Continental Divide? The Attitudes of US and Canadian Oncologists on the Costs, Cost-Effectiveness, and Health Policies Associated With New Cancer Drugs

Health Services and Outcomes

Continental Divide? The Attitudes of US and Canadian Oncologists on the Costs, Cost-Effectiveness, and Health Policies Associated With New Cancer Drugs

From the Sunnybrook Odette Cancer Center; University of Toronto; Keenan Research Center in the Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute for Clinical Evaluative Sciences, Toronto; McMaster University; Juravinski Cancer Center at Hamilton Health Sciences, Hamilton; Peel Regional Cancer Center, Mississauga, Ontario, Canada; University of Michigan School of Medicine, Ann Arbor, MI; Charles Sammons Cancer Center, Baylor University Medical Center, Dallas, TX; and the Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA.


ABSTRACT

Purpose Oncologists in the United States and Canada work in different health care systems, but physicians in both countries face challenges posed by the rising costs of cancer drugs. We compared their attitudes regarding the costs and cost-effectiveness of medications and related health policy.

Methods Survey responses of a random sample of 1,355 United States and 238 Canadian medical oncologists (all outside of Québec) were compared.

Results Response rate was 59%. More US oncologists (67% v 52%; P < .001) favor access to effective treatments regardless of cost, while more Canadians favor access to effective treatments only if they are cost-effective (75% v 58%; P < .001). Most (84% US, 80% Canadian) oncologists state that patient out-of-pocket costs influence their treatment recommendations, but less than half the respondents always or frequently discuss the costs of treatments with their patients. The majority of oncologists favor more use of cost-effectiveness data in coverage decisions (80% US, 69% Canadian; P = .004), but fewer than half the oncologists in both countries feel well equipped to use cost-effectiveness information. Majorities of oncologists favor government price controls (57% US, 68% Canadian; P = .01), but less than half favor more cost-sharing by patients (29% US, 41% Canadian; P = .004). Oncologists in both countries prefer to have physicians and nonprofit agencies determine whether drugs provide good value. 

(blogger's usual take (based on abstract): and patients in the determination process ??)

 






Conclusion Oncologists in the United States and Canada generally have similar attitudes regarding cancer drug costs, cost-effectiveness, and associated policies, despite practicing in different health care systems. The results support providing education to help oncologists in both countries use cost-effectiveness information and discuss drug costs with their patients.

Role of Vitamin and Mineral Supplementation and Aspirin Use in Cancer Survivors (abstract)

Note: abstract does not reference ovarian cancer "The potential beneficial or adverse effects of dietary supplements and aspirin in survivors of cancer warrant further study."

Review: Practical Considerations in Ovarian Cancer Chemotherapy (Medscape)

From Therapeutic Advances in Medical Oncology

Posted: 08/09/2010; Ther Adv Med Oncol. 2010;2(3):175-187. © 2010 Sage

• Abstract and Introduction
• Overview of Ovarian Cancer
• History of the Modern Treatment of Ovarian Cancer
• IP Chemotherapy
• Managing a Patient on IP Chemotherapy: A Nursing Perspective
• New Directions in Ovarian Cancer Treatment
• Conclusions

• References

e-ESO Online educational resource video (free) "The challenge of ovarian cancer in relapse" video/ESO

Note: requires registration (free)

e-grandround:

The challenge of ovarian cancer in relapse ^{CME accredited}

GR109 - 05 August 2010 - 18:15-19:00 CET
Expert: Eric Pujade-Lauraine, Hospital Hotel-Dieu, Paris, France
Discussant: Fedro A. Peccatori, European Institute of Oncology, Milano, Italy

Abstract: Cervical manifestation of a borderline type ovarian cancer with pseudomyxoma peritonei - a case report

Note: mucinous cell type is a cell type found in numerous organs including colon/rectum Abstract: Borderline tumours of the ovary (BOTs) are rare tumour entities that do not show any destructive or invasive growth in the majority of cases, even though they can display characteristics of malignant tumours The mucinous subtype can also originate from the appendix, and ovarian metastases can mimic primary ovarian BOTs, often accompanied by peritoneal manifestation in terms of pseudomyxoma peritonei. In cases where a concomitant appendiceal tumour is present, it may prove difficult to determine the primary tumour. This report describes a special case of BOT with a specific example of the complexity of the differential diagnosis of pseudomyxoma peritonei. Especially the case was simultaneously linked to appendiceal and ovarian cancer. Moreover, this case was exceptional for its unusual manifestation of BOT in the cervix.

