Methods:
Recognizing IBC to be a distinct entity, a
group of international experts met in December 2008 at the First
International
Conference on Inflammatory Breast Cancer to develop
guidelines for the management of IBC.
Background:
Neoadjuvant chemotherapy has shown a modest benefit in muscle-invasive bladder cancer patients; however, the subset of patients most likely to benefit has not been identified. BRCA1 plays a central role in DNA repair pathways and low BRCA1 expression has been associated with sensitivity to cisplatin and longer survival in lung and ovarian cancer patients.
Conclusions:
Our data suggest that BRCA1 expression may
predict the efficacy of cisplatin-based neoadjuvant chemotherapy and
may help
to customize therapy in bladder cancer patients.
To assess the morbidity
and mortality associated with extensive upper abdominal surgery (EUAS)
performed during primary cytoreduction for advanced ovarian carcinoma.
Note: includes stories from many longterm survivors as well as:
Ovarian Problems Discussion List
The Ovarian Problems Discussion List is a free e-mail discussion group that gives women with ovarian cancer and related problems a chance to exchange information and support daily. Supporters and family members are also encouraged to join this group, which is sponsored by the non-profit Association of Cancer Online Resources.
To SUBSCRIBE, go to www.acor.org, click on "mailing lists", and locate the Ovarian list - follow the instructions to join.
To reach the list managers for HELP, write to ovarian-request@listserv.acor.org . We now have over 1300 subscribers
"Addition of mesothelin to this combination did not show any improvement in the sensitivity. Conclusions: As a single marker, HE4 had the highest sensitivity for detecting ovarian carcinoma specially early stage disease. Combined CA125 and HE4 was a more accurate predictor of ovarian malignancy than either alone."
Note: article relates to the U.S.-based Commonwealth Fund report of June 25th, 2010 (see prior blog post); this was not the first Commonwealth Fund analysis which compared different countries on a variety of indices with Canada and the U.S. coming in dead last in overall rankings.
"The report compared Canada with other countries 18 times in the text.
These included two favourable comparisons and 16 unfavourable ones,
including indictments for long waits, the poor management of chronic
conditions (like diabetes), the lack of electronic systems, poor care
coordination and the failure to involve patients in decisions about
their care." Dr. Michael Rachlis is a health policy analyst and an associate professor at the University of Toronto.
"However, Santen said, the average age of the women in the WHI was 63. Only 3.4% of women in the study were ages 50 and 55, "the usual time when women would decide to take hormone therapy," he said."
----------------------------------------------------------------------------------------------------------------------------------------
The take-home message, he concluded, is that "physicians and patients need to rethink the use of menopausal hormone therapy based on these new data. "The statement suggests a change in perspective and a need to consider the risks and benefits [of hormone therapy] for women actually considering its use."
Note: focus on breast cancer/not specific to ovarian cancer; discusses high risk (BRCA's)
"In this issue of the Journal, Vernon et al. conducted a methodologically rigorous review of the literature on controlled behavioral interventions to increase repeat mammography screening among women at average risk for the disease.......The promise of breast cancer screening has fallen short of its goals because of its imprecision, failure to screen those at highest risk, lack of compliance with screening continuance over recommended periods of time, and gaps in access to or quality of diagnostic follow-up and treatment (20). It is no longer enough to simply conduct more interventions to understand which work best in motivating individuals to undergo repeat cancer screening. New paradigms, guided by evidence from modeling, novel trials, and new scientific discovery, will be needed to realize the promise of eliminating the burden of cancer."
"Prospective, randomized trials, designed to control for all known
variables, are mandatory to fully assess the potential for hormonal
chemoprevention in breast, endometrial and ovarian cancers."
Thirty-eight patients were
included. All patients were heavily pre-treated with a median of five
prior regimens. .....
The VEGF serum level decreased during treatment in
all patients. A low pre-treatment VEGF level was predictive to response.
Conclusions
Single agent bevacizumab has
activity in ovarian cancer patients. Pre-treatment serum VEGF seems to
have predictive value.
Reminder on stats: < 1.0 is decreased risk; > 1.0 is increased risk; OR=overall risk; edited some stats for ease of reading - see abstract/read more:
Conclusions
Parity and oral contraceptive use are
associated with reduced risks of fallopian tube cancer. In contrast,
hormone replacement therapy may be associated with an increase in the
risk of fallopian tube cancer.
"A new gene that normally protects againstovarian
cancer is switched-off in two-thirds of cases of the disease,
reveals a study published in the journal Neoplasia today.
This
'protector gene', known as EPB41L3, is inactivated in 65 per cent of
ovarian cancers.
And reactivating the gene halted tumour growth
and triggered large numbers of the cancer
cells to commit suicide.
The research, co-funded by Cancer
Research UK and gynaecological cancer
research charity
The Eve Appeal, raises the prospect for developing
therapies that mimic or restore the function of the gene to kill ovarian
cancer cells in a targeted way...."
Note: this article is free to view; requires registration
"In July, 2005, Lancet editors wrote that “we will require authors of clinical trials submitted to The Lancet to include a clear summary of previous research findings, and to explain how their trial's findings affect this summary.
They called for the relation between existing and new evidence to be referenced to a published systematic review or meta-analysis. The CONSORT statement2 first required in 1996 that findings should be interpreted to take into account the totality of the evidence.
Michael Clarke and colleagues have been monitoring since then how the five high-impact journals (Annals of Internal Medicine, BMJ, JAMA, The Lancet, and The New England Journal of Medicine) have been doing. They report in The Lancet today their latest results for May, 2009.
Their findings are discouraging: only one of 24 reports that were not first trials placed the results in the context of an updated systematic review in the Discussion. They conclude that there is no evidence of progress since 1997, and that editors and authors are not informing sufficiently those who have to make decisions about health care." Clearly, clinicians and others in health care need to know what the
results of research mean for patients. Authors and editors can help them by doing exactly what CONSORT4
and Clarke and colleagues call for. Authors need to spell out what
their study adds to other work and what that means for clinical
practice...."cont'd
Data from ICON7 will be submitted for presentation at an upcoming medical meeting, Genentech said.
The ICON7 study is sponsored by the Medical Research Council (MRC) in the UK, led by the MRC Clinical Trials Unit and conducted through an international network of researchers in the Gynaecologic Cancer InterGroup (GCIG).
