abstract: Ranked importance of outcomes of first-line versus repeated chemotherapy among ovarian cancer patients

Purpose  

To examine the importance of possible outcomes of first-line versus repeated chemotherapy to ovarian cancer patients and to compare doctors' treatment intentions with patients' beliefs about cure.

Methods  

Women with newly diagnosed (74) or relapsed (48) ovarian cancer were prospectively followed over 2 years. The level of importance they ascribed to four chemotherapy outcomes and their beliefs about cure were assessed. Their doctors independently specified intent of successive treatments.

Results  

Approximately half (54%) of newly diagnosed ovarian cancer patients (65% with residual disease >2 cm and 49% with no or ≤2 cm residual disease) ranked ‘tumour shrinkage (or decrease in blood levels of CA125)’ as ‘most important’ during first-line chemotherapy. Approximately two thirds (65–70%) of all women whose disease had relapsed also ranked ‘tumour shrinkage’ as ‘most important’ during repeated chemotherapy. Few women (<8%) rated symptom relief or absence of side-effects as most important. While both patients' and doctors' belief about cure decreased over successive treatments, patients grew more optimistic relative to doctors over time. Women's reports of advice by doctors about cure were consistent with doctors' stated intents for repeat chemotherapy. However, discordance between doctors' actual treatment intent and patients' beliefs about cure increased from 24% at first-line to 83% by fourth-line chemotherapy.

Conclusions  

Women prioritise tumour response as the most important outcome of chemotherapy for ovarian cancer. This priority predominates in women with residual and relapsed disease despite declining likelihood of cure. Women may still hope for a cure while acknowledging their doctor's advice that their disease is incurable.

Correlation of extreme drug resistant assay results and progression-free survival following intraperitoneal chemotherapy for advanced ovarian cancer (Oncotech assay)

Abstract

The aim of this study was to determine if in vitro extreme drug resistance (EDR) to platinum and/or taxane chemotherapy was predictive of patient response to intraperitoneal (I.P.) chemotherapy in patients with stage III or recurrent epithelial ovarian cancer (EOC).

Fifty-six patients were retrospectively identified who underwent optimal cytoreductive surgery for primary or recurrent eOC and then received at least three cycles of either intravenous (I.V.) or I.P. chemotherapy with platinum and paclitaxel-based chemotherapy. EDR to platinum and/or paclitaxel was determined using a commercially available assay (Oncotech, Inc., Tustin, CA).

The primary outcome measure was progression-free survival (PFS).

Twenty-nine (52%) patients received I.P. chemotherapy and 27 (48%) received I.V. chemotherapy. The patients were well matched in terms of age, stage, grade and histology. Ten (35%) patients in the I.OP. arm and ten (37%) patients in the I.V. arm showed EDR to either platinum and/or paclitaxel. Median PFS for all I.P. chemotherapy patients was 23 months, compared with 13 months for those receiving I.V. chemotherapy (p = 0.04).

Patients with EDR to platinum and/or taxane who underwent I.V. chemotherapy had a median PFS of 13.5 months, whereas those who underwent I.P. treatment had a median PFS of 15 months (p = 0.69). Median overall survival had not been reached at the time of analysis. No significant difference in PFS was noted between patients who underwent I.P. and those who underwent I.V. chemotherapy when EDR was predicted to either platinum or paclitaxel or both. These data suggest that the decision to offer I.P. chemotherapy, with the attendant increase in morbidity, in the setting of EDR to platinum and/or taxane chemotherapy, may not be beneficial. 

Prospective studies, preferably analyzing platinum or taxane EDR individually, are required to validate these observations.

Weekly paclitaxel in the treatment of recurrent ovarian cancer - abstract

Abstract:

Weekly paclitaxel is a highly active and well tolerated regimen that is increasingly being adopted for the treatment of relapsed ovarian cancer. This regimen is usually administered at 80-90 mg/m(2)/week, and the use of a 1 h infusion helps minimize myelosuppression. When compared with the 3-weekly schedule, weekly paclitaxel is better tolerated, with a reduced frequency of grade 3-4 toxic effects. Single-agent weekly paclitaxel for relapsed ovarian cancer yields response rates in the range of 20-62%; however, response duration can be short. Responses to weekly paclitaxel have been observed in patients whose tumors are resistant to 3-weekly paclitaxel. The level of activity of weekly paclitaxel for relapsed disease has led to its detailed evaluation in the first-line setting, and interest has been enhanced by the results of a Japanese Gynecological Oncology Group study that demonstrated a survival advantage for weekly paclitaxel compared with 3-weekly paclitaxel in combination with carboplatin as initial treatment. The enhanced efficacy of weekly paclitaxel may be due to greater drug exposure, a direct antiangiogenic effect, or both. Current research topics include the combination of weekly paclitaxel with molecular-targeted agents and the use of molecular profiling to better select patients for treatment.

Second-line treatment of first relapse recurrent ovarian cancer.Australian and New Zealand Journal of Obstetrics and Gynaecology abstract

Review Article

cytoreductive surgery • intraperitoneal chemotherapy • ovarian cancer
ABSTRACT

First-line therapy of advanced ovarian cancer involves primary cytoreductive surgery and adjuvant systemic chemotherapy. Progression of incompletely resected disease or recurrence after cytoreduction is inevitable. The approach to second-line treatment is ill-defined and chemotherapy remains the conventional approach, with surgery being reserved in some patients to debulk or palliate symptoms. Increasing evidence suggests that secondary cytoreduction improves progression-free and overall survival. This approach may be appropriate in selected patients. Intraperitoneal chemotherapy delivered in the adjuvant setting postoperatively has been shown to be more effective than systemic chemotherapy in advanced ovarian cancer after primary surgery. However, its use has not been well accepted and has not been adopted in secondary surgery. Hyperthermic intraperitoneal chemotherapy delivered intraoperatively during surgery has been of clinical interest and may prove to be efficacious and advantageous. The support of the gynaecological cancer medical and surgical community to embrace the efforts and assist in the recruitment of appropriate patients into randomised trials of first relapse recurrent ovarian cancer will provide answers to questions and establish evidence that would impact the care of ovarian cancer patients.

full free access: Women's Constructions of the 'Right Time' to Consider Decisions about Risk-Reducing Mastectomy and Risk-Reducing Oophorectomy (B.C.)

Methods (abstract): 

In-depth interviews were conducted with 22 BRCA1/2 carrier women and analyzed using qualitative, constant comparative methods. 

pdf file (free access):

A women-centred approach addresses issues beyond traditional
medical interventions, placing health in its broad social context, and also addresses barriers to access and respects women’s diversity [55]. Although risk-reducing surgery decisions are women’s decisions, women should not be saddled with the burden of tackling barriers to accessing health care services.
Health care professionals, health care organizations, and government must work hard to resolve these challenges.

 

Cochrane Journal Club

Index of Cochrane Journal Club articles

Finally – no more searching for relevant and interesting papers to discuss at your next journal club meeting! We provide everything you need to present the paper at your Journal Club meeting over that much needed cup of coffee.
Cochrane Journal Club is a free, monthly publication that introduces a recent Cochrane review, together with relevant background information, a podcast explaining the key points of the review, discussion questions to help you to explore the review methods and findings in more detail, and downloadable PowerPoint slides containing key figures and tables. You can even contact the review authors with your questions. 

Aimed at trainees, researchers and clinicians alike, every Cochrane Journal Club article is specially selected from the hundreds of new and updated reviews published in each issue of The Cochrane Library representing diverse clinical topics, and each one focuses on a review of special interest, such as practice-changing reviews, new methodology and evidence-based practice.

Self-monitoring and self-management of oral anticoagulation (Clinical) - Cochrane Journal Club

P L A I N  L A N G U A G E  S U M M A R Y

In conclusion, self-monitoring or self-management can improve the quality of oral anticoagulant therapy, leading to fewer thromboembolic
events and lower mortality, without a reduction in the number of major bleeds. Self-monitoring and self-management are not
feasible for all patients, which requires the identification and education of suitable patients.

