Tuesday, January 10, 2012
Essay - Steven Lewis - The Fraser Institute Wait Time Reports: Madness in the Method, but Method in the Madness :: Longwoods.com
The Fraser Institute Wait Time Reports: Madness in the Method, but Method in the Madness
Steven Lewis
"The answer lies in its (The Fraser Institute) mission statement, helpfully reproduced at the end of the wait times report: “Our vision is a free and prosperous world where individuals benefit from greater choice, competitive markets, and personal responsibility.” Public health care sucks because it must suck, because it’s public. Therefore, let’s gather skewed estimates on a hot-button issue, retail them as hard data, and lure Canadians toward the promised land of private medicine."
Canada: Cancer wars: are we winning? - Health - CBC News
....But trying to answer the question of whether the war on cancer is being won means stepping into a contradictory tangle of statistics, anecdotes, hopes and fears.....
Clifton Leaf, author of an article in Fortune magazine called "Why We're Losing the War On Cancer," is one of the beneficiaries of the success against certain cancers affecting children.......
Leaf focuses on actual death rates, which haven't budged much in decades for the diseases that tend to be the hardest to treat: lung cancer, pancreatic cancer, liver cancer.
Prognostic significance of L1CAM in ovarian (serous) cancer and its role in constitutive NF-κB activation
Background: Overexpression of L1-cell adhesion molecule (L1CAM) has been observed for various carcinomas and correlates with poor prognosis and late-stage disease. In vitro, L1CAM enhances proliferation, cell migration, adhesion and chemoresistance. We tested L1CAM and interleukin-1 beta (IL-1β) expression in tumor samples and ascitic fluid from ovarian carcinoma patients to examine its role as a prognostic marker.
MedWatch - consolidation/links - re: Excedrin, NoDoz, Bufferin, Gas-X Prevention, Endo Pharmaceuticals Opiate Products
http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm286265.htm?source=govdelivery
Message 1
From: FDA MedWatch
Date: Jan, Mon 9 2012 10:53 -0500 (EST)
Subject: FDA MedWatch - Novartis Consumer Health Over-The-Counter Products: Recall - Potential Presence of Foreign Tablets or Chipped or Broken Tablets or Gelcaps
Novartis Consumer Health Over-The-Counter Products: Recall - Potential Presence of Foreign Tablets or Chipped or Broken Tablets or Gelcaps
including Excedrin, NoDoz, Bufferin, Gas-X Prevention
AUDIENCE: Consumer, PharmacyISSUE: Novartis Consumer Health Inc. is voluntarily recalling all lots of over-the-counter products Exedrin, Bufferin, Gas-X Prevention and NoDoz. Reports were received of chipped and broken pills and inconsistent bottle packaging clearance practices at the Lincoln, Nebraska facility, which could result in the bottles containing foreign tablets, caplets, or capsules.
Mixing of different products in the same bottle could result in consumers taking the incorrect product and receiving a higher or lower strength than intended or receiving an unintended ingredient. This could potentially result in overdose, interaction with other medications a consumer may be taking, or an allergic reaction if the consumer is allergic to the unintended ingredient.
BACKGROUND: This voluntary recall pertains to all lots of select bottle packaging configurations from retailers of Excedrin and Nodoz products (expiry dates of December 20, 2014 or earlier), and Bufferin and Gax-X Products (expiry dates of December 20, 2013 or earlier), in the United States.
RECOMMENDATION: All of the pills in the bottle should look the same. If patients find a pill that is different in shape, size, color, or markings, they should bring their medicine bottle to their pharmacist and not take any of those pills.
Consumers that have the product(s) being recalled should stop using them and contact the Novartis Consumer Relationship Center at 1-888-477-2403 (available Monday-Friday 9 a.m. to 8 p.m. Eastern Time) for information on how to return the affected products.
