Keywords (article) : Early onset colorectal cancer, Microsatellite instability, Lynch syndrome, Microsatellite stable colorectal cancer
Sunday, August 08, 2010
How to Avoid a Heart Attack: Putting It All Together -Journal of the American Osteopathic Association
Note: this is not specific to treatment-related cardiovascular concerns
Conclusion
The central question posed in the letter to the editor by Juhl et al2 is whether supplements of vitamins E and C and the B vitamins have demonstrated an evidence-based reduction in patients' cardiovascular risk. Unfortunately, the authors' criticism of the perceived deficiencies of a previously published study1 does not constitute evidence to support their position; it serves only to point out those perceived flaws.
Multiple meta-analyses and reviews of published medical literature have convincingly established that there are few, if any, objective, evidence-based, well-designed trials to support the use of supplements of vitamins E or C or those in the B family to reduce risk of cardiovascular events. Furthermore, I am unaware of any study that advocates the use of these supplements to help patients or to rejuvenate our ailing medical delivery system.
If Dr Juhl and his coauthors2 seek to establish the medical value of these supplements, I would recommend that they design, participate in, and publish a study to establish their yet unproven hypothesis. Until such a goal is accomplished, my opinion (shared by researchers at the Mayo Clinic,3 the Cleveland Clinic,5 the AHRQ,12 and the American Heart Association19) is that published evidence clearly does not support the use of vitamins E, C, B6, B9, or B12 to improve patients' cardiovascular health.
A prospective study of dietary acrylamide intake and the risk of breast, endometrial, and ovarian cancers — Cancer Epidemiology, Biomarkers & Prevention
WHO website: What is acrylamide?
Abstract
Background
Acrylamide is a probable human carcinogen formed during cooking of many common foods. Epidemiological studies of acrylamide and breast cancer risk have been null; however, positive associations with ovarian and endometrial cancers have been reported. We studied acrylamide intake and risk of breast, endometrial, and ovarian cancers in a prospective cohort study.
Methods
We assessed acrylamide intake among 88,672 women in the Nurses' Health Study using food frequency questionnaires administered every four years. Between 1980 and 2006 we identified 6301 cases of invasive breast cancer, 484 cases of invasive endometrial adenocarcinoma, and 416 cases of epithelial ovarian cancer. We used Cox proportional hazards models to study the association between acrylamide and cancer risk.
Results
We found no association between acrylamide intake and breast cancer overall or according to estrogen and progesterone receptor status. We found an increased risk of endometrial cancer among high acrylamide consumers (adjusted relative risk [RR] for highest versus lowest quintile=1.41, 95% CI: 1.01-1.97, p-value for trend=0.03). We observed a non-significant suggestion of increased risk for ovarian cancer overall (RR 1.25, CI: 0.88-1.77, p-trend=0.12), with a significantly increased risk for serous tumors (RR 1.58, CI: 0.99-2.52, p-trend=0.04). Associations did not differ by smoking status.
Conclusions
We observed no association between acrylamide and breast cancer. Risk of endometrial cancer and possibly ovarian cancer was greater among high acrylamide consumers.
Impact
This is the second prospective study to report positive associations with endometrial and ovarian cancers. These associations should be further evaluated to inform public health policy.
abstract: (Aug 6, 2010) Histotype predicts the curative potential of radiotherapy: the example of ovarian cancers
Blogger's Note:
1) assumption - WAR (whole abdominal radiation - low dose/dosage; 2) ratio of cell types/RT; 3) study time period; 'apparent' stage 1/11; 4) surgical intervention by ?; 5) primary and/or secondary surgical debulking; 6) 'enhanced' as a %..... many questions in the absence of the full paper
Background: To explore the influence of ovarian cancer histotype on the effectiveness of adjuvant radiotherapy (RT).
Methods: A review of a population-based experience included all referred women with no reported macroscopic residuum following primary surgery who underwent adjuvant platin-based chemotherapy (CT), with or without sequential RT, and for whom it was possible to assign histotype according to the contemporary criteria.