Slipstream - When Patients Meet Online, Are There Side Effects? - NYTimes.com

Prognostic Relevance of Uncommon Ovarian Histology (abstract) multinational study

 Note:   and stage 1/11??;  see abstract for authors

Prognostic Relevance of Uncommon Ovarian Histology in Women With Stage III/IV Epithelial Ovarian Cancer.

BACKGROUND::
The prognostic relevance of uncommon epithelial ovarian cancer (EOC) histological subtypes remains controversial. The Gynecologic Cancer InterGroup (GCIG) initiated this meta-analysis to assess the relative prognosis of women with a diagnosis of rare EOC histologies from completed, prospectively randomized studies performed by cooperative GCIG study groups.

METHODS::
Studies eligible for analysis included first-line treatment of at least 150 patients with stage III/IV EOC treated with a platinum/taxane-based regimen. Collaborating groups were to provide patient-level data. Serous acted as the reference histology, and a proportional hazards model was used to estimate the relative rate of progression or death.

RESULTS::
Data on 8704 women with stage III/IV EOC from 7 randomized trials were included in these analyses. Two hundred twenty-one patients (2.5%) had clear cell carcinoma; 264 (3.0%), mucinous; and 36 (0.4%), transitional cell. The mean age of patients with serous histology was greater than those with mucinous (4.1 years) and clear cell (2.6 years, P < 0.001). Mucinous, clear cell, and transitional cell tumors were more likely to be completely resected than serous (P < 0.05). When controlling for age and residual disease, mucinous and clear cell tumors had shorter times to progression (hazards ratio [HR], 2.1; 95% confidence interval [CI], 1.8-2.4 and HR, 1.6; 95% CI, 1.4-1.9, respectively) and death (HR, 2.7; 95% CI, 2.3-3.1 and HR, 2.2; 95% CI, 1.8-2.6, respectively) compared with serous. The median overall survival for serous, clear cell, mucinous, and endometrioid histologies were 40.8, 21.3, 14.6, and 50.9 months.

CONCLUSIONS:: Mucinous and clear cell carcinomas are independent predictors of poor prognosis in stage III/IV EOC. Studies targeting these rare histological subtypes are warranted and will require significant intergroup collaboration.

abstract : Whole blood-derived miRNA profiles as potential new tools for ovarian cancer screening : British Journal of Cancer

Conclusion:

Our proof-of-principle study strengthens the hypothesis that neoplastic diseases generate characteristic miRNA fingerprints in blood cells. Still, the obtained OvCA-associated miRNA pattern is not yet sensitive and specific enough to permit the monitoring of disease progression or even preventive screening. Microarray-based miRNA profiling from peripheral blood could thus be combined with other markers to improve the notoriously difficult but important screening for OvCA.

abstract: EvidenceUpdates (Review) including professional commentaries: Drug and dietary interactions of the new and emerging oral anticoagulants

full free access: World Jnl Gastroenterology-Approach to early-onset colorectal cancer: Clinicopathological, familial, molecular and immunohistochemical characteristics

 World Journal of Gastroenterology - link to article    

Keywords (article) : Early onset colorectal cancer, Microsatellite instability, Lynch syndrome, Microsatellite stable colorectal cancer

How well can a screening test predict disease risk? « Genomes Unzipped

Low Frequency of Lynch Sydrome among Young Patients with Non-Familial Colorectal Cancer

Note: "young" referred to as those less than 50 yrs age

NCCN: online survey regarding patient assistance programs

NCCN Trends is a tool to help assess the opinions and habits of oncology patients, caregivers, case managers, and other groups.  This survey includes questions about patient assistance programs.  Results from this survey will help NCCN and the oncology community develop patient assistance programs and tools.

To participate in this month's survey, click:
http://www.surveymonkey.com/s.aspx?sm=Gjm3p1VQ7MPKULplsmwhTQ_3d_3d 

Answering the questions should take less than five minutes. Submit your answers by August 18, and by September 18, all responders will find out what the most common answers were for each question.  Only those individuals who participate will receive the results. All responses will be kept completely anonymous.

Please note that the aggregate results of the survey may be used with third party collaborators, including those individuals who participate in the survey. The results will always be presented ONLY in the format of an aggregated data report where the responses and identification of individual responders will not be possible. 

If you do not wish to receive further e-mails through SurveyMonkey related to NCCN Trends surveys or any other NCCN surveys, please click here: 


NCCN Trends 
National Comprehensive Cancer Network 
275 Commerce Drive, Suite 300 
Fort Washington, PA 19034 
+1 (215) 690-0300 

Ovarian malignant melanoma: a clinicopathologic study of 5 cases (abstract)

Surgical management of ovarian disease in infants, children, and adolescents: a 15-year review

RESULTS: A total of 231 patients were evaluated in this study, with a mean age of 12.8 years (range, 3 weeks to 20 years). There were 221 (95.7%) benign lesions and 10 (4.3%) were malignant.

Targeting annexin A4 to counteract chemoresistance in clear cell carcinoma of the ovary

Take home message: Annexin A4 enhances cancer cell chemoresistance and is overexpressed in tumors of patients with ovarian CCC. Targeting of annexin A4 may represent a future strategy to counteract resistance to chemotherapy in ovarian CCC.

he role of neoadjuvant chemotherapy in the management of patients with advanced stage ovarian cancer: Survey results from members of the SGO (Society of Gynecologic Oncologists)

Learning about ovarian cancer at the time of diagnosis: Video versus usual care

Upstaging pathologic stage I ovarian carcinoma based on dense adhesions is not warranted: A clinicopathologic study of 84 patients originally originally classified as FIGO stage II

Note: very interesting study, albeit abstract

 

Abstract

BACKGROUND: 

FIGO stage II ovarian cancer comprises 8% of ovarian cancers. It is a common but not universal practice to upstage densely adherent pathologic stage I tumors to stage II. FIGO guidelines are not clear, and data supporting this practice are sparse.

METHODS:

We retrospectively reviewed patients with stage II ovarian cancer and grouped them based upon histologic evidence of extraovarian extension. Tumors densely adherent to extraovarian structures but without histologic tumor outside the ovary were considered pathologic stage I. All others were considered surgical-pathologic stage II. Three histologic patterns of extraovarian tumor involvement were identified.

RESULTS:

Eighty-four patients were studied. Twenty-four patients had pathologic stage I disease and 60 had histologic evidence of extraovarian pelvic spread and were surgical-pathologic stage II. The 5-year survival for stage I was 100%, and the median survival was not reached. The 5-year survival for those with surgical-pathologic stage II disease was 56.8% and the median survival was 73months. There were no differences observed based upon pattern of extraovarian spread. The survival difference between pathologic stage I and surgical-pathologic stage II was significant (p<0.001). There were no differences seen in 5-year survival among surgical-pathologic stage II patients with serous, endometrioid or clear cell histologies (64.5%, 64.8% and 64.3% respectively).

CONCLUSION:

These retrospective data suggest that the practice of upstaging densely adherent pathologic stage I tumors to stage II may not be warranted. Cell type is not a prognostic factor in stage II.

Characteristics and survival associated with ovarian cancer diagnosed as first cancer and ovarian cancer diagnosed subsequent to a previous cancer

Abstract

Objective:
To examine the risk of subsequent primary ovarian cancer among women diagnosed previously with cancer (subsequent cohort) and to compare demographic and tumor characteristics affecting overall survival of these women and women diagnosed with first primary ovarian cancer (index cohort).


Methods: 
We identified the two cohorts of women using the 1973-2005 Surveillance, Epidemiology and End Results (SEER) result data. We calculated relative risk of subsequent primary ovarian cancer and estimated 5-year risks of dying (hazard-ratios) after diagnosis of the first or subsequent primary ovarian cancer in the two cohorts, respectively using Cox modeling.


Results:
Women diagnosed with index cancers of the corpus uteri, colon, cervix, and melanoma at age younger than 50 had increased risk of ovarian cancer within 5 years after diagnosis (p<0.05); young breast cancer survivors had continued risk beyond 20 years. In 5-year follow-up survival analysis, the factors associated with a better survival (p<0.05) were similar in both cohorts and included more recent diagnosis; localized or regional disease; age <50 years at diagnosis; and being white versus black. A lower risk of dying from mucinous, endometrioid, or non-epithelial tumors than from serous was seen after 15 months (p<0.01), or after 32 months from diagnosis of the index and subsequent cohorts, respectively. (clear cell??)