ICON7 is an international, multicentre, randomised, open-label, Phase III study in 1,528 women with previously untreated epithelial ovarian, primary peritoneal or fallopian tube carcinoma. The trial evaluates Avastin plus standard of care chemotherapy (carboplatin and paclitaxel) followed by the continued use of Avastin alone, compared to chemotherapy alone.
Steven A Narod Evaluation of: Kuhl C, Weigel S, Schrading S et al.: Prospective multicenter cohort study to refine management recommendations for women at elevated familial risk of breast cancer: the EVA trial. J. Clin. Oncol. 28, 1450–1457 (2010).
"In the EVA trial, Kuhl et al. screened 687 women at high risk of breast cancer for up to 3 years with annual MRI. A total of 27 breast cancers were diagnosed, including 11 DCIS and two local recurrences. There were no interval cancers. This data suggests that MRI screening can be used to downstage breast cancers, but larger studies with longer follow-up periods are required to confirm these findings."
"In 2004, the US Preventive Services Task Force (amongst other countries/guidelines) recommended against routine ovarian cancer screening [102]. None of the more recent findings overide this guideline. We must await the results of the two large-scale trials. Whether the results are positive or not, these trials will yield vital data to guide the next steps in biomarker research and subsequent guidelines for practice."
"... The use of quotes from well-regarded stem cell scientists and physicians is not uncommon on unscrupulous Internet websites, according to Weissman. Frequently these experts are unaware that their names are being used, and the quotes are fabricated or taken out-of-context from some other source.
As a result of the task force’s efforts to publicize these and other abuses, the ISSCR recently launched a publicly available website (www.closerlookatstemcells.org) where patients can learn more about stem cell biology, learn what questions to ask of potential clinics, and even submit a specific website for further investigation by the ISSCR."
To learn more about PreOvar, review the On-line Grand Rounds presented by Joanne Weidhaas, M.D., Ph.D., an Assistant Professor at Yale University in the Department of Therapeutic Radiology.
Non-epithelial ovarian cancers are
rare; their natural history is poorly understood and prognostic factors
remain unclear. A French website (www.ovaire-rare.org) was developed to
collect clinical cases and tumour samples in order to better define
prognostic factors and develop specific trials. We report the results of
the first 100 patients with germ cell (GCT) and sex cord-stromal (SCT)
tumours.
Conclusions
This online observatory allows
assessing medical practice for GCT and SCT in France. Histological
discrepancies between diagnosis and second opinion confirm the need for
systematic review before treatment. Extension to other rare gynaecologic
malignancies is on-going.
Borderline ovarian tumour (BOT) represents a rare and special tumour entity. Despite a generally favourable prognosis for patients with BOT, the presence of invasive peritoneal implants decreases the survival rate to 30-50%. In contrast to ovarian cancer, only few data exist concerning the current clinical management of patients with BOT. For this reason, the present analyses were performed for patients with BOT who were admitted into our online tumor conference for patients with gynaecological malignancies. Based on the results discussed in this article, the current aspects and problems regarding the diagnostic, surgical and conservative treatment and aftercare management of patients with BOT are considered.
"Arrayit's OvaDx(R), the market's first comprehensive diagnostic screening test for ovarian cancer, uses approximately 100 proteomic biomarkers to identify molecular beacons of ovarian cancer that accumulate in the bloodstream as soon as an ovarian tumor begins to develop. OvaDx(R) detects both early and late stage ovarian cancer with high sensitivity and specificity using Arrayit's proprietary microarrays, which are tiny medical devices that screen large numbers of patient samples in a highly miniaturized and automated manner. OvaDx(R) leverages Arrayit's patented manufacturing technology and will be marketed and sold upon FDA approval by the company's subsidiary Arrayit Diagnostics, Inc."
WCRF/AICR will keep you informed with the latest updates on the
Second Expert Report, Food, Nutrition, Physical Activity, and the
Prevention of Cancer: a Global Perspective.
World Cancer Research Fund International First Floor 19
Harley Street London, W1G 9QJ, UK Tel: +44-20-73434200 | Fax:
+44-20-73434220 http://www.wcrf.org/
American Institute for Cancer Research 1759 R Street
N.W. Washington, DC 20009, USA Tel: 202-328-7744 | Fax:
202-328-7226 http://www.aicr.org/
CONCLUSION:
Our results showed that OS and PFS of synchronous primary ovarian cancer in patients with endometrial cancer is better than those with ovarian metastasis patients. Pre- and intra-operative, intensive and careful assessment, and strict and continuous postoperative surveillance should pay attention to the endometrial cancer patients who preserved ovary for having possibility of coexisting occult ovarian lesions.
"Besides the high risk of developing colorectal carcinomas of 10–80%,
Lynch syndrome family members are at increased risk of developing
several extra-colonic cancers and tumours at a relatively young age:
endometrial cancer, carcinomas of the ovary, small bowel and biliary
tract cancer, sebaceous gland tumours and urothelial carcinomas (UC) of
the upper urinary tract. The
lifetime risk of upper urinary tract cancer in Lynch syndrome varies in
different studies from 0.4–20%.
Microsatellite instability (MSI) is present in these urothelial
carcinomas of the upper urinary tract."
"The majority of the studies were on women with advanced or metastatic breast cancer. Twenty-one studies included participants with myeloma, lymphoma, sarcoma or ovarian cancer, and three studies included a mixture of tumour types."
Background
We conducted a systematic review and meta-analysis to clarify the risk of early and late cardiotoxicity of anthracycline agents in patients treated for breast or ovarian cancer, lymphoma, myeloma or sarcoma.
Conclusions
Evidence is not sufficiently robust to support clear evidence-based recommendations on different anthracycline treatment regimens, or for routine use of cardiac protective agents or liposomal formulations. There is a need to improve cardiac monitoring in oncology trials.
Note: this study is an NIH study and excludes those with a known genetic syndrome
Study to Evaluate Families with History of Carcinoid Cancer
By The Carcinoid Cancer Foundation (CCF)
The Natural History of Familial Carcinoid Tumor is recruiting participants who are interested in being part of a study that will “evaluate families with a history of carcinoid cancer to determine ways to improve early detection and to find the gene that may cause the tumors.”
If you are a member of a family in which two or more immediate blood relatives have had gastrointestinal carcinoid tumors, you may be eligible for this study. Unaffected spouses of family members diagnosed with carcinoid cancer are also requested to participate.