Recurrent Ovarian Cancer: Use of Contrast-enhanced CT and PET/CT to Accurately Localize Tumor Recurrence and to Predict Patients’ Survival1 — Radiology

Abstract

Purpose: To compare accuracy and interobserver variability in the detection and localization of recurrent ovarian cancer with contrast material–enhanced (CE) computed tomography (CT) and positron emission tomography (PET)/CT and determine whether imaging findings can be used to predict survival.

Conclusion: Preliminary data suggest that CE CT and PET/CT may have similar accuracy in detection of recurrent ovarian cancer. Tumor size, number, and SUVmax may have potential as prognostic biomarkers for patients with recurrent ovarian cancer.

Casting light on 25-hydroxyvitamin D deficiency in ovarian cancer: A study from the NHANES (National Health and Nutrition Examination Surveys)

Abstract

Objectives

Ecological studies have long described a higher incidence of ovarian cancer in more extreme latitudes, where sun exposure, and presumably vitamin D exposure, is lower. Basic science studies have also noted polymorphisms of the vitamin D receptor in ovarian cancers. The aim of this study is to examine the relationship of serum vitamin D to ovarian cancer.

Conclusions

Prevalent ovarian cancer cases have lower serum 25-hydroxyvitamin D (25[OH]D) than the general population. Deficiency in vitamin D may provide an etiologic link between the long-known ecologic findings regarding latitude and the basic science noting polymorphisms in the vitamin D receptor.

SGO White Paper Ovarian Education Campaign [INTRODUCTORY PARAGRAPH-Herzog/Coleman] Project I-Background, Screening & Surveillance

Note: this journal requires subscription ($$$)

 Abstract

Ovarian cancer is a heterogeneous, rapidly progressive, highly lethal disease of low prevalence. The etiology remains poorly understood. Numerous risk factors have been identified, the most prominent involving an inherited predisposition in 10% of cases. Women with germline mutations associated with Hereditary Breast/Ovarian Cancer and Lynch syndromes have dramatically elevated risks (up to 46% and 12%, respectively). Risk-reducing salpingo-oophorectomy is the best method to prevent ovarian cancer in these high-risk women. Significant risk reduction is also seen in the general population who use oral contraceptives. Since up to 89% patients with early-stage disease have symptoms prior to diagnosis, increased awareness of the medical community may facilitate further workup in patients who otherwise would have had a delay. Despite enormous effort, there is no proof that routine screening for ovarian cancer in either the high-risk or general populations with serum markers, sonograms, or pelvic examinations decreases mortality. Further evaluation is needed to determine whether any novel biomarkers, or panels of markers, have clinical utility in early detection. Prospective clinical trials have to be designed and completed prior to offering of any of these new diagnostic tests. CA125 is currently the only biomarker recommended for monitoring of therapy as well as detection of recurrence. This commentary provides an overview on the background, screening and surveillance of ovarian cancer.

Objective To identify risk factors for the presence of a non-invasive lesion of the fallopian tube in women with a BRCA1 or BRCA2 mutation (abstract)

Objective

To identify risk factors for the presence of a non-invasive lesion of the fallopian tube in women with a BRCA1 or BRCA2 mutation.

Conclusion

The prevalence of tubal p53 signature and TIC (tubal intra-epithelial carcinoma)  increases with age at salpingectomy and with BMI. Oral contraceptive use is associated with a decrease in the prevalence of TICs.

Partners of long-term gynaecologic cancer survivors: Psychiatric morbidity, psychosexual outcomes and supportive care needs (abstract)

Objective

To describe long-term psychological morbidity, unmet supportive care needs, positive changes, sexual outcomes and relationship satisfaction in partners of gynaecologic cancer survivors, as compared with respective survivors.