Conclusions:
Age, stage, and histology affect ovarian cancer survival. The increased risk of ovarian cancer over time, especially among breast and colon cancer survivors who are less than 50 years of age, suggests common etiologies and necessitates careful surveillance by health care providers and increased survivors awareness through educational efforts.

(Avastin) Bevacizumab-induced small bowel perforation in a patient with breast cancer without intraabdominal metastases (abstract)

incoming President - Message from Annette Leal Mattern, President of the Board | Ovarian Cancer National Alliance

"I am greatly honored to be chosen to serve as President of the Board of Directors of the Ovarian Cancer National Alliance. It is an appointment that I accept with grave responsibility and great optimism. Most especially, I am encouraged by my colleagues, a board and staff of dedicated professionals who give their time and talents to this cause because they believe, as do I, that one day we will change the horror that is ovarian cancer....."cont'd

Also (background):
"Annette Leal Mattern, an ovarian cancer survivor and a member of the Ovarian Cancer National Alliance, was first diagnosed with the disease 23 years ago and has battled and survived reoccurrences ever since."

MabCure, Inc. Files Provisional Patent in the U.S. for Ovarian Cancer Antibodies - press release/financial news

"In a blinded study of 54 blood samples, MabCure's MAbs correctly diagnosed 16 of the 17 ovarian cancers with a diagnostic sensitivity of 94 percent and 100 percent specificity. The samples were comprised of 17 patients with ovarian cancer, 5 patients with benign tumors of the ovaries, 24 healthy young females and 8 males.

"Beyond the value of our test to diagnose ovarian cancer in a highly accurate manner and with no false positives, the potential value of our proprietary MAbs is also in helping to identify tumor-specific antigens or cancer-specific targets for the ultimate treatment of ovarian cancer," said Gonenne."

Genetic Alliance: Upcoming Advocates Partnership Program Opportunities sponsorship deadline August 20th

Upcoming Advocates Partnership Program Opportunities

The Advocates Partnership Program aims to foster new connections among members of the genetics community. Highlights for participants include engaging in thought-provoking discussions and attending exclusive daily briefings with professionals working in your area of interest.

Acceptance into the Advocates Partnership Program also includes:

• waived full registration to the NSGC Annual Conference and ASHG Annual Meeting
• reimbursement for up to $250 for transportation, hotel accommodations, or airfare

---

Now accepting applications for the Advocates Partnership Program at the NSGC Annual Education Conference – October 14-17 in Dallas, TX.

Deadline for applications: Friday, August 20, 2010
Applications will be accepted on a rolling basis; please apply early!

For the preliminary conference program, please go to: www.nsgc.org/conferences/aec.cfm.

The culture of faith and hope. Patients' justifications for their high estimations of expected therapeutic benefit when enrolling in early phase oncology trials (abstract)

BACKGROUND:
Patients' estimates of their chances of therapeutic benefit from participation in early phase trials greatly exceed historical data. Ethicists worry that this therapeutic misestimation undermines the validity of informed consent.

CONCLUSIONS:
Expressions of high expected therapeutic benefit had little to do with reporting knowledge and more to do with expressing optimism. These results have implications for understanding how to obtain valid consent from participants in early phase clinical trials.

Access : Awareness of ovarian cancer risk factors, beliefs and attitudes towards screening -baseline survey of 21,715 women participating in the UK Collaborative Trial of Ovarian Cancer Screening : British Journal of Cancer

Note: this study shows awareness levels in women who were wishing to enroll in a clinical trial program as opposed to the numerous surveys which have been done in the general population eg. the results would differ

Background:
Women's awareness of ovarian cancer (OC) risks, their attitudes towards and beliefs about screening, together with misunderstandings or gaps in knowledge, may influence screening uptake.

Methods:
In total, 21 715 post-menopausal women completed questionnaires before randomisation into the UK Collaborative Trial of Ovarian Cancer Screening.

abstract: The impact of socioeconomic status on stage of cancer at diagnosis and survival. Cancer Aug 2, 2010 (does not include ovarian cancer)

"A population-based study in Ontario, Canada"

METHODS:
All incident cases of breast, colon, rectal, nonsmall cell lung, cervical, and laryngeal cancer diagnosed in Ontario during the years 2003-2007 were identified by using the Ontario Cancer Registry.

CONCLUSIONS:
Despite universal healthcare, SES remains associated with survival among patients with cancer in Ontario, Canada. Disparities in outcome were not explained by differences in stage of cancer at time of diagnosis.

Germline Genetic Variation, Cancer Outcome, and Pharmacogenetics -- abstract (references Lynch/BRCAs)

ABSTRACT
Studies of the role of germline or inherited genetic variation on cancer outcome can fall into three distinct categories. First, the impact of highly penetrant but lowly prevalent mutations of germline DNA on cancer prognosis has been studied extensively for BRCA1 and BRCA2 mutations as well as mutations related to hereditary nonpolyposis colorectal cancer syndrome (Lynch Syndrome). These mainly modest-sized analyses have produced conflicting results. Although some associations have been observed, they may not be independent of other known clinical or molecular prognostic factors. Second, the impact of germline polymorphisms on cancer prognosis is a burgeoning field of research. However, a deeper understanding of potentially confounding somatic changes and larger multi-institutional, multistage studies may be needed before consistent results are seen. Third, research examining the impact of germline genetic variation on differential treatment response or toxicity (pharmacogenetics) has produced some proof-of-principle results. Putative germline pharmacogenetic predictors of outcome include DPYD polymorphisms and fluorouracil toxicity, UGT1A1 variation and irinotecan toxicity, and CYP2D6 polymorphisms and tamoxifen efficacy, with emerging data on predictors of molecularly targeted or biologic drugs. Here we review data pertaining to these germline outcome and germline toxicity relationships. (full text requires $$/subscription)

Curis (financial news) - phase 11 advanced ovarian cancer results Aug 2010 (hedgehog pathway inhibitor)

CAMBRIDGE, Mass., Aug 03, 2010 (BUSINESS WIRE) -- Curis, Inc. /quotes/comstock/15*!cris/quotes/nls/cris (CRIS 1.75, -0.02, -1.13%) , a drug development company seeking to develop next generation targeted small molecule drug candidates for cancer treatment, today reported its financial results for the second quarter ended June 30, 2010.

"Although we were disappointed to announce during the second quarter of 2010 that the topline results from Genentech and Roche's Phase II clinical trial with the hedgehog pathway inhibitor GDC-0449 in metastatic colorectal cancer indicated that the trial did not meet its primary endpoint, we are encouraged that Genentech is testing GDC-0449 in two additional tumor types, which should provide more information on its potential in cancers where we believe the Hedgehog pathway acts via different mechanisms of action," said Dan Passeri, Curis' President and Chief Executive Officer. "We expect that results will be available from the Phase II advanced ovarian cancer trial in the very near term and that we will communicate the topline results within August...."cont'd

Editorial - Current Opinion in Oncology Sept 2010 issue (ovarian cancer/gyn)

In this issue, we present two generic themes: the first relates to managing patients with ovarian cancer and Glenn McCluggage presents an excellent review of the difficult area of diagnosing and categorizing borderline tumours of the ovary. No multidisciplinary meeting is complete without clinicians asking their pathologist difficult questions relating to the significance of the different appearances that can occur in this group of tumours and whether patients should receive further staging and treatment and how they should be followed up. Glenn McCluggage describes the clinical significance of the different subtypes and appearances and he presents a very clear exposition of the field which will be extremely helpful to clinicians. In this issue, we also take a broad look at ovarian cancer in terms of a review of current thoughts on first-line therapy from Dr D'Hondt and colleagues and an article focused on relapsed disease. The era of targeted therapies in oncology is well and truly upon us and ovarian cancer is very much part of this therapeutic revolution with the development of PARP inhibitors for patients with BRACA mutations and defects. Data are emerging very quickly on the usefulness of PARP inhibition and Stan Kaye and colleagues give an excellent summary of the current position.