"Some gynaecological cancers are uncommon, such as sex cord-stromal tumours, malignant germ-cell tumours, vulvar carcinoma, melanoma of the female genital tract, clear-cell carcinoma of the ovary and endometrium, neuroendocrine tumours of the cervix, and gestational trophoblastic neoplasia. All these cancers have different clinicopathological characteristics, suggesting different molecular biological pathogeneses. Despite aggressive treatment, some cancers recur or respond poorly to therapy. Comprehensive knowledge of the molecular biology of each cancer might help with development of novel treatments that maximise efficacy and minimise toxic effects. Targeted therapy is a new treatment strategy that has been investigated in various tumours in clinical and laboratory settings. Since these cancers are rare and large clinical trials are difficult to do, molecular biological techniques might allow rapid proof-of-principle experiments in few patients. Novel targeted agents either alone or in combination with other treatments offer promising therapeutic options."
Conclusion:
Amsterdam criteria and each of the Bethesda criteria were inadequate for identifying MSH6 mutation-carrying kindreds. MSH6 mutations may be more common than currently assumed, and the penetrance/expression of MSH6 mutations, as derived from families meeting current clinical criteria, may be misleading. To increase detection rate of MMR mutation carriers, all cancers in the Lynch syndrome tumour spectrum should be subjected to immunohistochemical analysis and/or analysis for microsatellite instability.
Objective:
"To explore oncologists' preferences for hypothetical outcome scenarios (i.e. health states) resulting from various treatment options." Conclusions:
"These data suggest that oncologists may choose treatments that maximize clinical efficacy only when not associated with severe toxicities or low emotional well-being unless associated with a large improvement in efficacy. Physicians may prefer a more toxic chemotherapy regimen that improves survival, and are more willing to compromise emotional well-being for a large survival advantage in the setting of newly diagnosed disease. Slight improvements in clinical efficacy may not be acceptable to oncologists unless associated with higher emotional well-being for the patient."
OBJECTIVE:
Based on considerable prospective data, risk-reducing salpingo-oophorectomy (RRSO) is one of the most beneficial interventions available to reduce ovarian/breast cancer risk in BRCA carriers and high-risk women. The purpose of this study was to describe the initial surgical outcomes and learning curve analysis associated with laparoendoscopic single-site (LESS) RRSO with and without hysterectomy.
RESULTS:
A total of 58 patients were evaluated; 36 (63%) were BRCA1/2
carriers and 38 (63%) had breast cancer.
"Prospective studies are needed to assess the relative benefits of LESS
compared with more conventional minimally invasive approaches."
"These data show that cisplatin resistance in HGS (high grade serous) carcinoma develops from pre-existing minor clones but that enrichment for these clones is not apparent during short-term chemotherapy treatment
Abstract:
"CONCLUSION: In advanced ovarian cancer patients who achieve a CCR (complete clinical response) following induction chemotherapy, optimal cytoreduction may confer a greater clinical benefit from a maintenance approach compared to suboptimal cytoreduction."
Abstract:
"Inherited loss-of-function mutations in the tumor suppressor genes BRCA1,
BRCA2, and multiple other genes predispose to high risks of
breast and/or ovarian cancer. Cancer-associated inherited mutations
in these genes are collectively quite common, but
individually rare or even private. Genetic testing for BRCA1
and BRCA2 mutations has become an integral part of clinical
practice, but testing is generally limited to these two genes and to
women
with severe family histories of breast or ovarian
cancer.
To determine whether massively parallel, “next-generation”
sequencing
would enable accurate, thorough, and cost-effective
identification of inherited mutations for breast and ovarian cancer, we
developed a genomic assay to capture, sequence, and
detect all mutations in 21 genes, including BRCA1 and BRCA2,
with inherited mutations that predispose to breast or ovarian cancer"
"There were zero false-positive calls of nonsense
mutations, frameshift mutations, or genomic
rearrangements for any gene in any of the test samples. This approach
enables
widespread genetic testing and personalized risk
assessment for breast and ovarian cancer"
blog Note: at the time of this post, full free access to the paper was available; a search of the paper for the term 'side effects' = O with the exception of references
study: "There are several limitations to our study. First,we were unable to determine the reasons for nonadherence and discontinuation."
"BACKGROUND: Mucinous ovarian cancer raises problems of differential diagnoses because it is often difficult to distinguish the primary from the metastatic form. Most metastatic ovarian tumors originate from the gastrointestinal tract, mainly colorectal, gastric, pancreatic; the gallbladder is a very rare source of ovarian metastases. CASE: We report a case of ovarian metastases from a gallbladder cancer, incidentally diagnosed more than 2.5 years earlier during a laparoscopic intervention for biliary lithiasis. CONCLUSION: The interest of this case lies in the long progression-free survival, the venous thromboembolism syndrome that preceded by a few months the diagnosis of the ovarian mass and the discrepancy between the radiologic and the laparoscopic stage assessment."
"The orally available compound, GDC-0449, is the farthest along in clinical development. Initial clinical trials in basal cell carcinoma and treatment of select patients with medulloblastoma have shown good efficacy and safety."
"Ambulatory patients with advanced ovarian or breast cancer were enrolled to receive treatments at an outpatient academic oncology center."
Conclusions.
This pilot study demonstrates that an 8-week outpatient acupuncture course is feasible for advanced cancer patients and produces a measurable benefit that should be evaluated in controlled trials.
Conclusions. VAEs seem to have an impact on QoL and reduction of side effects of conventional therapies (chemotherapy, radiation) in experimental trials as well as in routine daily application. The influence on fatigue especially should be investigated further.
Abstract:
"The essential trace element selenium, which is a crucial cofactor in the most important endogenous antioxidative systems of the human body, is attracting more attention from both laypersons and expert groups. The interest of oncologists mainly focuses on the following clinical aspects: protection of normal tissues, sensitizing in malignant tumors, antiedematous effect, prognostic impact of selenium, and effects in primary and secondary cancer prevention. Selenium is a constituent of the small group of selenocysteine-containing selenoproteins and elicits important structural and enzymatic functions. Selenium deficiency has been linked to increased infection risk and adverse mood states. It has been shown to possess cancer-preventive and cytoprotective activities in both animal models and humans. It is well established that it has a key role in redox regulation and antioxidant function, and hence in membrane integrity, energy metabolism, and protection against DNA damage. Recent clinical trials have shown the importance of selenium in clinical oncology. In 2009, a significant benefit of sodium selenite supplementation—with no protection of tumor cells, which is often suspected by oncologists— was shown in a prospective randomized trial in gynecologic cancer patients undergoing radiation therapy. More recently, concerns arose from 2 large clinical prevention trials (NPC, SELECT) that selenium may increase the risk of developing type 2 diabetes. Despite obvious flaws in both studies and good counterarguments, controversy remains on the possible advantages and risks of selenium in cancer prevention. However, in the light of the recent clinical trials the potential benefits of selenium supplementation in tumor patients are becoming obvious, even though further research is needed."