Healthcare professionals and patients are encouraged to report adverse events or side effects related to the use of these products to the FDA's MedWatch Safety Information and Adverse Event Reporting Program:
- Complete and submit the report Online: www.fda.gov/MedWatch/report.htm
- Download form or call 1-800-332-1088 to request a reporting form, then complete and return to the address on the pre-addressed form, or submit by fax to 1-800-FDA-0178
http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm286265.htm
Message 2
From: FDA MedWatch
Date: Jan, Mon 9 2012 11:13 -0500 (EST)
Subject: FDA MedWatch - Endo Pharmaceuticals Opiate Products by Novartis Consumer Health: Public Health Advisory - Potential Safety Risk
Endo Pharmaceuticals Opiate Products by Novartis Consumer Health: Public Health Advisory - Potential Safety Risk
Including the following products:- Opana ER (oxymorphone hydrochloride) Extended-Release Tablets CII
- Opana (oxymorphone hydrochloride) CII
- Oxymorphone hydrochloride Tablets CII
- PERCOCET (oxycodone hydrochloride and acetaminophen USP) Tablets CII
- PERCODAN (oxycodone hydrochloride and aspirin, USP) Tablets CII
- ENDOCET (oxycodone hydrochloride and acetaminophen USP) Tablets CII
- ENDODAN (oxycodone hydrochloride and aspirin, USP) Tablets CII
- MORPHINE SULFATE Extended-Release Tablets CII
- ZYDONE (hydrocodone bitartrate/acetaminophen tablets, USP) CIII
AUDIENCE: Pharmacy, Consumers
ISSUE: FDA is advising healthcare professionals and patients of a potential problem with opiate products manufactured and packaged for Endo Pharmaceuticals by Novartis Consumer Health at its Lincoln, Nebraska manufacturing site. Due to problems that occurred when these products were packaged and labeled at the site, tablets from one product type may have carried over into packaging of another product. This could result in a stray pill of one medicine ending up in the bottle of another product.
BACKGROUND: Opiates are potent medications used to alleviate pain and are available only by prescription. Endo Pharmaceuticals reports that they are aware of only three product mix-ups with respect to these products since 2009; all three were detected by pharmacists. Endo is not aware of any patient having experienced a confirmed product mix-up, nor any adverse events attributable to a product mix-up.
RECOMMENDATION: FDA advises patients and healthcare professionals to examine opiate medicines made by Endo in their possession and ensure that all tablets are the same.
Healthcare professionals and patients are encouraged to report adverse events or side effects related to the use of these products to the FDA's MedWatch Safety Information and Adverse Event Reporting Program:
- Complete and submit the report Online: www.fda.gov/MedWatch/report.htm
- Download form or call 1-800-332-1088 to request a reporting form, then complete and return to the address on the pre-addressed form, or submit by fax to 1-800-FDA-0178
http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm286280.htm
You are encouraged to report all serious adverse events and product quality problems to FDA MedWatch at www.fda.gov/medwatch/report.htm
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Monday, January 09, 2012
open access: Recurrent Somatic DICER1 Mutations in Nonepithelial Ovarian Cancers — NEJM (germ cell, sex cord-stromal, leydig, granulosa...
"Sex cord–stromal tumors and germ-cell tumors account for less than 10% of ovarian cancers.1 Unlike epithelial ovarian cancers, both sex cord–stromal tumors and germ-cell tumors can also occur in the testicle; testicular germ-cell tumors are the most common cancer in boys and men of European descent between the ages of 15 and 34 years.2,3 Other than a pathognomonic somatic mutation in FOXL2 in adult granulosa-cell tumors,4-6 little is known about the pathogenesis of ovarian sex cord–stromal tumors and germ-cell tumors. Recently, germline mutations in the microRNA processing gene DICER1 have been reported in probands with pleuropulmonary blastoma or the related familial tumor dysplasia syndrome, known as pleuropulmonary blastoma–family tumor and dysplasia syndrome (Online Mendelian Inheritance in Man [OMIM] number, 601200), which includes cystic nephroma, ovarian sex cord–stromal tumor (especially Sertoli–Leydig cell tumor), and multinodular goiter.7......."
open access: Jan 2012 - Assessing the malignant potential of ovarian inclusion cysts in postmenopausal women within the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS): a prospective cohort study
Objective To evaluate the malignant
potential of ultrasound-detected ovarian inclusion cysts in the
development of ovarian cancer (OC) in postmenopausal women.
Design Prospective cohort study.
Setting UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS).
Population Postmenopausal women.