Gordon Rustin sets the results of his trial on early versus late treatment of relapsed disease in the wider context of follow-up strategies. The debate relating to the follow-up of patients with ovarian cancer has always been one that has simmered in the background but with the release of the data from Professor Rustin's trial the whole issue of the management of patients following the completion of first-line therapy, has become an area of great interest and much argument. As a companion article, we have an excellent update presented by Drs Moore and MacLaughlan on biomarkers in epithelial ovarian cancer. This sets into context some of the recent data on new biomarkers and their possible usefulness in the important area of ovarian cancer screening.

Many of the most hotly argued controversies in cancer relate to the treatment of patients with early disease. The balance between not compromising potentially curative therapy and causing unnecessary long-term morbidity in cured patients is one that can be very difficult to ascertain because often the data are not mature or available due to the lengthy follow-up required before definitive answers emerge. We present controversies in three areas of gynaecological malignancy relating to the management of early stage disease namely vulva cancer, cervical cancer and endometrial cancer. Professor van der Zee and colleagues describe the current status of sentinel node biopsy for early stage vulva cancer and Drs Al-Mansour and Verschraegen give a very complete review of the data relating to locally advanced cervical cancer and give clinicians clear recommendations. Finally, the issue of the management of lymph nodes in uterine cancer is excellently discussed by Drs Delpech and Barranger.

This issue is very full with a lot of data presented but the authors have described often very complex areas with real clarity and the conclusions that they draw will help all of us who are practising physicians in the area of gynaecological oncology manage our patients better.

Weight, Physical Activity, Diet, and Prognosis in Breast and Gynecologic Cancers JCO (abstract)

ABSTRACT

Diet, physical activity, and weight may affect prognosis among women who are diagnosed with breast or gynecologic cancer. Observational studies show associations between being overweight or obese and weight gain with several measures of reduced prognosis in women with breast cancer and some suggestion of poor prognosis in underweight women. Observational studies have shown an association between higher levels of physical activity and improved breast cancer–specific and all-cause mortality, although a dose-response relationship has not been established. One large randomized controlled trial reported increased disease-free survival after a mean of 5 years in patients with breast cancer randomly assigned to a low-fat diet versus control. However, another trial of similar size found no effect from a high vegetable/fruit, low-fat diet on breast cancer prognosis. The few reported studies suggest that obesity negatively affects endometrial cancer survival, while the limited data are mixed for associations of weight with ovarian cancer prognosis. Insufficient data exist for assessing associations of weight, physical activity, or diet with prognosis in other gynecologic cancers. Associations of particular micronutrient intake and alcohol use with prognosis are not defined for any of these cancers. The effects of dietary weight loss and increase in physical activity on survival or recurrence in breast and gynecologic cancers are not yet established, and randomized controlled trials are needed for definitive data.

PARP inhibition: targeting the Achilles' heel of DNA repair..PARP inhibition: targeting the Achilles' heel of DNA repair to treat germline and sporadic ovarian cancers

abstract: How to follow-up patients with epithelial ovarian cancer : Current Opinion in Oncology

Abstract: Red meat and colorectal cancer: a critical summary of prospective epidemiologic studies.

"Colinearity between red meat intake and other dietary factors (e.g. Western lifestyle, high intake of refined sugars and alcohol, low intake of fruits, vegetables and fibre) and behavioural factors (e.g. low physical activity, high smoking prevalence, high body mass index) limit the ability to analytically isolate the independent effects of red meat consumption. Because of these factors, the currently available epidemiologic evidence is not sufficient to support an independent positive association between red meat consumption and colorectal cancer."

Abstract: The role of body mass index, physical activity, and diet in colorectal cancer recurrence and survival: a review of the literature.

"In conclusion, only a paucity of data is available about the effect of dietary and other lifestyle factors on colorectal cancer recurrence and survival. Thus far, no clear conclusions can be drawn. Future studies are warranted, particularly on postdiagnosis BMI and diet."

Acute Pain Caused by Paclitaxel (Taxol) in Patients With Cancer - Full Text View - ClinicalTrials.gov

clinical trial: Attitudes About Childbearing And Fertility With Inherited Breast And Ovarian Cancer Syndromes (HBOC) - Full Text View - ClinicalTrials.gov

Purpose

Objectives:

- To evaluate the attitudes and opinions of women undergoing genetic counseling for hereditary breast and ovarian cancer syndrome, both before and after testing, in regards to pregnancy and fertility

ongoing clinical trial: Women Who Are At Risk Or May Have Lynch Syndrome - Full Text View - ClinicalTrials.gov

Search of: ovarian cancer | Open Studies | received on or after 07/01/2010 - List Results - ClinicalTrials.gov

Found 9 studies with search of:

ovarian cancer | Open Studies | received on or after 07/01/2010

Include studies that are not seeking new volunteers.