Method

Self-report measures were administered to a cross-sectional sample of 68 partners recruited via patient survivors.

Conclusion

The majority of partners reported excellent sexual outcomes and little perceived change since the survivors' diagnosis. The association between unmet needs and psychological morbidity suggests a useful target for further intervention. Despite methodological limitations, these data are novel and present a starting point for further investigation to improve outcomes for survivors and partners.

The National Cancer Database report on advanced-stage epithelial ovarian cancer: Impact of hospital surgical case volume on overall survival and surgical treatment paradigm (abstract)

Objective

To examine the effect of hospital procedure volume and other prognostic variables on overall survival outcome and likelihood of receiving standard recommended care among patients with advanced-stage epithelial ovarian cancer.

Conclusions

Hospital ovarian cancer surgical volume ≥ 21 cases/year is associated with a higher likelihood of patients with Stage IIIC/IV epithelial ovarian cancer receiving standard treatment (surgery followed by adjuvant chemotherapy). Even after adjusting for treatment paradigm and other factors, hospital volume ≥ 21 cases/year was significantly predictive of improved overall survival outcome.

Hospice enrollment for terminally ill patients with gynecologic malignancies: Impact on outcomes and interventions (abstract)

Objective 

To determine survival and interventions for patients with non-curative gynecologic malignancies based on supportive care enrollment.

  
Conclusions
While retrospective reviews evaluating hospice are challenging, our data suggest no detrimental impact on survival for hospice patients. Continued evaluation for patients at the end-of-life is necessary in order to optimize resource utilization.

pilot program - Drug mishap reporting system created for consumers - Canadian Medical Association Journal

Note: the article does not mention until the final statements that this is a pilot project NOR does the website



The new national medication incident reporting system is the first of its kind to directly engage Canadian consumers

http://safemedicationuse.ca/report/index.html

"Health care practitioners and hospitals have been reporting medication incidents using similar tools for years, but there’s never been a formal mechanism to collect incident reports from consumers," says Bonnie Salsman, project lead for the website, which was developed with support from Health Canada.


In the past, if a consumer wanted to report a medication mistake, they had to use a tool designed for health care workers, or else ask a medical practitioner to report the incident on their behalf.


"It wasn’t a consumer-friendly process. It was really difficult for people to get their concerns heard without doing a considerable amount of footwork first," says Salsman. "That there were still patients who took the initiative to report incidents using the practitioner reporting system showed us how helpful a consumer tool would be."


The website offers Canadians a simplified form to report any medication incident involving the use of prescription and nonprescription drugs, natural health products, imported products, or devices used to administer medicine. Consumers can report incidents that occur at any stage in the prescribing, dispensing, administration, or monitoring of a medication. They can also offer their own suggestions on how to avoid similar mishaps in future....cont'd

According to the 2008 Commonwealth Fund International Health Policy Survey of Sicker Adults, 1 in 10 Canadians with health problems have reported receiving the wrong medication or doses when filling a prescription or when hospitalized in the last two years, while nearly 1 in 7 said they had experienced a medication error in the past two years.
The Institute for Safe Medication Practices Canada will continue to monitor the success of the website’s pilot phase in the coming months, and expects to report preliminary results to Health Canada this fall.

ISMP Canada will:

• review your report
• look for system problems that could cause errors to happen
• prepare recommendations that are designed to prevent mistakes with medication
• send recommendations about medication safety to health professionals and consumers
• provide consumer-focused information and tips about medication safety on the SafeMedicationUse.ca website

ISMP Canada will not:

• investigate a complaint on your behalf with an organization or health professional that is responsible for an error in care
• investigate the actions of individual practitioners
• report (for disciplinary purposes) the incident to professional authorities responsible for regulating the practice of health professionals
• release or publish any information that could identify the reporter of an incident, a patient, a health professional or an organization involved in an incident

Ovatax

New Data Demonstrates Effectiveness of Clarient’s Ovatax™ Test for Ovarian Cancer.