Conclusions Postmenopausal women with ultrasound-detected inclusion cysts do not seem to be at increased risk of ovarian or breast/endometrial (hormone-dependent) cancers.
see also
Table 1. Details of ovarian cancers detected in the cohort of women with inclusion cysts in year 1
Table 2. Details of ovarian cancers detected in the cohort of women with normal scans in year 1
Conclusions Postmenopausal women with ultrasound-detected inclusion cysts do not seem to be at increased risk of ovarian or breast/endometrial (hormone-dependent) cancers.
see also
Table 1. Details of ovarian cancers detected in the cohort of women with inclusion cysts in year 1
Table 2. Details of ovarian cancers detected in the cohort of women with normal scans in year 1
| Table 3. Relative risks of developing gynaecological cancers in women with inclusion cysts |
|---|
abstract: Therapy-related myeloid leukemia after treatment for epithelial ovarian carcinoma: An epidemiological analysis
CONCLUSION: Development of t-AML is a rare but lethal event among EOC patients, and its incidence has decreased significantly since the use of platinum/taxane-based chemotherapy became the standard of care.
video: Maurie Markman, MD - Incredibly Shrinking Risk for Secondary AML (leukemia as a second primary treatment related)
referenced paper:
Citation: Vay A, Kumar S, Seward S, et al. Therapy-related myeloid leukemia after treatment for epithelial ovarian carcinoma: an epidemiological analysis. Gynecol Oncol. 2011;123:456-460. Abstract
Canadian Medical Association Journal: Nothing cutting edge about Canadian ehealth strategy, critics say
Blogger's Note: note the 'PC" reference to the billion dollar e-health scandal
Editorial: Canadian Medical Association - Early and continuing education: a prescription for achieving patient-centred care
"....It thus seems likely that bringing the patient’s perspective into the system isn’t enough to achieve the health outcomes people want and expect.
Even a perfect system won’t work if patients don’t know how to access it effectively. No matter what resources are available, lack of knowledge about what resources exist — both within and outside the health care system — and how to access them keeps people from receiving what they need when they need it. Also, our failure to help patients adequately understand their disease and its treatment underlies much of the suboptimal adherence to treatment that leads to otherwise preventable outcomes......"
Novartis' Troubles With Packaging Continue (drug packaging concerns) important to read
"Novartis Consumer Health announced earlier today a recall on certain OTC medicines that were badly packaged and might have broken or chipped pills, as well as incorrect product mixed into bottles of pills. Rather worrying for consumers with risks of possible wrong or overdoses of their medicine.
Now the problems seem to be more endemic with the FDA inspection of the Novartis' Manufacturing facility finding other drugs that may have become mixed in the packing process."
"The products in the spotlight this time are opiate products made for Endo Pharmaceuticals by Novartis Consumer Health. The FDA is working closely with both companies to resolve the problems and prevent them occurring in the future.The FDA is providing links on its website to help consumers and practitioners identify if there is a wrong pill in their medication. Patients and healthcare professionals would be wise follow the instructions on the links below closely, to identify whether there is a wrong pill in a medication bottle. Whilst the previous issue related to OTC products, these powerful oxymorphone and oxymorphone based painkillers could cause a patient serious issues if wrongly taken."
The problem relates to the following products :
- Opana® ER (oxymorphone hydrochloride) Extended-Release Tablets CII
- Opana® (oxymorphone hydrochloride) CII
- Oxymorphone hydrochloride Tablets CII
- PERCOCET® (oxycodone hydrochloride and acetaminophen USP) Tablets CII
- PERCODAN® (oxycodone hydrochloride and aspirin, USP) Tablets CII
- ENDOCET® (oxycodone hydrochloride and acetaminophen USP) Tablets CII
- ENDODAN® (oxycodone hydrochloride and aspirin, USP) Tablets CII
- MORPHINE SULFATE Extended-Release Tablets CII
- ZYDONE® (hydrocodone bitartrate/acetaminophen tablets, USP) CIII
Visual Guide
Additional information is available from the FDA and Endo's website :
http://www.fda.gov/Drugs/DrugSafety/ucm286226.htm
http://www.fda.gov/Drugs/DrugSafety/ucm286232.htm
NT Times Health: Really? The Claim: Grief Can Cause a Heart Attack
"In a large new study, scientists have confirmed what the medical world has long suspected (blogger's note - and patients/families have known): The so-called broken-heart syndrome is real. The study, published on Monday in Circulation: Journal of the American Heart Association, found that a person’s heart attack risk is 21 times higher than normal the day after a loved one dies....."