Display Options

Rank	Status	Study
1	Recruiting	Study Comparing Tumor Debulking Surgery Versus Chemotherapy Alone in Recurrent Platinum-Sensitive Ovarian Cancer Conditions: Fallopian Tube Cancer; Ovarian Cancer; Peritoneal Cavity Cancer Intervention: Procedure: Tumor Debulking Surgery (surgery in recurrent ovarian disease)
2	Recruiting	Study With Wee-1 Inhibitor MK-1775 and Carboplatin to Treat Ovarian Cancer Condition: Epithelial Ovarian Cancer Intervention: Drug: MK-1775 and carboplatin
3	Not yet recruiting	Study for Women With Platinum Resistant Ovarian Cancer Evaluating EC145 in Combination With Doxil® (PROCEED) Condition: Ovarian Cancer Interventions: Drug: EC145; Drug: Pegylated Liposomal Doxorubicin (PLD/Doxil®/Caelyx®); Drug: placebo; Drug: EC20
4	Not yet recruiting	Paclitaxel and Carboplatin With or Without Bevacizumab in Treating Patients With Stage III or Stage IV Ovarian Epithelial Cancer, Primary Peritoneal Cancer, or Fallopian Tube Cancer Conditions: Fallopian Tube Cancer; Ovarian Cancer; Peritoneal Cavity Cancer Interventions: Drug: carboplatin; Drug: paclitaxel
5	Recruiting	Pemetrexed Disodium and Docetaxel in Treating Patients With Advanced Solid Tumors Conditions: Breast Cancer; Esophageal Cancer; Gastric Cancer; Head and Neck Cancer; Lung Cancer; Ovarian Cancer; Prostate Cancer Interventions: Drug: docetaxel; Drug: pemetrexed disodium
6	Recruiting	Low-Fiber Diet or High-Fiber Diet in Preventing Bowel Side Effects in Patients Undergoing Radiation Therapy for Gynecological Cancer, Bladder Cancer, Colorectal Cancer, or Anal Cancer Conditions: Anal Cancer; Bladder Cancer; Cervical Cancer; Colorectal Cancer; Fallopian Tube Cancer; Gastrointestinal Complications; Ovarian Cancer; Radiation Toxicity; Sarcoma Interventions: Dietary Supplement: dietary intervention; Other: laboratory biomarker analysis; Procedure: gastrointestinal complications management/prevention; Procedure: management of therapy complications; Radiation: selective external radiation therapy
7	Recruiting	Analysis of Tumors From Patients With Inherited Cancers Having Had Two Surgeries (Primary + Recurrent, or 2 Separate Types of Cancer) Conditions: Breast Cancer; Ovarian Cancer Intervention:
8	Recruiting	Heated Chemotherapy for Cancers That Have Spread to the Chest Cavity Conditions: Pleural Metastases; Breast Cancer; Colon Cancer; Ovarian Cancer; Uterine Cancer; Renal Cell Cancer; Thymic Cancer Intervention: Procedure: Surgical debulking and Intrathoracic Hyperthermic Chemotherapy
9	Recruiting	Deferasirox for Treating Patients Who Have Undergone Allogeneic Stem Cell Transplant and Have Iron Overload Conditions: Iron Overload; Accelerated Phase Chronic Myelogenous Leukemia; Adult Acute Lymphoblastic Leukemia in Remission; Adult Acute Myeloid Leukemia in Remission; Adult Acute Myeloid Leukemia With 11q23 (MLL) Abnormalities; Adult Acute Myeloid Leukemia With Del(5q); Adult Acute Myeloid Leukemia With Inv(16)(p13;q22); Adult Acute Myeloid Leukemia With T(15;17)(q22;q12); Adult Acute Myeloid Leukemia With T(16;16)(p13;q22); Adult Acute Myeloid Leukemia With T(8;21)(q22;q22); Atypical Chronic Myeloid Leukemia, BCR-ABL Negative; Blastic Phase Chronic Myelogenous Leukemia; Chronic Eosinophilic Leukemia; Chronic Myelomonocytic Leukemia; Chronic Neutrophilic Leukemia; Chronic Phase Chronic Myelogenous Leukemia; De Novo Myelodysplastic Syndromes; Disseminated Neuroblastoma; Extranodal Marginal Zone B-cell Lymphoma of Mucosa-associated Lymphoid Tissue; Myelodysplastic/Myeloproliferative Neoplasm, Unclassifiable; Nodal Marginal Zone B-cell Lymphoma; Noncontiguous Stage II Adult Burkitt Lymphoma; Noncontiguous Stage II Adult Diffuse Large Cell Lymphoma; Noncontiguous Stage II Adult Diffuse Mixed Cell Lymphoma; Noncontiguous Stage II Adult Diffuse Small Cleaved Cell Lymphoma; Noncontiguous Stage II Adult Immunoblastic Large Cell Lymphoma; Noncontiguous Stage II Adult Lymphoblastic Lymphoma; Noncontiguous Stage II Grade 1 Follicular Lymphoma; Noncontiguous Stage II Grade 2 Follicular Lymphoma; Noncontiguous Stage II Grade 3 Follicular Lymphoma; Noncontiguous Stage II Mantle Cell Lymphoma; Noncontiguous Stage II Marginal Zone Lymphoma; Noncontiguous Stage II Small Lymphocytic Lymphoma; Poor Prognosis Metastatic Gestational Trophoblastic Tumor; Previously Treated Myelodysplastic Syndromes; Primary Myelofibrosis; Recurrent Adult Acute Lymphoblastic Leukemia; Recurrent Adult Acute Myeloid Leukemia; Recurrent Adult Burkitt Lymphoma; Recurrent Adult Diffuse Large Cell Lymphoma; Recurrent Adult Diffuse Mixed Cell Lymphoma; Recurrent Adult Diffuse Small Cleaved Cell Lymphoma; Recurrent Adult Hodgkin Lymphoma; Recurrent Adult Immunoblastic Large Cell Lymphoma; Recurrent Adult Lymphoblastic Lymphoma; Recurrent Cutaneous T-cell Non-Hodgkin Lymphoma; Recurrent Grade 1 Follicular Lymphoma; Recurrent Grade 2 Follicular Lymphoma; Recurrent Grade 3 Follicular Lymphoma; Recurrent Malignant Testicular Germ Cell Tumor; Recurrent Mantle Cell Lymphoma; Recurrent Marginal Zone Lymphoma; Recurrent Mycosis Fungoides/Sezary Syndrome; Recurrent Neuroblastoma; Recurrent Ovarian Epithelial Cancer; Recurrent Ovarian Germ Cell Tumor; Recurrent Small Lymphocytic Lymphoma; Refractory Chronic Lymphocytic Leukemia; Refractory Hairy Cell Leukemia; Relapsing Chronic Myelogenous Leukemia; Secondary Acute Myeloid Leukemia; Secondary Myelodysplastic Syndromes; Splenic Marginal Zone Lymphoma; Stage I Multiple Myeloma; Stage II Multiple Myeloma; Stage II Ovarian Epithelial Cancer; Stage III Adult Burkitt Lymphoma; Stage III Adult Diffuse Large Cell Lymphoma; Stage III Adult Diffuse Mixed Cell Lymphoma; Stage III Adult Diffuse Small Cleaved Cell Lymphoma; Stage III Adult Hodgkin Lymphoma; Stage III Adult Immunoblastic Large Cell Lymphoma; Stage III Adult Lymphoblastic Lymphoma; Stage III Chronic Lymphocytic Leukemia; Stage III Grade 1 Follicular Lymphoma; Stage III Grade 2 Follicular Lymphoma; Stage III Grade 3 Follicular Lymphoma; Stage III Malignant Testicular Germ Cell Tumor; Stage III Mantle Cell Lymphoma; Stage III Marginal Zone Lymphoma; Stage III Multiple Myeloma; Stage III Ovarian Epithelial Cancer; Stage III Small Lymphocytic Lymphoma; Stage IIIA Breast Cancer; Stage IIIB Breast Cancer; Stage IIIC Breast Cancer; Stage IV Adult Burkitt Lymphoma; Stage IV Adult Diffuse Large Cell Lymphoma; Stage IV Adult Diffuse Mixed Cell Lymphoma; Stage IV Adult Diffuse Small Cleaved Cell Lymphoma; Stage IV Adult Hodgkin Lymphoma; Stage IV Adult Immunoblastic Large Cell Lymphoma; Stage IV Adult Lymphoblastic Lymphoma; Stage IV Breast Cancer; Stage IV Chronic Lymphocytic Leukemia; Stage IV Grade 1 Follicular Lymphoma; Stage IV Grade 2 Follicular Lymphoma; Stage IV Grade 3 Follicular Lymphoma; Stage IV Mantle Cell Lymphoma; Stage IV Marginal Zone Lymphoma; Stage IV Ovarian Epithelial Cancer; Stage IV Small Lymphocytic Lymphoma Intervention: Drug: deferasirox

Medical News: FDA Warns of Cure-All Product Based on Bleach - in Product Alert, OTC from MedPage Today

"The FDA has warned consumers not to use a product called Miracle Mineral Solution -- which makes broad health claims -- because it's actually an industrial strength bleach.

"Consumers who have MMS should stop using it immediately and throw it away," the agency urged.

The FDA has received several reports of people who have suffered severe nausea, vomiting, and life-threatening hypotension after drinking a mixture containing the product.

Sometimes labeled as Miracle Mineral Supplement, MMS is 28% sodium chlorite. Its instructions call for consumers to mix it with citrus juice or another acidic substance.

An enormous variety of health claims are made for the product, including treatment of HIV, hepatitis, the H1N1 flu virus, common colds, acne, and cancer.

According to the FDA, the mixture produces chlorine dioxide, a potent bleach used for stripping textiles and industrial water treatment.

At the doses consumers would ingest under these directions, this agent is known to cause nausea, vomiting, diarrhea, and symptoms of severe dehydration, the FDA said.

MMS is distributed on Internet sites and online auctions by multiple independent distributors with varying labels, the agency said..."cont'd

Press Release: Canada's Leading Ovarian Cancer "Patient" Advocate Speaks at Sask Conference

 

OCATS

Ovarian Cancer Awareness & Treatment in Saskatchewan

A SUPPORT & ACTION GROUP FOR ANYONE AFFECTED BY GYNECOLOGIC CANCERS

M E D I A   R E L E A S E

CANADA’S LEADING OVARIAN CANCER “PATIENT” ADVOCATE SPEAKS AT SASK CONFERENCE

For Immediate Release

REGINA, July 26, 2010  - Conference Co-Chairs Scott Livingstone, CEO Sask Cancer Agency and Darlene Gray, President, OCATS, in partnership with CNT Management Group, invite survivors, support people and the medical community to the first ever Gynecologic Cancer Conference, Strategies for Survival on September 24, 2010 at the Regina Inn.  Early Bird registration fees available until the end of July for this important event featuring some of the province’s most knowledgeable specialists in female reproductive cancers.  Experts will address clinical study trials for new drug therapies, managing cancer recurrence, the emotional aspects of cancer diagnoses, identifying families with hereditary risks, alternative and complimentary therapies available and the roles of our nurses, general practitioners, and pharmacists in cancer care delivery.