"Shielded" ovarian cancer cells may survive chemotherapy.
"The researchers compared the characteristics of cell lines from the tumour at the time of diagnosis to cell lines from the same patients once the disease had been treated and become resistant."
""By examining the characteristics of ovarian tumours we now think that cells resistant to chemotherapy grow as part of the tumour. This means that when patients have treatment, cells that respond to chemotherapy are destroyed but this leaves behind resistant cells which then form another tumour of completely resistant cells. This seems to explain why successful treatment for relapsed patients is difficult. What needs to be developed now is a therapy designed to target the resistant cells.""
"The incidence of urinary tract injury is low in most gynaecological operations but, if undiagnosed, is a cause of significant postoperative morbidity for the patient and litigation for the gynaecologist. A Medline search of studies of urinary tract injury at gynaecological surgery show that only one in 10 ureteral injuries and one in three bladder injuries are detected at the time of surgery without intra-operative cystoscopy. As cystoscopy is not routinely performed by the majority of gynaecologists during surgery, even in difficult cases, failure to detect injury to the urinary tract by itself should not be seen as negligence. However, all gynaecologists performing pelvic surgery should be encouraged to become competent in cystourethroscopy and perform this intra-operatively, at least in all high-risk cases of gynaecological surgery."
http://jco.ascopubs.org/cgi/content/full/28/19/e321?cmpid=jco_etoc_1July2010
"...Overall, I think that there will be no need for institutionalreview boards of community-based centers or universities totake up a formal position in this context. Indeed, I think thatthe more and more diffuse use in the clinical practice of PLD40 mg/m2 will be, in and by itself, stronger than any regulatoryrules, and that the lower and safer PLD dose level will tacitlyreplace the US Food and Drug Administration–approved dosagein clinical trials.
"...It is essential that those reading this letter do not misinterpret its meaning. There is absolutely no intent in this discussion to vilify any individual, organization, or company involved in the oncology drug development paradigm. It is unquestionably the case that all working in this arena have as their major goal the advancement of antineoplastic strategies that are effective, relatively safe, and that improve the survival and quality of life of patients with cancer.
Found 8 studies with search of: ovarian cancer | Open Studies | received from 06/01/2010 to 06/27/2010
1 Not yet recruiting Incidence of Cancer in Women at Increased Genetic Risk of Ovarian Cancer
Conditions: Breast Cancer; Fallopian Tube Cancer; Ovarian Cancer; Peritoneal Cavity Cancer
Interventions: Other: questionnaire administration; Procedure: evaluation of cancer risk factors; Procedure: quality-of-life assessment; Procedure: study of high risk factors
2 Recruiting N-acetylcysteine Given IV With Cisplatin and Paclitaxel in Patients With Ovarian Cancer
Conditions: Ovarian Carcinoma, Stage 3 or 4; Epithelial Ovarian Carcinoma; Primary Peritoneal Carcinoma
Interventions: Drug: Paclitaxel; Drug: N-acetylcysteine; Drug: Cisplatin
3 Not yet recruiting Study of JI-101 in Patients With Advanced Head and Neck Cancers, Ovarian Cancers or K-RAS Mutant Colon Cancers
Conditions: Cancer; Head & Neck Cancer; Ovarian Cancer; Colon Cancer
Interventions: Drug: JI-101; Drug: Everolimus
4 Not yet recruiting Veliparib and Liposomal Doxorubicin Hydrochloride in Treating Patients With Recurrent Ovarian Cancer, Fallopian Tube Cancer, or Primary Peritoneal Cancer or Metastatic Breast Cancer
Conditions: Breast Cancer; Fallopian Tube Cancer; Ovarian Cancer; Peritoneal Cavity Cancer
Interventions: Drug: pegylated liposomal doxorubicin hydrochloride; Drug: veliparib; Other: laboratory biomarker analysis; Other: pharmacological study
5 Not yet recruiting Safety Study of MGAH22 in HER2-positive Carcinomas
Conditions: Breast Cancer; Gastric Cancer; Bladder Cancer; Ovarian Cancer; Non-small Cell Lung Cancer
Intervention: Biological: MGAH22
6 Recruiting Assessing Fertility Potential in Female Cancer Survivors
Condition: History of Cancer
Intervention:
7 Recruiting Intraperitoneal Ropivacaine Nebulization for Pain Control After Gynecologic Laparoscopic Surgery
Condition: Ovarian Cysts
Interventions: Drug: Ropivacaine nebulization; Drug: Ropivacaine instillation
8 Recruiting Effects of Exercise for Overweight Women With Polycystic Ovary Syndrome
Conditions: Polycystic Ovary Syndrome; Obesity
Interventions: Other: 16-week exercise training program; Other: Control Group without PCOS
Note: detailed article on PARP's/BRCA
"....Interest in PARP inhibition was perhaps best reflected by the question an attendee at the packed session put to Dr. Gelmon.
"My problem is, as a practicing oncologist, I see these great, wonderful results, in a very difficult population of patients with ovarian cancer," he said. "I want to know when I can get my hands on some. There are patients dying today because of this lack of access.""
".....Already, in its pilot phase, this NIH-supported project has produced comprehensive molecular classification systems for ovarian cancer and glioblastoma, which is the most common form of brain cancer. This information may help doctors do a better job of matching individual patients with the therapies that are most likely to work well for them. What's more, the findings may lead to new therapies directed at the molecular changes underlying various subtypes of cancer.