Results: Seven hundred and three subjects were eligible, of these 351 received RT. For those with apparent stage I and II tumors, the cohort with clear cell (C), endometrioid (E), and mucinous (M) disease who additionally received RT exhibited a 40% reduction in disease-specific mortality and a 43% reduction in overall mortality.
Conclusions: The curability of those with stage I and II C-, E-, and M-type ovarian carcinomas was enhanced by RT-containing adjuvant therapy. This benefit did not extend to those with stage III or serous tumors. These findings necessitate reassessments of the role of RT and of the nonselective surgical and CT approaches that have characterized ovarian cancer care.
Are we keeping research participants safe enough? Canadian Medical Association Journal - Editorial
"There is no question that research participants need protection. But regulations have grown so burdensome that they are overwhelming the very things they are meant to support and safeguard. Consequently, clinical research has been substantially decreased among industrialized countries."
abstract: How to follow-up patients with epithelial ovarian cancer : Current Opinion in Oncology
How to follow-up patients with epithelial ovarian cancer
Miller, Rowan E; Rustin, Gordon JS
Abstract
Purpose of review: Despite optimal primary treatment most patients with advanced epithelial ovarian cancer will relapse. This review discusses the controversy regarding surveillance and the timing of treatment for recurrent disease.
Recent findings: Routine physical examination has a limited role in the detection of recurrent ovarian cancer. PET/computed tomography (CT) has been shown to be useful in detecting small volume disease not apparent on traditional imaging in patients with suspected recurrence based on symptoms and/or rising CA125. The results of PET/CT can alter treatment plans and have particular use in guiding site-directed therapy. The benefits of early detection and systemic treatment of recurrence are now in doubt following the presentation of the MRC/EORTC CA125 surveillance trial. The impact on survival of secondary cytoreductive surgery requires more investigation.
Summary: Uncertainties remain in the surveillance and timing of treatment for relapsed disease. Patients should be informed of these uncertainties and become involved in decisions regarding their follow-up.
Saturday, August 07, 2010
full free access: Landes Bioscience Journals: Cancer Biology & Therapy "Where's the Passion?"
Scott E. Kern
The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; Baltimore, MD USA 2010
Note: click on pdf for full free access
......"During the survey period, off-site laypersons offer comments on my observations. “Don’t the people with families have a right to a career in cancer research also?” I choose not to answer. How would I? Do the patients have a duty to provide this “right", perhaps by entering suspended animation?"
"Could “doused passion” be the major bottleneck impairing medical research?".....
website: Patient Power: Program Replay Library > Date > August 2010
8/4/2010 - Webcast
Participatory Evidence: Opportunities & Threats
Download MP3 | Request a Transcript | In medicine, evidence separates modern scientific treatment from Folk Art. Medical evidence is acquired through observation, experimentation, and information sharing in scientific peer-reviewed journals. When new treatments are used, millions of patients around the world provide additional evidence for what works and what doesn't.
In our new world of instant information exchange and empowered patients, how are clinicians and empowered patients challenging traditional ways to collect, evaluate, and publish evidence? What evidence should we trust? This program, moderated by Peter Frishauf, frames the issues and proposes at least one solution to sorting through the evidence puzzle.
Guests:
Peter Frishauf, Founder of MedscapeRichard Smith, M.D., Director of the Ovations Initiative
Jessie Gruman, Ph.D., President, Center for the Advancement of Health
Larry Green, DrPH, ScD(Hon.), Professor of Epidemiology and Biostatstics, UCSF Helen Diller Family Comprehensive Cancer Center
abstract: DNA copy numbers profiles in affinity-purified ovarian clear cell carcinoma (research/pathology)
Note: in research
CONCLUSIONS: This study provides the first high resolution, genome-wide view of DNA copy number alterations in ovarian CCC. The findings provide a genomic landscape for future studies aimed at elucidating the pathogenesis and developing new target-based therapies for CCCs.
Abstract
PURPOSE: Advanced ovarian clear cell carcinoma (CCC) is one of the most aggressive ovarian malignancies, in part because it tends to be resistant to platinum-based chemotherapy. At present, little is known about the molecular genetic alterations in CCCs except that there are frequent activating mutations in PIK3CA. The purpose of this study is to comprehensively define the genomic changes in CCC based on DNA copy number alterations.