A conference highlight will be a presentation by Canada’s leading ovarian cancer “patient” advocate, Sandi Pniauskas.  Other experts presenting at the conference include the following.

Dr. Christopher Giede, Gynecologic Oncologist at the Royal University Hospital, Saskatoon and the team leader of Saskatchewan gynecologic oncology team of female reproductive cancer specialists.

Dr. Muhammad Salim, Medical Oncologist at the Allan Blair Cancer Centre, Regina and the specialist of all our Clinical Study Trials. 

Dr. Vicki Holmes, Medical Director of the Women’s Mid-Life Health Centre in Saskatoon. Dr. Holmes developed the concept of this centre and is the resident physician at the centre.

Rosalee Longmoore, RN, a Registered Nurse for 34 years with a wide range of experience on all Saskatchewan medical nursing issues.

Andrew Gilbertson, Pharmacist and owner of Hill Avenue Drugs, Regina, Regina’s first and currently only pharmacy that specializes in compounding custom prescription medications.

Dr. Heather Fox, Naturopath, a health specialist with over 30 years experienced and a registered doctor of Natural Medicine through the Examining Board of Natural Medicine Practitioners, Canada.

Monica Milas, Personal Growth and Healing Services Counsellor and Therapist.

Wendy Stoeber, Genetic Counsellor at the Division of Medical Genetics, Royal University Hospital, Saskatoon.

And a member of the Gynecologic Oncology Program Working Group, Scott Livingstone, the new CEO of the Sask Cancer Agency, will speak about Saskatchewan’s new Gynecologic Oncology Program.

The conference will include an exhibit hall marketplace and be followed by the OCATS Annual Benefit Gala and Silent Auction featuring Jack Semple and presentation of the OCATS 2010 Catleya Award of Collaboration & Vision.  Conference on-line registration at  http://guest.cvent.com/EVENTS/Info/Summary.aspx?e=ce9c4a0f-157e-4a42-ab49-0f19dae902e3. A group guestroom rate is available at the Regina Inn by asking for the OCATS event.  Discounted conference fees available for OCATS members and all students.  For more information please contact Darlene at 306-775-1848 or CNT Management Group Claire Bélanger-Parker [claire.belanger-parker@cntgrp.ca].

For more info contact Darlene Gray at OCATS at 306-775-1848, cell 529-3199 or darlenegray@sasktel.netdarlenegray@sasktel.net

# # #

e-Patients: Changing the Health Care System in Real-Time Tuesday, September 21, 2010 Toronto (Note: fees)

Note: conference fees which would exclude most patients/e-patients from attending

e-Patients: Changing the Health Care System in Real-Time
Tuesday, September 21, 2010
Novotel Toronto Centre
45 The Esplanade
Toronto, Ontario M5E 1W2

Registration
Registration will take place on Tuesday, September 21, 2010,
at 8:30am at the Novotel Toronto Centre, 45 The Esplanade,
Toronto.
Space is not guaranteed, unless payment is received
prior to the event.Registration FeeMember (OHA/OHPA/MOHLTC):
$495.00 + HST $64.35 = Total $559.35
Non-member:
$980.00 + HST $127.40 = Total $1107.40

EvidenceUpdates: Cochrane Collaboration review: Vaccines for preventing influenza in healthy adults including professional commentaries and warning

CONCLUSIONS: Influenza vaccines have a modest effect in reducing influenza symptoms and working days lost. There is no evidence that they affect complications, such as pneumonia, or transmission.

WARNING: This review includes 15 out of 36 trials funded by industry (four had no funding declaration). An earlier systematic review of 274 influenza vaccine studies published up to 2007 found industry funded studies were published in more prestigious journals and cited more than other studies independently from methodological quality and size. Studies funded from public sources were significantly less likely to report conclusions favorable to the vaccines. The review showed that reliable evidence on influenza vaccines is thin but there is evidence of widespread manipulation of conclusions and spurious notoriety of the studies. The content and conclusions of this review should be interpreted in light of this finding.

Also: link to the Cochrane Collaboration review (The Cochrane Library):

Background
Different types of influenza vaccines are currently produced worldwide. Healthy adults are presently targeted mainly in North America.

Objectives
Identify, retrieve and assess all studies evaluating the effects of vaccines against influenza in healthy adults

Authors' conclusions
Influenza vaccines have a modest effect in reducing influenza symptoms and working days lost. There is no evidence that they affect complications, such as pneumonia, or transmission.

WARNING:

This review includes 15 out of 36 trials funded by industry (four had no funding declaration). An earlier systematic review of 274 influenza vaccine studies published up to 2007 found industry funded studies were published in more prestigious journals and cited more than other studies independently from methodological quality and size. Studies funded from public sources were significantly less likely to report conclusions favorable to the vaccines. The review showed that reliable evidence on influenza vaccines is thin but there is evidence of widespread manipulation of conclusions and spurious notoriety of the studies. The content and conclusions of this review should be interpreted in light of this finding.





Plain language summary

Vaccines to prevent influenza in healthy adults
Over 200 viruses cause influenza and influenza-like illness which produce the same symptoms (fever, headache, aches and pains, cough and runny noses). Without laboratory tests, doctors cannot tell the two illnesses apart. Both last for days and rarely lead to death or serious illness. At best, vaccines might be effective against only influenza A and B, which represent about 10% of all circulating viruses. Each year, the World Health Organization recommends which viral strains should be included in vaccinations for the forthcoming season.

Authors of this review assessed all trials that compared vaccinated people with unvaccinated people. The combined results of these trials showed that under ideal conditions (vaccine completely matching circulating viral configuration) 33 healthy adults need to be vaccinated to avoid one set of influenza symptoms. In average conditions (partially matching vaccine) 100 people need to be vaccinated to avoid one set of influenza symptoms. Vaccine use did not affect the number of people hospitalised or working days lost but caused one case of Guillian-Barré syndrome (a major neurological condition leading to paralysis) for every one million vaccinations. Fifteen of the 36 trials were funded by vaccine companies and four had no funding declaration. Our results may be an optimistic estimate because company-sponsored influenza vaccines trials tend to produce results favorable to their products and some of the evidence comes from trials carried out in ideal viral circulation and matching conditions and because the harms evidence base is limited.

Cochrane Collaboration review: Elastic compression stockings for prevention of deep vein thrombosis

Background

One of the settings where deep vein thrombosis (DVT) in the lower limb and pelvic veins occurs is in hospital with prolonged immobilisation of patients for various surgical and medical illnesses. Using graduated compression stockings (GCS) in these patients has been proposed to decrease the risk of DVT.

Objectives

To determine the magnitude of effectiveness of GCS in preventing DVT in various groups of hospitalised patients.

Authors' conclusions

GCS are effective in diminishing the risk of DVT in hospitalised patients. Data examination also suggests that GCS on a background of another method of prophylaxis is more effective than GCS on its own.

Plain language summary

Elastic compression stockings for prevention of deep vein thrombosis during a hospital stay
Hospital patients can develop deep vein thrombosis (DVT) in the legs and pelvic veins immediately after surgery or if they are not mobile because of a medical illness. Symptoms vary from none to pain and swelling in the legs. A blood clot can move from the leg to the lungs with the danger of pulmonary embolism and death. Usually the DVT clears up or has long term effects such as high venous pressure in the leg, leg pain, swelling, darkening of the skin or inflammation.

DVT can be prevented using compression or drugs but drugs may cause bleeding, which is a particular concern in surgical patients. Graduated elastic compression stockings help prevent blood clots forming in the legs by applying varying amounts of pressure to different parts of the leg. Our review confirmed that graduated compression stockings reduce the risk of DVT in hospitalised patients. Our findings also suggest that wearing elastic stockings as well as receiving another method of prophylaxis has increased benefit. We identified 18 randomised controlled trials, eight comparing wearing stockings to no stockings and 10 comparing stockings plus another method with that method alone in patients undergoing surgery. The other methods used were Dextran 70, aspirin, heparin and mechanical sequential compression.