"This month, PLoS Genetics is publishing an article from the company 23andMe reporting the first genome-wide association studies (GWAS) on multiple traits ascertained by self-reported information provided through the Internet from over 10,000 participants who pay the company for providing whole genome genotypes [1]. The paper passed through scientific review by a panel of three experts relatively quickly and is sure to attract the attention of anyone with freckles, curly hair, or an aversion to asparagus. Novel associations are described for four intrinsically interesting traits (out of 22 considered), while known associations with hair and eye color are replicated in a dynamic data-gathering context. Additionally, intriguing observations on the interaction between genetic self-knowledge and self-report of phenotypes are described. The implications of the successful application of this Internet-enabled approach to GWAS research were considered to be more than sufficient to warrant publication in the journal.
However, publication was delayed for six months while the editors sought a variety of opinions on three issues: ethical review, consent, and data access...."
Note: see prior blog posting "BSB4uD" (Be Smart Before You Donate) - +$1million dollars in salaries and rising
Job Categories: Program / Project Evaluation & Development
Position Type: Part Time
Job Region: QC - Quebec City
Location(s): 4950 chemin Queen Mary
Career Level: Experienced (Non-manager)
Ad Online Since: 06/22/2010
Application Deadline: 07/06/2010
abstract:
Women diagnosed with ovarian cancer may experience many shortterm and long-term effects from cancer and its treatment. Cancer has more than a physical impact, yet there is a lack of information about the types of needs these women have and whether they want help in meeting their needs. The main purpose of this cross-sectional, descriptive study was to identify the supportive care needs (physical, emotional, social, informational, spiritual, psychological and practical) of women with ovarian cancer who attended a comprehensive, outpatient cancer centre. A further purpose was to determine if women wanted assistance in meeting those needs. A total of 50 women diagnosed with ovarian cancer participated in this study by completing a self-report questionnaire (The Supportive Care Needs Survey). The data indicated that a range of supportive care needs remained unmet for this patient group. Eight of the top 10 most frequently reported needs were psychosocial, such as fears about the cancer returning or spreading. The women also expressed a range of difficulty in managing their needs. However, despite this reality, significant numbers of women indicated they did not wish to have assistance from the clinic staff with some needs. Suggestions for practice and future research are offered to assist oncology nurses in providing care to these women.
OBJECTIVE: To examine the
effect of hospital procedure volume and other prognostic variables on
overall survival outcome and likelihood of receiving standard
recommended care among patients with advanced-stage epithelial ovarian
cancer. CONCLUSIONS: Hospital ovarian cancer surgical volume >/=21 cases/year
is associated with a higher likelihood of patients with Stage IIIC/IV
epithelial ovarian cancer receiving standard treatment (surgery followed
by adjuvant chemotherapy). Even after adjusting for treatment paradigm
and other factors, hospital volume >/=21 cases/year was significantly
predictive of improved overall survival outcome.
CONCLUSIONS:
Both integrated FDG-PET/CT and contrast-enhanced multidetector CT are sensitive surveillance modalities for the detection of recurrent ovarian cancer; the use of both modalities aids decisions on treatment plans and may ultimately have a favorable impact on prognosis. However, contrast-enhanced multidetector CT is recommended for the regular follow-up for ovarian cancer patients after initial treatment.
Conclusions. Advanced age can deter oncologists from choosing intensive cancertherapy, even if patients are
highly functional and lack comorbidities.Education on
tailoring cancer treatment and a greater use ofcomprehensive
geriatric assessment may reduce cancer undertreatmentin the
geriatric population.
"This study explored the impact of gender on cancer patients' needs and preferences, and found that, of all the patient- and disease-related factors, gender was the most important independent predictor of patient preferences."
Note:very complicated condition/conditions/subsets of conditions and requires specialist consultation/s.
"When patients with cancer develop neurologic symptoms, common causes include metastasis, infections, coagulopathy, metabolic or nutritional disturbances, and neurotoxicity from treatments. A thorough clinical history, temporal association with cancer therapies, and results of ancillary tests usually reveal one of these mechanisms as the etiology. When no etiology is identified, the diagnosis considered is often that of a paraneoplastic neurologic disorder (PND). With the recognition that PNDs are more frequent than previously thought, the availability of diagnostic tests, and the fact that, for some PNDs, treatment helps, PNDs should no longer be considered diagnostic zebras, and when appropriate should be included in the differential diagnosis early in the evaluation."
"The study used a convenience sample of patients undergoing surveillance following curative treatment for localized cancer who completed a paper survey to estimate the maximum copayment patients are willing to pay for better treatment outcomes. Results suggest that patients may be less willing to pay high copayments for treatments with modest benefit. In addition, sociodemographic factors such as education and employment status were associated with willingness to pay."
"In conclusion, this study demonstrates that it is feasible to measure cancer patients' WTP (willingness to pay) for treatments in both the adjuvant and palliative settings. In addition, our results support the hypothesis that cancer patients' WTP for treatment may be influenced by both sociodemographic factors and their assessment of the treatment's value. If confirmed in a larger, more heterogeneous population, these findings suggest that insurance benefit designs based on treatment value may be feasible for cancer treatment. However, they also highlight the risk that higher out-of-pocket expenses may contribute to socioeconomic disparities in cancer care."
"In a phase I trial, a generally well-tolerated dose was identified at which the majority of patients achieved pazopanib plasma concentrations above the concentration required for maximal in vivo inhibition of VEGFR-2 phosphorylation in preclinical models.
Administered as monotherapy, evidence of antitumor activity was observed in phase II studies in several tumor types, including soft tissue sarcoma, renal cell cancer (RCC), ovarian cancer, and non-small cell lung cancer.
Recently, the U.S. Food and Drug Administration granted approval for treatment with pazopanib in patients with RCC based on the longer progression-free survival time observed with this agent in a placebo-controlled, randomized trial.