EXPERIMENTAL DESIGN: We performed 250K high-density single nucleotide polymorphism array analysis in 12 affinity-purified CCCs and 10 CCC cell lines. Discrete regions of amplification and deletion were also analyzed in additional 21 affinity-purified CCCs using quantitative real-time PCR.
RESULTS: The level of chromosomal instability in CCC as defined by the extent of DNA copy number changes is similar to those previously reported in low-grade ovarian serous carcinoma but much less than those in high-grade serous carcinoma. The most remarkable region with DNA copy number gain is at chr20, which harbors a potential oncogene, ZNF217. This discrete amplicon is observed in 36% of CCCs but rarely detected in serous carcinomas regardless of grade. In addition, homozygous deletions are detected at the CDKN2A/2B and LZTS1 loci. Interestingly, the DNA copy number changes observed in fresh CCC tissues are rarely detected in the established CCC cell lines.
CONCLUSIONS: This study provides the first high resolution, genome-wide view of DNA copy number alterations in ovarian CCC. The findings provide a genomic landscape for future studies aimed at elucidating the pathogenesis and developing new target-based therapies for CCCs.
abstract: FDG-PET/CT in advanced ovarian cancer staging: Value and pitfalls in detecting lesions in different abdominal and pelvic quadrants compared with laparoscopy
CONCLUSION:
Our results suggest that PET/CT may prove a useful tool for pre-surgical staging of ovarian cancer with a sensitivity and specificity of 78 and 68%, respectively. However, it may be used in combination with laparoscopy for better results. PET/CT showed an adequate correlation between SUVmax values and laparoscopy findings of lesions >5mm, but a high rate of false negative results in lesions <5mm such as in carcinomatosis. PET/CT should be used carefully in early stage disease, with low risk of peritoneal infiltration, because of high rate of false positive results, to avoid unnecessary therapy procedures.
abstract: Messenger RNA expression and methylation of candid tumor suppressor genes and risk of ovarian cancer (serous cell type)
Note: edited stats for ease of reading (italics)
Abstract
To investigate the association of expression and promoter methylation of tumor-suppressor genes with risk of ovarian cancer, we conducted a case-control study of 102 patients with serous epithelial ovarian cancer and 100 patients without ovarian cancers.
We measured mRNA expression levels (by real-time reverse transcription polymerase chain reaction) and methylation status (by methylation-specific polymerase chain reaction) of five candidate genes (BRCA1, BRCA2, hMLH1 (Lynch Syndrome gene) , MGMT, and DNMT3B) in tumors from the cases and normal ovaries from the controls.
We found that mRNA expression levels of the five genes were decreased in tumors than in normal ovaries with 0.39-fold for BRCA1, 0.25-fold for BRCA2, 0.42-fold for hMLH1, 0.45-fold for MGMT, and 0.87-fold for DNMT3B, calculated by the 2(-DeltaDeltaCT) method.
Ovarian cancer risk (odds ratios, ORs) was associated with low expression of all genes
2.95 for BRCA1,
3.65 for BRCA2,
5.25 for hMLH1 (one of the Lynch Syndrome genes)
However, methylation status was not associated with gene expression levels in the tumors, except for hMLH1 whose mean (+/- SD) gene expression was significantly lower in methylated (13.0 +/- 7.6) than in unmethylated (31.2 +/- 44.8) tumors (P < 0.001).
We concluded that low mRNA expression of these tumor-suppressor genes, likely due to molecular mechanisms in addition to the promoter methylation in some instances, may be a biomarker for ovarian cancer risk in this study population. Larger studies are needed to validate our findings.
Advanced Studies in Oncology Webcast: Evidenced based management of Chemotherapy Induced Febrile Neutropenia
define: Febrile neutropenia: the development of fever, often with other signs of infection
link to webcast
Abstract/free full access: Scope of nanotechnology in ovarian cancer therapeutics
Note: in research/technical
Abstract
This review describes the use of polymer micelle nanotechnology based chemotherapies for ovarian cancer. While various chemotherapeutic agents can be utilized to improve the survival rate of patients with ovarian cancer, their distribution throughout the entire body results in high normal organ toxicity. Polymer micelle nanotechnology aims to improve the therapeutic efficacy of anti-cancer drugs while minimizing the side effects.