2nd source: EvidenceUpdates: Cochrane Collaboration review; Drug therapy for the management of cancer-related fatigue including professional comment

2010 Cochrane Collaboration Review: Drug therapy for the management of cancer-related fatigue

Blogger's disclaimer/comments:
1) consumer reviewer of this Cochrane Collaboration review; 
2) a special appreciation to our own ovarian cancer survivors for their input/opinions on this issue
                  ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Note: included in the review were recent studies on the side effects of 
erythropoietin and darbopoetin

Abstract

Background

This is an updated version of the original Cochrane review published in issue 1 2008 (Minton 2008). Cancer-related fatigue (CRF) is common, under-recognised and difficult to treat. There have been studies looking at drug interventions to improve CRF but results have been conflicting depending on the population studied and outcome measures used. No previous reviews of this topic have been exhaustive or have synthesised all available data.

Objectives

To assess the efficacy of drugs for the management of CRF.

Authors' Conclusions
There is increasing evidence that psychostimulant trials provide evidence for improvement in CRF at a clinically meaningful level. There is still a requirement for a large scale RCT of methylphenidate to confirm the preliminary results from this review. There is new safety data which indicates that the haemopoietic growth factors are associated with increased adverse outcomes. These drugs can no longer be recommended in the treatment of CRF. Readers of the first review should re-read the document in full.

Plain language summary

Drugs for cancer-related fatigue
Fatigue associated with cancer is a significant problem. It can occur because of side effects of treatment or because of the disease itself. It can have a significant impact on a person's ability to function. The causes of fatigue are not fully understood and so it is very difficult to treat appropriately. This review has examined drug treatment for fatigue as it represents one of the ways this problem can be tackled. The review authors looked at trials in all types of cancer and at all stages of treatment. Fifty studies met the inclusion criteria but only 31 (7104 participants) were deemed suitable for detailed analysis as they explored fatigue in sufficient detail. They found mixed results with some drugs showing an effect on fatigue - most notably drugs that stimulate red blood cell production and also drugs that improve levels of concentration. Methylphenidate, a stimulant drug that improves concentration, is effective for the management of cancer-related fatigue but the small samples used in the available studies mean more research is needed to confirm its role. Erythropoietin and darbopoetin, drugs that improve anaemia, are effective in the management of cancer-related fatigue. However safety concerns and side effects from these drugs mean that they can no longer be recommended to treat cancer fatigue.

abstract: Patients' perceptions of communication with the health care team during chemotherapy for the first recurrence of ovarian cancer

abstract: Continued chemotherapy after complete response to primary therapy among women with advanced ovarian cancer (meta-analysis)

CONCLUSIONS

Although individual studies have not yet convincingly shown a survival advantage with maintenance chemotherapy in OC, this meta-analysis demonstrates that continued chemotherapy after completion of primary therapy for OC improves PFS and OS. Benefits are greatest in patients with advanced stage OC who reach complete clinical or pathologic response after primary therapy.

Ranking prestige of medical diseases | KevinMD.com blogger + link to the study abstract Album/Westin authors

Note: the ranking list includes ovarian cancer but interestingly not breast

Soc Sci Med. 2008 Jan;66(1):182-8. Epub 2007 Sep 12.

Do diseases have a prestige hierarchy? A survey among physicians and medical students.

Album D, Westin S.

University of Oslo, Oslo, Norway. dag.album@sosiologi.uio.no

Abstract

Surveys have shown that the prestige of medical specialities is ordered hierarchically. We investigate whether similar tacit agreement in the medical community also applies to diseases, since such rankings can affect priority settings in medical practice. A cross-sectional survey was performed in three samples of physicians and medical students in Norway in 2002. A questionnaire was sent to 305 senior doctors (response rate, 79%), 500 general practitioners (response rate, 65%) and 490 final-year medical students (response rate, 64%). Outcome measures were ratings on a 1-9 scale of the prestige these respondents believed most health personnel would accord to a sample set of 38 different diseases as well as 23 medical specialities. Both diseases and specialities were clearly and consistently ranked according to prestige. Myocardial infarction, leukaemia and brain tumour were among the highest ranked, and fibromyalgia and anxiety neurosis were among the lowest. Among specialities, neurosurgery and thoracic surgery were accorded the highest rank, and geriatrics and dermatovenerology the lowest. Our interpretation of the data is that diseases and specialities associated with technologically sophisticated, immediate and invasive procedures in vital organs located in the upper parts of the body are given high prestige scores, especially where the typical patient is young or middle-aged. At the other end, low prestige scores are given to diseases and specialities associated with chronic conditions located in the lower parts of the body or having no specific bodily location, with less visible treatment procedures, and with elderly patients.

abstract: (repost) Differences in tumor type in low-stage versus high-stage ovarian carcinomas

Int J Gynecol Pathol. 2010
Köbel M, Kalloger SE, Huntsman DG, Santos JL, Swenerton KD, Seidman JD, Gilks CB; Cheryl Brown (ovarian cancer survivour/deceased) Ovarian Cancer Outcomes Unit of the British Columbia Cancer Agency, Vancouver BC.
Department of Pathology, University of Calgary, Calgary AB, Canada T2N 2T9. martin.kobel@cls.ab.ca


Abstract

Although there are recognized differences in the type of ovarian carcinomas between those tumors diagnosed at low versus high stage, there is a lack of data on stage distribution of ovarian carcinomas diagnosed according to the current histopathologic criteria from large population-based cohorts. We reviewed full slide sets of 1009 cases of 2555 patients diagnosed with ovarian carcinoma that were referred to the British Columbia Cancer Agency over a 16-year period (1984 to 2000).
On the basis of the reviewed cases we extrapolated the distribution of tumor type in low-stage (I/II) and high-stage (III/IV) tumors. We then compared the frequencies with those seen in a large hospital practice.
The overall frequency of tumor types was as follows: high-grade serous-68.1%, clear-cell-12.2%, endometrioid-11.3%, mucinous-3.4%, low-grade serous-3.4%, rare types-1.6%. High-grade serous carcinomas accounted for 35.5% of stage I/II tumors and 87.7% of stage III/IV tumors.
In contrast, clear-cell (26.2% vs. 4.5%), endometrioid (26.6% vs. 2.5%), and mucinous (7.5% vs. 1.2%) carcinomas were relatively more common among the low-stage versus high-stage tumors.
This distribution was found to be very similar in 410 consecutive cases from the Washington Hospital Center. The distribution of ovarian carcinoma types differs significantly in patients with low-stage versus high-stage ovarian carcinoma when contemporary diagnostic criteria are used, with consistent results seen in 2 independent case series. These findings reflect important biological differences in the behavior of the major tumor types, with important clinical implications.

Vascular Endothelial Growth Factor Is a Promising ... [Mol Cancer Ther. 2010] - PubMed result

Mol Cancer Ther. 2010 Jul 27. [Epub ahead of print]

Vascular Endothelial Growth Factor Is a Promising Therapeutic Target for the Treatment of Clear Cell Carcinoma of the Ovary.

Mabuchi S, Kawase C, Altomare DA, Morishige K, Hayashi M, Sawada K, Ito K, Terai Y, Nishio Y, Klein-Szanto AJ, Burger RA, Ohmichi M, Testa JR, Kimura T.

Authors' Affiliations: 1Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine; 2Department of Obstetrics and Gynecology, Osaka Police Hospital; 3Department of Obstetrics and Gynecology, Osaka Medical College, Osaka, Japan; 4Women's Cancer Program, 5Cancer Genetics and Signaling Program, and 6Department of Surgery, Fox Chase Cancer Center, Philadelphia, Pennsylvania; and 7Department of Obstetrics and Gynecology, Kansai Rosai Hospital, Amagasaki, Japan.