------------------------------------------------------------
"Furthermore, preliminary data from a small phase II study inwomen
with progressive, platinum-pretreated ovarian cancer showeda
cancer antigen 125 response (defined as a confirmed decrease50% from baseline) in 11 (31%) patients, with a median
durationof response of 113 days.*>"
(*Annals of Oncology 19 (Supplement 8): viii211–viii216, 2008
doi:10.1093/annonc/mdn512:
PAZOPANIB (GW786034) IS ACTIVE IN WOMEN WITH
ADVANCED EPITHELIAL OVARIAN, FALLOPIAN TUBE AND
PERITONEAL CANCERS: RESULTS OF A PHASE II STUDY
M. Friedlander1, K.C. Hancock2, B. Benigno3, D. Rischin4, M. Messing5,
C.A. Stringer6, J.P. Hodge7, B. Ma7, G. Matthys7, J.J. Lager7
1Oncology Day Center, Prince of Wales Hospital, Randwick, Sydney/
AUSTRALIA, 2Oncology, Texas Oncology, Fort Worth/UNITED STATES OF
AMERICA, 3Oncology, SE Gynecologic Oncology, Atlanta/UNITED STATES OF
AMERICA, 4Oncology, Mercy Hospital for Women, Melbourne/AUSTRALIA,
5Oncology, Texas Oncology, Bedford/UNITED STATES OF AMERICA,
6Oncology, Texas Oncology, Dallas/UNITED STATES OF AMERICA, 7Scientific
Communications, GlaxoSmithKline, Research Triangle Park/UNITED STATES
OF AMERICA )
" Putting pazopanib into perspective and comparing it with otherVEGFR
TKIs that have been approved for a longer time are difficultand
have to be done on the basis of indirect comparisons, giventhe
lack of data from comparative trials among the several treatmentoptions."
"MuGard is indicated in Europe for the prevention and management of oral mucositis, and has been used by over 2,000 cancer patients globally. A total of 185 documented patients from various studies utilized MuGard in both prophylactic and curative settings"
OBJECTIVES: The purpose of this study is to determine the prevalence of BRCA1 and BRCA2 mutations among a large series of women with carcinoma of the fallopian tube.
METHODS: Two series of women diagnosed with carcinoma of the fallopian tube were studied. Women identified from the Ontario Cancer Registry who were diagnosed with fallopian tube cancer between 1990 and 1998 and between 2002 and 2004. A second, hospital-based series was identified at Cedars Sinai Medical Centre, Los Angeles, California. These women were diagnosed between 1991 and 2007. Each subject was approached to provide her family history and ethnic background and to provide a blood sample for genetic testing for mutations in the BRCA1 and BRCA2 genes.
RESULTS: In total, 108 patients with fallopian tube cancer were recruited (70 from Ontario and 38 from Los Angeles). Thirty-three patients (30.6%) were found to have a deleterious mutation; 23 in BRCA1 (21.3%) and 10 in BRCA2 (9.3%). The prevalence of mutations was 55.6% in Jewish women and was 26.4% in non-Jewish women. A family history of ovarian or breast cancer was positive for 24 women (23.3%); of these, 14 had a mutation (58.3%). Fourteen (14.4%) of the patients had a previous history of breast cancer; of these, 10 (71.4%) had a mutation. 40.3% of the women who were diagnosed with fallopian tube cancer before age 60 had a mutation, compared with 17.4% of the women diagnosed at age 60 and above.
CONCLUSIONS: Approximately 30% of women with fallopian tube cancer have a mutation in BRCA1 or BRCA2. The highest frequencies of BRCA mutations were seen in women with fallopian tube cancer diagnosed under age 60, in Jewish women, in women with a family history of breast or ovarian cancer, and in women with a personal history of breast cancer. All patients diagnosed with invasive fallopian tube cancer should be considered candidates for genetic testing.
A few years ago, I was asked to write a paper on ovarian cancer specific to the Survivors' Debate. Carolyn and Tracy were enlisted to co-author the article - a team approach for those who know best. This was the final version which went unpublished. It went unpublished mainly because editorial requests virtually 'sanitized' the article to the point where our message became close to irrelevant. At that point, I declined our involvement. On behalf of my - our friends, Carolyn and Tracy, and with the beneficial advances brought on through social media, here is the final and unedited version.
Authors:
Carolyn Benivegna*, Tracy Gorden*, Sandi Pniauskas (*with us in spirit)
During her research for a presentation
concerning cancer patients’ voices in healthcare, SandiPniauskas
took special notice of a paper published by an expert panel that included the following
statement: "Patients or their representatives should not attend the Multidisciplinary
Cancer Conference to ensure unbiased case review" (Report
dated June 2006, www.cancercare.on.ca/pdf/pebcmccf.pdf).
While it would be imprudent to take this
singular and remarkable quote as the “rule du jour,” this philosophy, and
others similar to it, are prevalent in both private perception and in published
literature on cancer survival.
We can be thankful for more enlightened
views, such as this example from the Journal of Health and Social Policy
that, instead, celebrates the voices and contributions of (non-medical) health
educators and activists:
The activists'
efforts wrested control of “authoritative knowledge” that had once
been the sole domain
of the “experts” with advanced medical training. They used
this knowledge to
empower “average” people with medical information…to
promote self help and
engage in civil disobedience, which led to changes in
healthcare delivery (2006;21(3):55-69).
As ovarian cancer survivors
we have learned much over the years.
Average, everyday citizens are taking active roles in their treatments
and educating themselves about this deadly disease. Yet in our view, and through the course of
shedding light on this disease and the experiences of those living with it, it
has become obvious that there is no such thing as an “average” survivor.
Ovarian cancer is not
a new disease; in fact, it has been traced back as far as Egyptian times. Advancements in research, education,
awareness and access to care have gained some momentum, but they have also hit
many roadblocks. As ovarian cancer
survivors with international grassroots connections
to, and support from, other survivors we
regularly discuss where this disease has been, and where it is going. We now feel it is time to move these
behind-the-scenes discussions to open forums.
By being informed and proactive
women with ovarian cancer, we have recognized the value and importance of
conducting our own critical analysis. Most
importantly, we have learned to shift the focus onto the human elements and
burdens of suffering that we experience each day in our communities.
Creating
a public forum for ovarian cancer survivors
As those living with this disease, we dream
of what the future holds in terms of early detection, education, research,
treatment and a cure. This dream has evolved in the form of organizing two
ovarian cancer conferences for October 2007 -- one to be held in Novi, Michigan
(US) and another in Toronto, Ontario (Canada) -- both entitled, “Survivors’ Debate: The Past Decade
in Ovarian Cancer.”
These public meetings are the result of a
collaborative effort by proactive and knowledgeable ovarian cancer survivors
with supporting oncology nurses. They will take place with the understanding
that they will be fully inclusive – everyone is welcome -- but that the focus
will remain on the experiences, needs and concerns of cancer patients and
survivors, their families and friends.
The conferences will take place in two
locations in two countries because our issues are the same: access to care,
awareness, early detection, survival rates and genetics. The directive and
focus of both conferences is to offer a place to exchange ideas honestly and
openly without judgment or bias.