What Parents Tell Their Kids About Breast-Cancer Gene Test Results - Health Blog - WSJ
Blogger's Note: this has been an area of much discussion and debate over many years which not only includes age issues (age of majority-adult) but also ethical dilemmas (eg. because you carry a mutation the risk of a cancer varies and does always mean a cancer diagnosis).
------------------------------------------------------------------------------------
"If you were tested for the “breast cancer gene” — mutations in the BRCA1 and BRCA2 genes that raise the risk of breast, ovarian and other cancers — would you tell your children?...."
"There isn’t much to do with the information for that age group: kids who learn that a parent carries a BRCA mutation aren’t advised to have the test themselves until at least age 18, and any additional screening resulting from a positive result wouldn’t likely begin until age 25, says Angela Bradbury, lead author of the study and the director of breast and ovarian cancer risk assessment at Fox Chase Cancer Center in Philadelphia......"
Medical News: Statins Up Diabetes Risk in Older Women - in Primary Care, Diabetes from MedPage Today (2nd article)
Action Points
- This study found that older women who take statins may be at an increased risk for developing type 2 diabetes.
- Note that the risk was seen with all types of statins.
In an analysis of data from the Women's Health Initiative, postmenopausal women who were on a statin at study entry had almost a 50% greater risk of diabetes than those who weren't on the cholesterol-lowering drugs, Yunsheng Ma, MD, PhD, of the University of Massachusetts School of Medicine, and colleagues reported online in the Archives of Internal Medicine.
"This study urges us to further evaluate the risk-benefit profile of statins," Ma told MedPage Today, adding that the ratio will likely vary by patient population....."
webinar - Wed Jan 11th - 2011 Commonwealth Fund International Health Policy Survey of Sicker Adults
| Date: | Wed, Jan 11, 2012 |
| Time: | 11:30 AM EST |
| Duration: | 1 hour 30 minutes |
| Host(s): | Christine Haran |
2011 Commonwealth Fund International Health Policy Survey of Sicker Adults
|
Please register for this meeting.
|
|
|
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Meeting Description: |
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This webinar will examine the findings of the latest International Health Policy Survey of Sicker Adults in Eleven Countries, conducted
in Australia, Canada, France, Germany, the Netherlands, New Zealand,
Norway, Sweden, Switzerland, the United Kingdom, and the U.S.
Published
in November, the study compared the experiences of adults with complex
care needs on financial barriers to care, access to care, care
coordination, preventive care, and support for self-management.
International respondents from England, Switzerland, and the Netherlands
will comment on survey findings.
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Multinational Comparisons of Health Systems Data, 2011 - The Commonwealth Fund including link to 2011 patient care coordination (11 countries)
"International comparisons of health care systems offer valuable tools to health ministers, policymakers, and academics wishing to evaluate the performance of their country's system. In this chartbook, we use data collected by the Organization for Economic Cooperation and Development (OECD) to compare health care systems and performance on a range of topics, including spending, hospitals, physicians, pharmaceuticals, prevention, mortality, quality of care, and prices. We present data across several industrialized countries: Australia, Canada, Denmark, France, Germany, Japan, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States. Whenever possible, we also present the median value of all 34 members of the OECD.......
Downloads
message from David Haas ' Networks That Support Cancer Patients
Blogger's Note: please respond directly to David
Networks
That Support Cancer Patients
Receiving a cancer diagnosis is a frightening
and life-changing event. It brings worries about treatment and fear of dying,
as well as how to keep spirits up during the darkest days. There are many
things to consider, big decisions to be made and emotions can be overwhelming. This where cancer support networks come in.
A support network is made up of people who have gone through the cancer experience and can lend their own unique perspective, in the hope of helping others. The groups meet in hospitals, libraries, in church or other public spaces and are led by doctors, social workers and psychologists who understand the challenges of cancer, from breast cancer to mesothelioma.
Face to face groups offer an intimate atmosphere of sharing and social activities, as well as love and understanding. It is in these support networks that the many different faces of cancer can be seen clearly and stories of survival can be heard. Sometimes all a patient needs for encouragement is to know they are not alone.
