based procedures such as prophylactic mastectomy vary by physician characteristics such as specialty and geographic region. The providers whom patients see for testing may contribute to variations in prophylactic treatments."
Feasibility of Screening for Lynch Syndrome Among Patients With Colorectal Cancer
Feasibility of Screening for Lynch Syndrome Among Patients With Colorectal Cancer -- Hampel et al. 26 (35): 5783 -- Journal of Clinical Oncology
Conclusion:
One of every 35 patients with CRC has LS, and each has at least three relatives with LS; all of whom can benefit from increased cancer surveillance. For screening, IHC is almost equally sensitive as MSI, but IHC is more readily available and helps to direct gene testing. Limiting tumor analysis to patients who fulfill Bethesda criteria would fail to identify 28% (or one in four) cases of LS.
"Patient First" Review Launched - First of its Kind in Canada
Without patient input, the benefits to the patients, organization, clinician and the healthcare system as a whole may never be fully realized. Decision-makers must begin to enact this commitment to collaborative patient-centred care by engaging patients in discussions....
JCO Editorial: Palliative Care and Oncology: Growing Better Together
JCO.2008.20.2671v1.pdf (application/pdf Object)
"....Caution is warranted amid our enthusiasm, lest
those of us seeking to advance and expand palliative care inadvertently
propagate a provider-centric orientation, rather than the patient- and
family-centered approach we desire. Palliative care programs and
clinics are instrumental, but are not ends in themselves. Simply stated:
it is not about us, and never was. Specialist clinicians and teams
represent structures and related processes of health care. Although
worthy foci for health service research, the structures and processes of
care must not divert attention from the outcomes that matter most to
people living with cancer and their families......Naturally, people do not always fit neatly into one of these
categories— being treated for cure, living with, dying from, or surviving
cancer—and the clinicians who serve them must resist being
constrained within arbitrary silos of services....." cont'd
Monday, December 08, 2008
news item - HPV vaccinations ‘not safe’ says former Health Canada employee
The Bracebridge Examiner and Gravenhurst Banner - HPV vaccinations ‘not safe’ says former Health Canada employee
"One of Canada’s leading experts in vaccines and antibiotics is calling the federally funded human papillomavirus (HPV) immunization campaign for Grade 8 girls a giant public health experiment.
“People are the guinea pigs for this vaccine,” says Shiv Chopra, a former Health Canada microbiologist.
His advice to the public: “Do not take it (the HPV vaccination). We don’t know anything about it. It’s nothing but a money-making device.”"
The Bracebridge Examiner and Gravenhurst Banner - HPV vaccinations ‘not safe’ says former Health Canada employee
The Bracebridge Examiner and Gravenhurst Banner - HPV vaccinations ‘not safe’ says former Health Canada employee
"One of Canada’s leading experts in vaccines and antibiotics is calling the federally funded human papillomavirus (HPV) immunization campaign for Grade 8 girls a giant public health experiment.
“People are the guinea pigs for this vaccine,” says Shiv Chopra, a former Health Canada microbiologist.
His advice to the public: “Do not take it (the HPV vaccination). We don’t know anything about it. It’s nothing but a money-making device.”"
Sunday, December 07, 2008
Ovarian Cancer National Alliance - Regulatory - FDA HE4
Ovarian Cancer National Alliance - Regulatory - FDA HE4
"Our survey showed that most women are unaware of ovarian cancer symptoms......Survey results show that 50 percent of the respondents did not know about the specialty of gynecologic oncologists. Furthermore, 48 percent of the respondents reported that the doctors they contacted to evaluate symptoms did not refer them to gynecologic oncologists...."
Time to stop ovarian cancer screening in BRCA 1/2 mutation carriers?
HighWire Press -- Medline Abstract
"Annual gynecological screening of women with a BRCA1/2 mutation to prevent advanced stage ovarian cancer is not effective."
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