Patients need an environment where they
feel encouraged to discuss the many difficulties they face. Sometimes it is very difficult to find that space
-- a place without fear of retribution, criticism or dismissive attitudes. Patient-to-patient
discussion and counseling offers this environment. It allows for in-depth
dialogue on a variety of topics that detail what strategies work for survivors
and their families and what is not effective. Healthcare settings just do not
currently lend themselves to foster the dialogue that is needed for survivors
that this new forum provides.
However, the conferences will also focus on
creating a public force to expedite change, which can only start with
communication. Born from need – an arena
for discussion for ovarian cancer survivors by survivors -- the “Survivors’
Debate” has taken form.
But while the conferences are about patients
speaking for themselves they are not speaking by themselves. With this
new forum for dialogue, debate and discussion, we can highlight the detailed
knowledge and expertise of our international ovarian cancer community with
almost a decade of experience behind us, and explain why, as a community, we
work. But we will also be able to explore the variety of reasons why what is
needed by survivors and their friends and families is not currently being translated
into caregiving.
Our ovarian cancer survivor connections and
bonds have formed through the years by enduring extreme challenges and personal
losses. The only bias we have as survivors is the bias to endure and to survive
to the best of our abilities, not only as individuals but, importantly, as a
community. To be very blunt, previously this has included much silent
suffering.
It is long past due that we take our real
issues into a public forum and encourage everyone to participate. We plan to
make some long overdue noise at these debates about ovarian cancer, and we
envision that these two scheduled events are only the beginning of a completely
new trend in ovarian cancer activism.
Ovarian cancer is a serious and under-recognized threat to women's
health which kills more women than all of the gynaecologic cancers
combined. The lifetime risk of contracting
ovarian cancer is one in seventy. Ovarian cancer is very treatable when caught early, but the
vast majority of cases are not diagnosed until too late, which means that while
it is not as common as some other cancers, it remains a woman’s cancer with a
poor survival rate.
Unfortunately, an early detection test still remains elusive and
contrary to public perception, the PAP test is not a screening test for ovarian
cancer. Efforts to diagnose ovarian cancer is through a combination of: tumor
marker test (called the CA125), a bimanual pelvic/rectal exam and transvaginal
ultrasound. Actual confirmation of the diagnosis of ovarian cancer is confirmed
with surgery and pathology reports (eg. Laboratory tests on tissues specimens).
When ovarian cancer is caught before it has spread beyond the ovaries 80-90% of
women will survive five years. When diagnosed after the disease has spread, the
chance of five-year survival drops to approximately 20-30% or less.
Signs and symptoms
Symptoms of ovarian cancer are nonspecific
and mimic those of many other more common conditions. However, as a result of the original work in
1999 of Cindy Melancon
, RN
(who died of ovarian cancer in 2003) and DrBarbaraGoff, it has now been established that
both early and advanced stage ovarian cancer do have recognizable symptoms.
A consensus expert panel convened earlier
this year concluded that the following four symptoms are much more likely to
occur in women with ovarian cancer than women in the general population:
* Bloating;
* Pelvic or abdominal pain;
* Difficulty eating or feeling full quickly;
* Urinary symptoms (urgency or frequency).
Several other symptoms have been commonly
reported by women with ovarian cancer, as well; these symptoms include fatigue,
indigestion, back pain, pain with intercourse, constipation and menstrual
irregularities. A woman should consult with
a health care professional if any of these symptoms persist or feel abnormal.
What you can do
* Understand your family history (e.g., ovarian, breast, colorectal
cancer,endometrial cancers);
*
Educate yourself and understand ovarian cancer as it relates to your
specific diagnosis;
*
Communicate your concerns with your healthcare professional;
*
Recognize and support other ovarian cancer women/families in your
community;
*
Join an online support or face-to-face support group;
*
Join a cancer organization or a program in your community and/or
hospital.
Ovarian cancer
is not a silent disease – speak up and speak out
Have a look:
ACOR – Ovarian Cancer Mailing List
(ASSOCIATION OF CANCER ONLINE RESOURCES
An adverse event is any undesirable experience associated with the use of a medical product in a patient. The event is serious and should be reported when the patient outcome is:
Death
Report if the patient's death is suspected as being a direct outcome of the adverse event. Life-Threatening
Report if the patient was at substantial risk of dying at the time of the adverse event or it is suspected that the use or continued use of the product would result in the patient's death.
Examples: Pacemaker failure; gastrointestinal hemorrhage; bone marrow suppression; infusion pump failure which permits uncontrolled free flow resulting in excessive drug dosing. Hospitalization (initial or prolonged)
Report if admission to the hospital or prolongation of a hospital stay results because of the adverse event.
Examples: Anaphylaxis; pseudomembranous colitis; or bleeding causing or prolonging hospitalization.
Disability
Report if the adverse event resulted in a significant, persistent, or permanent change, impairment, damage or disruption in the patient's body function/structure, physical activities or quality of life.
Examples: Cerebrovascular accident due to drug-induced hypercoagulability; toxicity; peripheral neuropathy.
Congenital Anomaly
Report if there are suspicions that exposure to a medical product prior to conception or during pregnancy resulted in an adverse outcome in the child.
Examples: Vaginal cancer in female offspring from diethylstilbestrol during pregnancy; malformation in the offspring caused by thalidomide. Requires Intervention to Prevent Permanent Impairment or Damage
Report if you suspect that the use of a medical product may result in a condition which required medical or surgical intervention to preclude permanent impairment or damage to a patient.
Examples: Acetaminophen overdose-induced hepatotoxicity requiring treatment with acetylcysteine to prevent permanent damage; burns from radiation equipment requiring drug therapy; breakage of a screw requiring replacement of hardware to prevent malunion of a fractured long bone.
FDA to Communicate Safety Monitoring Activities to Consumers and Health Care Professionals New website will contain safety reports on recently approved drugs, biologics
prIME Oncology invites you to view important Clinical SpotlightsSM on new ovarian cancer data just released from the 2010 Oncology Annual Meeting in Chicago.
View an expert analysis with Gini Fleming, MD, and Bradley Monk, MD, and a supplemental perspective and discussion with Bradley Monk, MD, and Michael Birrer, MD, PhD,
regarding newly released data concerning targeting angiogenesis in the
treatment of ovarian cancer as reported in the GOG-0218 trial.