Cancer support networks can be found on the Internet, as well. This type of group is suited for those who are too ill to attend a public get together, or wish to talk about their experience anonymously. Online support often encourages a larger degree of sharing, as there is no pressure of speaking in front of a live group or fear of judgment over physical weakness and a loss of looks.
Regardless of the type of network a patient participates in, it is the emotional support that matters, as this is just as important as the medical treatment itself. Maintaining a positive outlook and eliminating feelings of isolation can go a long way toward promoting remission of the disease.
Any cancer patient who wishes to take part in a support network can ask their doctor, social worker or simply do a search online. Most patients are recommended to join a support group as a regular part of their treatment.
Cancer is not a death sentence. It is a chance to regain perspective and begin life again from a new place.
A support network is made up of people who have gone through the cancer experience and can lend their own unique perspective, in the hope of helping others. The groups meet in hospitals, libraries, in church or other public spaces and are led by doctors, social workers and psychologists who understand the challenges of cancer, from breast cancer to mesothelioma.
Face to face groups offer an intimate atmosphere of sharing and social activities, as well as love and understanding. It is in these support networks that the many different faces of cancer can be seen clearly and stories of survival can be heard. Sometimes all a patient needs for encouragement is to know they are not alone.
Cancer support networks can be found on the Internet, as well. This type of group is suited for those who are too ill to attend a public get together, or wish to talk about their experience anonymously. Online support often encourages a larger degree of sharing, as there is no pressure of speaking in front of a live group or fear of judgment over physical weakness and a loss of looks.
Regardless of the type of network a patient participates in, it is the emotional support that matters, as this is just as important as the medical treatment itself. Maintaining a positive outlook and eliminating feelings of isolation can go a long way toward promoting remission of the disease.
Any cancer patient who wishes to take part in a support network can ask their doctor, social worker or simply do a search online. Most patients are recommended to join a support group as a regular part of their treatment.
Cancer is not a death sentence. It is a chance to regain perspective and begin life again from a new place.
Sunday, January 08, 2012
open access: Molecular Cancer | Role of Bcl-3 in solid tumors
"In this regard, it is interesting that, in addition to the known deregulation in leukemias and lymphomas, genome-wide expression studies have shown that Bcl-3 is overexpressed in breast cancer, glioblastoma tumors, ovarian cancer and, intriguingly, teratomas and embryonal> carcinomas (additional file 2). Although not validated, these results support the potential importance of this oncogene in a variety of tumors."
Role of Bcl-3 in solid tumors
Published: 23 December 2011
Abstract (provisional)
Bcl-3 is an established oncogene in hematologic malignancies, such as B-cell chronic lymphocytic leukemias. Nevertheless, recent research has shown that it also participates in progression of diverse solid tumors. The present review summarizes the current knowledge of Bcl3 role in solid tumors progression, including some new insights in its possible molecular mechanisms of actionThe complete article is available as a provisional PDF. The fully formatted PDF and HTML versions are in production.
Why Some People Live to 110 - Drugs.com MedNews
"......In what they describe as a first-of-a-kind study, the researchers analyzed the whole genome sequences of a man and a woman who lived past the age of 114 and found that they had as many disease-associated genes as other people.
For example, the man had 37 genetic mutations associated with increased risk for colon cancer....."
Jan 8th - Novartis Consumer Health Inc. Issues Voluntary Nationwide Recall of Certain Over-the-Counter Products... -- Excedrin, NoDoz, Bufferin, Gas-X Prevention
PARSIPPANY, N.J., Jan. 8, 2012 /PRNewswire/ -- Novartis Consumer Health, Inc. (NCH) announced today that it is voluntarily recalling all lots of select bottle packaging configurations of Excedrin® and NoDoz® products with expiry dates of December 20, 2014 or earlier as well as Bufferin® and Gas-X Prevention® products with expiry dates of December 20, 2013 or earlier, in the United States. NCH is taking this action as a precautionary measure because the products may contain stray tablets, capsules, or caplets from other Novartis products, or contain broken or chipped tablets...........
open access Frontiers | Epigenomics of Ovarian Cancer and Its Chemoprevention | Frontiers in Epigenomics
.......Due to the atypical syndrome of the early stage of ovarian cancer, it is difficult to diagnose in its early stages. By the time most ovarian cancers are diagnosed, they are already at stage III or IV. The two most significant obstacles to the effective treatment of ovarian cancers are the lack of early diagnostic markers and the development of drug resistance after therapeutic treatment of advanced disease. Ovarian cancer screening with transvaginal ultrasound (TVU) and CA125 was evaluated in the Prostate, Lung, Colorectal, and Ovarian (PLCO) trial, however, it was revealed that the predictive value of both tests was relatively low (Buys et al., 2005). Increasing evidence indicates that epigenetic mechanisms may play a major role in the development of ovarian cancer..........