Conclusions
Polymer micelle nanotechnology has demonstrated that nanoparticles are capable of loading anti-cancer drugs which can be specifically targeted to tumors through the conjugation of tumor specific antibody/moiety. Multi-functional polymer micelles, including nanogels/magnetic based micelles, possess characteristics which could improve ovarian cancer therapy. These formulations have capabilities of MRI visible targeting, targeted photodynamic therapy, thermosensitive therapy and luminescence/nearinfrared/
multi-model imaging properties, which will allow tracking and monitoring of nanoformulations and accumulated drug(s) at the tumor site during the therapy procedure.
Friday, August 06, 2010
Medical News: Anesthesia Given by Nurses Found Safe - in Anesthesiology, Anesthesiology from MedPage Today
The analysis -- funded by the American Association of Nurse Anesthetists -- looked at what happened after Medicare allowed opting out in 2001.
The study was financed by the American Association of Nurse Anesthetists.
The authors did not report any potential conflicts but declared themselves to be "wholly responsible for the data, analyses, and conclusions."
The authors did not report any potential conflicts but declared themselves to be "wholly responsible for the data, analyses, and conclusions."
Seth's Blog: Are you a bullfrog in a china shop?
"They make a lot of noise but don't break anything.
They're annoying but not dangerous.
They create a swirl but no impact.
They don't ship."
They're annoying but not dangerous.
They create a swirl but no impact.
They don't ship."
Quality of life and meaning of life: measuring the unmeasurable
Note: see Einstein's quote at the top of this blog
Abstract
Quality of life (QoL) in medicine and in oncology is an accepted parameter for the evaluation of the benefit of treatments. Scientific methods exist to assess QoL measures in clinical trials. However, many components of the person that are properly humane and determine the patient’s attitude towards the disease are not measured by current criteria. Based on clinical experience, the author considers that a shift in knowledge and in doctors’ attitudes is required to also include non-measurable parameters in the doctor-patient relationship.
Journal Issue (index) Journal of Medicine and the Person
Note: there are numerous articles of interest, but, subscription required $$$
abstract: Characteristics of older newly diagnosed cancer patients refusing cancer treatments
Note: the abstract does not include what criteria was used to define "older"
Conclusion
The majority of older newly diagnosed cancer patients underwent the recommended cancer treatment but partial or complete cancer treatment refusal in older newly diagnosed cancer patients was not uncommon.
abstract: Ranked importance of outcomes of first-line versus repeated chemotherapy among ovarian cancer patients
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 traditionalmedical 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.
Thursday, August 05, 2010
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.
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.
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.
Wednesday, August 04, 2010
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
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.
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.
Tuesday, August 03, 2010
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
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.Applications will be accepted on a rolling basis; please apply early!
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.
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."
Sunday, August 01, 2010
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
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 |
| Rank | Status | Study | ||||
|---|---|---|---|---|---|---|
| 1 | Recruiting | Study Comparing Tumor Debulking Surgery Versus Chemotherapy Alone in Recurrent Platinum-Sensitive Ovarian Cancer
| ||||
| 2 | Recruiting | Study With Wee-1 Inhibitor MK-1775 and Carboplatin to Treat Ovarian Cancer
| ||||
| 3 | Not yet recruiting | Study for Women With Platinum Resistant Ovarian Cancer Evaluating EC145 in Combination With Doxil® (PROCEED)
| ||||
| 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
| ||||
| 5 | Recruiting | Pemetrexed Disodium and Docetaxel in Treating Patients With Advanced Solid Tumors
| ||||
| 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
| ||||
| 7 | Recruiting | Analysis of Tumors From Patients With Inherited Cancers Having Had Two Surgeries (Primary + Recurrent, or 2 Separate Types of Cancer)
| ||||
| 8 | Recruiting | Heated Chemotherapy for Cancers That Have Spread to the Chest Cavity
| ||||
| 9 | Recruiting | Deferasirox for Treating Patients Who Have Undergone Allogeneic Stem Cell Transplant and Have Iron Overload
|
Saturday, July 31, 2010
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.
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