See study, titled “Expression of TLE3 Predicts Response to Taxane Therapy in Ovarian Carcinoma,” included 293 carcinoma samples mostly collected at UAB

New Zealand - "Opening Doors" first ever Hereditary Breast and Ovarian Cancer (BRCA's) conference - professionals and public October 1st

Overview

On Friday 1st October and Saturday 2nd October, at the Latimer Conference Centre, Christchurch will be hosting people from all over New Zealand who are impacted by Hereditary Breast and Ovarian Cancer, specifically the BRCA mutation. Medical practitioners and the public will be coming together to share experiences, increase their understanding, learn about advancements in this field, have questions answered and meet others in similar situations.

Medscape article: Simple Cysts and Ovarian Cancer Risk

Curis announces preliminary results of GDC-0449 Phase II clinical trial in advanced ovarian cancer - press release

".... Accordingly, Roche and Genentech have indicated that they plan to further analyze the data, including subset analyses in the coming months. Following these analyses, they expect to make a portfolio decision regarding whether, or to what extent, they will continue development of GDC-0449 in advanced ovarian cancer.

“While we await the final analysis of the data from this advanced ovarian cancer study, we remain optimistic about the continued evaluation of GDC-0449 in tumors such as basal cell carcinoma”

No obvious new safety signals were observed in patients treated with GDC-0449. It is expected that data from this Phase II study will be submitted for presentation at an upcoming medical meeting....cont'd

No Gene For That? | The Daily Scan | GenomeWeb (personality)

UK media article: Patient safety at risk from eurosceptics (re: hours of work)

blogger's note: while the patient safety communities typically reflect on airline safety/rules, it is always interesting to observe that no, if any,  references are made to the transportation industry (as a whole) and in particular the fatigue issues. Many studies have been done on fatigue/commercial vehicle safety hours of work issues. In addition, studies have been done not only on fatigue but also on the effects of alcholism (impairment/performance).

Who owns pink ideas or cure slogans? Welcome to the Charity Brawl - Gary Schwitzer's HealthNewsReview Blog

 blogger's note:  patients are not typically aware of  'turf' wars in charities, irrespective of 'color'. Turf wars are typically thought of as issues between governments, professions etc but not usually associated with charities. Thus the importance of not only expert patients but an informed public.

1) article: Gary Schwitzer's HealthNewsReview Blog

2) Wall Street Journal reports on an ugly dispute
 Charity Brawl: Nonprofits Aren't So Generous When a Name's at Stake

abstract: Imaging of the gastrointestinal complications of systemic chemotherapy

Abstract:

Gastrointestinal complications of chemotherapy may be serious and potentially life-threatening. Familiarity with and awareness of the potential complications associated with various chemotherapeutic agents/regimens is paramount to enable accurate and timely diagnosis. In this article we review the radiological manifestations of the most notable gastrointestinal complications associated with chemotherapeutic administration.

Article Outline (requires subscription/$$$)

Introduction

Neutropenic enterocolitis

Pseudomembranous colitis

Ulceration

Perforation

GI haemorrhage

Ileus

Obstruction

Mesenteric infarction

Conclusion

Figure 1. A 70-year-old woman on day 10 of idorubicin and cytosine arabinoside chemotherapy for acute myeloid leukaemia developed vomiting, abdominal pain, loose bloody stool, and was profoundly neutropenic. Intravenous contrast-enhanced CT demonstrates diffuse colonic mural thickening (black arrow), with surrounding mesenteric stranding (white curved arrow) and ascites (black curved arrow). The distribution is pan-colonic. This constellation of clinical and radiological findings is highly suggestive of neutropenic enterocolitis.

View Within Article

Discriminative MRI features of fallopian tube masses (abstract)

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.

full free access: Landes Bioscience Journals: Cancer Biology & Therapy "Where's the Passion?"

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  |  ShareThis 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 Medscape
Richard 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.

Progress in ovarian cancer trials: The GCIG consensus model - Is bigger, better?

Note: no abstract/subscription required ($$$)

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.

Malignant Acanthosis Nigricans (dermatology/skin disorder) Associated with Ovarian Cancer

abstract

eMedicine: Acanthosis Nigricans

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

Clinical Trial Participants Are There Willingly - in Public Health & Policy, Clinical Trials

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.

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."

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."

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

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