In this analysis, we will evaluate the current status of epigenomics of ovarian cancer and will include epigenetic mechanisms involved in ovarian cancer development such as DNA methylation, histone modifications, and non-coding microRNA. Development of biomarkers, the epigenetic basis for drug resistance and improved chemotherapy for ovarian cancer will also be assessed. In addition, the potential use of natural compounds as epigenetic modulators in chemotherapy shows promise in moving to the forefront of ovarian cancer treatment strategies........
open access journal: Frontiers | Grand Challenges in Oncology | Frontiers in Oncology
Frontiers in Oncology
This new open access journal has one of the major goals to be the forum for publications in the most important areas of cancer research, spanning from diagnosis, and prevention to treatment of early and advanced cancer and drug development, to the most cutting edge technologies that can be implemented to study cancer and improve its treatment. The fast pace of research and its ever increasing scope and breath, require a comprehensive forum that allows both the depth of research and a broad readership. This will be accomplished by a large series of subspecialties within Frontiers in Oncology, which span the major areas of disease-oriented research, epidemiology and prevention, treatment, and basic research.
open access: A person-time analysis of hospital activity among cancer survivors in England - UKPMC Article - UK PubMed Central
Conclusion:
The person-time approach used in this study is more revealing than a simple enumeration of cancer survivors and hospital admissions. Hospital activity among cancer survivors is highest soon after diagnosis. The effect of age on the amount of hospital activity is different for each type of cancer.
...........This paper highlights the significant effect that time since diagnosis has on the average amount of hospitalisation experienced by cancer survivors. The majority of cancer-related admitted hospital episodes of care occurred in the first year following diagnosis (when initial cancer treatment takes place); however, there was also a significant amount of hospital activity in the period 1–5 years after diagnosis, particularly among survivors of colorectal and lung cancers, which is indicative of the ongoing consequences of cancer and its treatment. Other work has shown that the final year before death also contains significant amounts of hospitalisation of cancer survivors (Maddams et al, 2011). These findings help to understand the burden of cancer on the health service, but further work is still required to identify potential areas of unmet needs among cancer survivors.
open access: Fruit and vegetables and cancer risk - UKPMC Article - UK PubMed Central
Blogger's note: the article/reference(s) does not include ovarian cancer research on this issue
The possibility that fruit and vegetables may help to reduce the risk of cancer has been studied for over 30 years, but no protective effects have been firmly established..........
Saturday, January 07, 2012
open access: As-Needed Morphine: Yes, but at What Dose and at What Interval?
..........Given the above-illustrated opinion conflicts, with a 10-fold variation in dose and a six-fold variation in timing interval, a search through published sources was conducted, mirroring a wide range of combinations regarding recommendations for both the PRN narcotic doses and the appropriate intervals at which they should be repeated in the event of continued pain. Data from 22 review articles and texts that review guidelines for the treatment of cancer pain, presented in Table 3, 1-22 provided a 20-fold variation in recommended narcotic doses (1% to 20% of daily doses) along with scattered opinions, or no direction, regarding appropriate dose intervals for potential repeat doses...............
.............Specific guidelines for prescribing opioids are needed to allow practitioners to feel comfortable in administering these medications. These guidelines must include how to determine the appropriate dose for breakthrough pain, and the appropriate and safe interval that will allow for rapid pain relief, but maintain patient safety. On completion of this project, the 2004 National Comprehensive Cancer Network guidelines for cancer pain were found.27 These guidelines come to similar conclusions that recommend the use of intravenous narcotic doses of 10% to 20% of the daily intravenous morphine equivalent and the use of repeat doses at 15-minute intervals, if pain is still present. The information from this project might be used to facilitate continuous-improvement projects at individual institutions. Such a project is in process locally. The incorporation of this new information regarding PRN narcotic use should better serve the needs of patients.