Abstract

This study examines the role of vascular endothelial growth factor (VEGF) as a therapeutic target in clear cell carcinoma (CCC) of the ovary, which has been regarded as a chemoresistant histologic subtype. Immunohistochemical analysis using tissue microarrays of 98 primary ovarian cancers revealed that VEGF was strongly expressed both in early-stage and advanced-stage CCC of the ovary. In early-stage CCCs, patients who had tumors with high levels of VEGF had significantly shorter survival than those with low levels of VEGF. In vitro experiments revealed that VEGF expression was significantly higher in cisplatin-refractory human CCC cells (RMG1-CR and KOC7C-CR), compared with the respective parental cells (RMG1 and KOC7C) in the presence of cisplatin. In vivo treatment with bevacizumab (Avastin) markedly inhibited the growth of both parental CCC cell-derived (RMG1 and KOC7C) and cisplatin-refractory CCC cell-derived (RMG1-CR and KOC7C-CR) tumors as a result of inhibition of tumor angiogenesis.
The results of the current study indicate that VEGF is frequently expressed and can be a promising therapeutic target in the management of CCC. Bevacizumab may be efficacious not only as a first-line treatment but also as a second-line treatment of recurrent disease in patients previously treated with cisplatin.
Mol Cancer Ther; 9(8); OF1-12. (c)2010 AACR.

Prevalence of lymph node metastasis in primary mucinous carcinoma of the ovary

Abstract

OBJECTIVE:: To estimate the prevalence of lymph node involvement in women with primary mucinous ovarian carcinomas.
METHODS:: A retrospective study was performed of patients with primary mucinous ovarian carcinomas evaluated at a single institution between 1985 and 2007. A gynecologic oncology pathologist evaluated all cases. Patients with tumors of low malignant potential and mucinous carcinomas metastatic to the ovary from other primary sites were excluded.
RESULTS:: Patients with primary mucinous ovarian carcinomas were identified (n=107). All patients underwent primary surgery. At time of surgery, 93 patients (87%) had tumors that grossly appeared to be confined to the ovary, and 14 patients (13%) had evidence of extraovarian disease. Of the 93 patients with tumors that grossly appeared to be confined to the ovary at surgical exploration, 51 (55%) underwent lymphadenectomy (n=27 pelvic and paraaortic, n=19 pelvic only, n=5 paraaortic only). Of these 51 patients, none had metastatic disease to the pelvic or paraaortic lymph nodes. In addition, there were no significant differences in progression-free survival and overall survival rates between the patients who underwent lymphadenectomy and those who did not.
CONCLUSION:: There were no cases of isolated lymph node metastases among women with primary mucinous carcinoma grossly confined to the ovary, suggesting that routine lymphadenectomy may be omitted in these patients.
LEVEL OF EVIDENCE:: III.
(link to 'levels of evidence': http://www.cancer.gov/cancertopics/pdq/levels-evidence-adult-treatment

New Cancer Treatment Center to Open in Michiana, Indiana - Newsroom

Future Oncology -- Summary: Palonosetron for the prevention of chemotherapy-induced nausea and vomiting in patients with cancer

Drug Evaluation
Palonosetron for the prevention of chemotherapy-induced nausea and vomiting in patients with cancer
Rudolph M Navari‌1,2


Chemotherapy-induced nausea and vomiting (CINV) is associated with a significant deterioration in quality of life. The emetogenicity of the chemotherapeutic agents, repeated chemotherapy cycles and patient characteristics (e.g., female gender, younger age, low alcohol consumption and history of motion sickness) are the major risk factors for CINV. This article provides a detailed description of palonosetron, a second-generation 5-hydroxytryptamine-3 (5-HT3) receptor antagonist, which has been approved for the prevention of acute CINV in patients receiving either moderately or highly emetogenic chemotherapy and for the prevention of delayed CINV in patients receiving moderately emetogenic chemotherapy...... palonosetron in combination with dexamethasone demonstrated better control of delayed CINV in patients receiving highly emetogenic chemotherapy and had a similar safety profile. Owing to its efficacy in controlling both acute and delayed CINV, palonosetron may be very effective in the clinical setting of multiple-day chemotherapy and bone marrow transplantation.

Editorial: The Elusive Goal of Maintaining Population (Breast) Cancer Screening: It Is Time for a New Paradigm JNCI

"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."

Team Continuum - Home - "What We're About" - (NY/Marathon)

Note: the Mission Statement is worthy of note, as a FYI.




What We're About

Team Continuum is dedicated to helping cancer patients and their families minimize the disruptions, hardships and uncertainties of everyday life so that they can focus on crucial medical care. We provide immediate and vital assistance - both practical and personal - every step of the way, such as paying household expenses, offering friendship and moral support, and funding health care facilities to enhance the delivery of care, communications and educational services.

Study Indicates Ginkgo biloba Does Not Reduce the Risk of Cancer [NCCAM Research Results]

Note: age specific/comments

Women Won't Wait - Document Details | What's the Budget? Where's the Staff? (not cancer specific related)

Social networks: The great tipping point test - tech - 26 July 2010 - New Scientist

Racial differences in stage at diagnosis and survival from epithelial ovarian cancer: A fundamental cause of disease approach

Social Science & Medicine

abstract:

Associations between race, socioeconomic status (SES) and health outcomes have been well established. One of the ways in which race and SES affect health is by influencing one’s access to resources, which confers ability to avoid or mitigate adverse outcomes. The fundamental cause of disease approach argues that when a new screening tool is introduced, individuals with greater resources tend to have better access to the innovation, thus benefiting from early detection and leading to better survival.  

Conversely, when there is no established screening tool, racial and SES differences in early detection may be less pronounced.

Most ovarian cancer is diagnosed at advanced stages, because of the lack of an effective screening tool and few early symptoms. However, once detected, racial differences may still be observed in mortality and survival outcomes. We examined the racial differences in diagnosis and survival among ovarian cancer cases diagnosed during 1994–1998, in Cook County, Illinois (N = 351). There were no racial differences in the stage at diagnosis: 51.7% of white and 52.9% of black women were diagnosed at later stages (III and IV). Only age was associated with the stage at diagnosis. Tumor characteristics also did not differ between white and black women. Compared to white women, black women were less likely to be married, less educated, more frequently used genital powder, had tubal ligation, and resided in higher poverty census tracts. As of December 31, 2005, 44.3% of white and 54.5% of black women had died of ovarian cancer. Controlling for known confounding variables, the hazard ratio for ovarian cancer death between black and white women was 2.2. The findings show that fundamental cause perspective provides a potential framework to explore subtleties in racial disparities, with which broader social causes may be accounted for in explaining post diagnosis racial differences.

Genetic Risk Score Associated With Breast Cancer Risk; Predictive of Type of Disease

>“In this large study including 10,306 women with breast cancer and 10,393 without the disease, we confirm that some of the more important common genetic variants for breast cancer have different effects on different tumor types.”

PLoS ONE: Functional Exploration of the Adult Ovarian Granulosa Cell Tumor-Associated Somatic FOXL2 Mutation p.Cys134Trp (c.402C>G)

Conclusions/Significance

Here, we confirm the specificity of the FOXL2 c.402C>G mutation in adult OGCTs and begin the exploration of its molecular significance. This is the first study demonstrating that the p.Cys134Trp mutant does not have a strong impact on FOXL2 localization, solubility, and transactivation abilities on a panel of proven target promoters, behaving neither as a dominant-negative nor as a loss-of-function mutation. Further studies are required to understand the specific molecular effects of this outstanding FOXL2 mutation.

Think tank calls for FDA to forgo approval of drugs cleared by European regulator - media article

2010 Conference | Ovarian Cancer National Alliance - video, pics, information

"In case you missed this year’s Conference, we have provided with you educational materials for you to print and disseminate in your local communities. You can also find video clips and pictures from the Conference using the teal button above. Please check back as this will be updated in the next few days."

Canadian Medicine: Little sympathy for lung cancer patients "Can't we do better?"

blogger's Note: really the question is not can we do better, but why we have not (aside from stigmatization aka: judging others)  given:
1) science's apparent apolitical stance;
2) decision-makers' rationale (evidence based??);
3) politicization of science/results 

"...Heather McQuaid, an oncology social worker maintains that lung cancer patients feel stigmatized. The superficial attitude that gives way to this stigma may very well be the reason why $25 million was invested in breast cancer research in 2007, compared with a paltry $8 million towards lung cancer, directly “impacting on the support these cancer victims receive, particularly from the healthcare system,” according to CEO and President of the Canadian Lung Association, Heather Borquez. Can’t we do better?"