An eNewsflash and downloadable slide deck highlighting these new data accompany these interviews.
"Immunohistochemistry helps in the distinction between SCTs of the ovary and other primary or metastatic ovarian neoplasms with eosinophilic and clear-cell histology. In addition, immunohistochemistry can confirm the presence of recurrent SCT, if no sufficient clinical history is provided. As some SCTs can be positive for epithelial markers and histologically similar epithelial tumors can be positive for sex cord stromal markers, the use of multiple immunohistochemical stains is recommended."
"...Did that create a chain reaction! Fox
Run’s Paul Benivegna, a Korean War veteran who chairs the
community’s hobby shop, got to work designing a veterans-themed float..." cont'd
1) study period - "We calculated age-cancer-specific screening rates for ages 40-60 using the Canadian Community Health Survey (2003 and 2005), a cross-sectional, nationally representative survey of health status, health care utilization and health determinants in the Canadian population."
2) includes: breast, mammography, PSA
Note: abstract onlyOR = overall risk; 1.0+ denotes an increased risk; in this study, mucinous cell type was the key finding Methods:Associations were evaluated in the Ovarian Cancer Association Consortium, including 16 studies of 5,593 epithelial ovarian carcinoma cases and 9,962 controls of white non-Hispanic origin.
Results: The five polymorphisms were not associated with ovarian carcinoma overall ; however, associations for the minor allele at TYMS rs495139 were observed for carcinomas of mucinous type (OR, 1.19; 95% CI, 1.03-1.39; P = 0.02), clear cell type (OR, 0.86; 95% CI, 0.75-0.99; P = 0.04), and endometrioid type (OR, 0.90; 95% CI, 0.81-0.99; P = 0.04; Pheterogeneity = 0.001). Restriction to low-grade mucinous carcinomas further strengthened the association for the mucinous type (OR, 1.32; 95% CI, 1.07-1.62; P = 0.01). TYMS rs495139 was not associated with serous type (OR, 1.06; 95% CI, 1.00-1.13; P = 0.05).
Conclusions:TYMS rs495139 may be associated with a differential risk of ovarian carcinoma types, indicating the importance of accurate histopathologic classification.
Impact: Biomarkers that distinguish ovarian carcinoma types are few, and TYMS rs495139 may provide a novel clue to type etiology.
"....governed by the duty to put patients first..." Note: background on Steven Lewis:
Bio:
Steven Lewis is a health policy and research consultant based in Saskatoon, and Adjunct Professor of Health Policy at the University of Calgary and Simon Fraser University (where he was Visiting Scholar from January to April 2007). Prior to resuming a full-time consulting practice he headed a health research granting agency and spent 7 years as CEO of the Health Services Utilization and Research Commission in Saskatchewan. He has served on various boards and committees, including the Governing Council of the Canadian Institutes of Health Research, the Saskatchewan Health Quality Council, the Health Council of Canada, and the editorial boards of several journals, including the newly launched Open Medicine. His published work covers topics such as reforming and strengthening medicare, improving health care quality, primary health care, regionalization, and the management of wait times.
Conclusions
Combination therapy is administered more often than carboplatin; especially in those with younger age, better PS and nonmucinous histology. Recurrence and death rates were similar with both treatments. Well-designed trials are needed to identify the optimum chemotherapy regimen in this group.
Conclusions:
The major conclusions related to the overall benefits and risks of MHT expressed as the number of women per 1000 taking MHT for 5 yr who would experience benefit or harm. Primary areas of benefit included relief of hot flashes and symptoms of urogenital atrophy and prevention of fractures and diabetes. Risks included venothrombotic episodes, stroke, and cholecystitis. In the subgroup of women starting MHT between ages 50 and 59 or less than 10 yr after onset of menopause, congruent trends suggested additional benefit including reduction of overall mortality and coronary artery disease. In this subgroup, estrogen plus some progestogens increased the risk of breast cancer, whereas estrogen alone did not. Beneficial effects on colorectal and endometrial cancer and harmful effects on ovarian cancer occurred but affected only a small number of women. Data from the various Women's Health Initiative studies, which involved women of average age 63, cannot be appropriately applied to calculate risks and benefits of MHT in women starting shortly after menopause.
At the present time, assessments of benefit and risk in these younger women are based on lower levels of evidence.
Introduction Inhibition of Angiogenesis for Anticancer Purposes Process of Carcinogenesis and Subsequent Tumor
Angiogenesis Angiopoietins and TIE Receptors Delta/Jagged-Notch Signaling HIF Antiangiogenesis Compounds Inhibitors of Growth Factors, RTKs, and Signaling
Pathways Monoclonal Antibodies Directed at EGFRPI3K/AKT/mTOR Pathway Inhibitors MAPK-Farnesyltransferase Rho and Ras InhibitorsHIF Pathways and Binding... Known and Potential Side Effects From the Inhibition of
AngiogenesisConclusions References
Conclusions:
The complex molecular pathways that govern tumor angiogenesis are logical targets for pharmacological manipulation given the important role they play in the growth and development of cancers.
The quality of oncologic pathology testing currently is focused on the evaluation of testing steps involved in the ordering, procuring, processing, interpreting, reporting, and decision making based on pathology test results. Most errors in cancer diagnosis are related to several factors and not simply a pathologist's interpretation. Clinical practitioners may improve the safety of oncologic pathology testing services by facilitating communication between clinical services and pathology laboratories at all levels of testing.
We have shown an association between tamoxifen and its metabolites and estrogen serum levels. An impact of CYP2C19 predicted activity on tamoxifen, as well as estrogen kinetics may partly explain the observed association between tamoxifen and its metabolites and estrogen serum levels. Since the role of estrogen levels during tamoxifen therapy is still a matter of debate further prospective studies to examine the effect of tamoxifen and estrogen kinetics on treatment outcome are warranted."
"SGO Practice Survey Task Force Chairman James Orr, MD, said in a news release, “The information in this report is a useful tool not only to current, practicing gynecologic oncologists with regard to how their practice composition relates to their peers, but also has important implications for individuals considering a career in this subspecialty, medical schools interested in creating a specialty program, and hospitals and health systems investigating the addition of specialized cancer care to their women's health care programs.”"
50% from baseline) in 11 (31%) patients, with a median
duration of response of 113 days.*>"
Click here to view the interviews, eNewsflash, and downloadable slide deck
from this data release.