When a Decision Must Be Made: Role of Computer Modeling in Clinical Cancer Research
Every day, multidisciplinary oncology teams make dozens of treatment decisions that may have a tremendous impact on a patient's survival and quality of life. Made with the best of intentions, these decisions are informed by basic science and clinical research findings, clinical experience, and health policy. All too often, results from the gold standard of clinical trial research, a randomized controlled trial (RCT), that fit the specific details of the patient's situation are not available to guide these decisions...........
open accerss: Exposure–response relationship of AMG 386 in combination with weekly paclitaxel in recurrent ovarian cancer and its implication for dose selection
Abstract
Purpose
Blogger's Note: stats removed for ease of reading (eg. CI):
Progression-free survival (the primary endpoint) in the phase 2 study was 7.2 months in the AMG 386 10 mg/kg QW dose group and 5.7 months in the 3 mg/kg group, compared with 4.6 months for placebo. Results from Tarone’s test and dose-exposure analyses suggested a dose–response effect for PFS across the three arms....
To characterize exposure–response relationships of AMG 386 in a phase 2 study in advanced ovarian cancer for the facilitation
of dose selection in future studies.
.....AMG 386 (previously referred to as 2xCon4) is an investigational peptide-Fc fusion protein that mediates antiangiogenic effects
by potently and selectively inhibiting the interaction of angiopoietin-1 and angiopoietin-2 with Tie2 [16].
Primary endpoint results from a phase 2 study of AMG 386 in combination
with weekly paclitaxel for the treatment of recurrent
ovarian cancer showed longer median progression-free
survival (PFS) for patients receiving AMG 386 at 10 and 3 mg/kg once
weekly (QW), compared with placebo (the data are
described in the primary analysis [17]). Additional dose-exposure analyses suggested a dose–response effect across treatment arms......
Blogger's Note: stats removed for ease of reading (eg. CI):
Progression-free survival (the primary endpoint) in the phase 2 study was 7.2 months in the AMG 386 10 mg/kg QW dose group and 5.7 months in the 3 mg/kg group, compared with 4.6 months for placebo. Results from Tarone’s test and dose-exposure analyses suggested a dose–response effect for PFS across the three arms....
not yet recruiting: Integrated Molecular Profiling in Advanced Cancers Trial - breast, non-small cell lung, colorectal, ovarian, phase 1 (patients) - Full Text View - ClinicalTrials.gov UHN (Toronto)
Advanced cancer
Purpose
Advanced breast, non-small cell lung, colorectal and ovarian cancers; as well as patients who are phase I trial candidates
Substantial progress has been made in the treatment of cancer
through the use of targeted therapies, but what works for one patient
might not work for another patient. Certain drugs are now being
developed that target specific molecules in the body that are believed
to be part of the disease.
Biomarkers are specific characteristics of the cancer
that may help provide prognostic information (i.e. how well patients
will be regardless of the treatments given) or help predict sensitivity
or resistance to a specific treatment.
The study will collect archival tumor samples (previously collected biopsy or surgical tumor samples) to provide biomarker data about a patient's cancer,
in order to help their physicians to identify which clinical trials of
molecularly targeted therapies may be most appropriate for the patient
in the future.
Integrated Molecular Profiling in Advanced Cancers Trial (IMPACT)
This study is not yet open for participant recruitment.
Verified on January 2012 by University Health Network, Toronto
First Received on January 4, 2012.
Last Updated on January 5, 2012
History of Changes
| Sponsor: | University Health Network, Toronto |
|---|---|
| Collaborator: | Princess Margaret Hospital, Canada |
| Information provided by (Responsible Party): | University Health Network, Toronto |
| ClinicalTrials.gov Identifier: | NCT01505400 |
Prognostic significance of L1CAM in (serous) ovarian cancer and its role in constitutive NF-κB activation
Conclusions:
L1CAM expression contributes to the invasive and metastatic phenotype of serous ovarian carcinoma. L1CAM expression and shedding in the tumor microenvironment could contribute to enhanced invasion and tumor progression through increased IL-1β production and NF-κB activation.
open access: Development and validation of a prediction index for hand-foot skin reaction in cancer patients receiving sorafenib
Background: This study describes a repeated measures prediction index to identify patients at high risk of ≥ grade 2 hand-foot skin reaction (HFSR) before each week of sorafenib therapy.
Results: Pretreatment white blood cell count, female gender, good performance status, presence of lung and liver metastases and number of affected organs were predictors for ≥ grade 2 HFSR.
U.S. - Planned Cooperative Group Merger Is Generating Concern - NCI clinical trials - gynecologic oncologists, funding, more common cancers, GOG....
A proposed overhaul of the National Cancer Institute’s clinical trials system has created anxiety among gynecologic researchers who fear projects in women’s cancer will be diminished in a scramble for funding with more common malignancies.......
Friday, January 06, 2012
Study of Medicare Patients Finds Most Hospital Errors Unreported - NYTimes.com
WASHINGTON — Hospital employees recognize and report only one out of seven errors, accidents and other events that harm Medicare patients while they are hospitalized, federal investigators say in a new report.
Yet even after hospitals investigate preventable injuries and infections that have been reported, they rarely change their practices to prevent repetition of the “adverse events,” according to the study, from Daniel R. Levinson, inspector general of the Department of Health and Human Services.......
Pathology of Breast and Ovarian Cancers among BRCA1 and BRCA2 Mutation Carriers: Results from the Consortium of Investigators of Modifiers of BRCA1/2 (CIMBA)
Background: Previously, small studies have found that BRCA1 and BRCA2
breast tumors differ in their pathology. Analysis of larger datasets of
mutation carriers should allow further tumor characterization.
Methods: We used data from 4,325 BRCA1 and 2,568 BRCA2 mutation carriers to analyze the pathology of invasive breast, ovarian, and contralateral breast cancers.
There were no significant differences in ovarian cancer morphology between BRCA1 and BRCA2 carriers (serous: 67%; mucinous: 1%; endometrioid: 12%; clear-cell: 2%).
Genomics|Update| - Cancer Program Standards 2012 ensuring patient-centered care
Announcements
- Cancer Program Standards 2012: Ensuring Patient-Centered Care
[PDF 3.58 MB]
from the American College of Surgeons includes new standards for Risk Assessment and Genetic Counseling.
Cochrane Evidence Updates - Antiemetics: American Society of Clinical Oncology clinical practice guideline update
Clinicians underestimate the incidence of nausea, which is not as well controlled as emesis (vomiting).
Cochrane Evidence Updates - Information interventions for orienting patients and their carers to cancer care facilities (including professional commentaries)
AUTHORS' CONCLUSIONS:
This review has demonstrated the feasibility and some potential benefits of orientation interventions. There was a low level of evidence suggesting that orientation interventions can reduce distress in patients. However, most of the other outcomes remain inconclusive (patient knowledge recall/ satisfaction). The majority of studies were subject to high risk of bias, and were likely to be insufficiently powered. Further well conducted and powered RCTs are required to provide evidence for determining the most appropriate intensity, nature, mode and resources for such interventions. Patient and carer-focused outcomes should be included.
open access: BMJ - Identifying women with suspected ovarian cancer in primary care: derivation and validation of algorithm | BMJ
Objective
To derive and validate an algorithm to estimate the absolute risk of having ovarian cancer in women with and without symptoms.
Main outcome The primary outcome was incident diagnosis of ovarian cancer recorded in the next two years.
The incidence rate in our population was higher than published national data based on cancer registries.2
What is already known on this topic
- Ovarian cancer is the second most common gynaecological cancer and most women are diagnosed with late stage disease, which has a poor survival rate
- Earlier diagnosis could improve with more targeted investigation of symptomatic patients and increased public awareness of symptoms, which is a major challenge given the non-specific nature of some of the symptoms
What this study adds
- An algorithm based on simple clinical variables such as age, family history of ovarian cancer, anaemia, abdominal pain, abdominal distension, rectal bleeding, postmenopausal bleeding, appetite loss, and weight loss, which the patient is likely to know or which are routinely recorded in general practice computer systems, can estimate absolute risk of ovarian cancer in women with and without symptoms in primary care
- The algorithm could be integrated into general practice clinical computer systems and used to assess risk in women presenting with and without symptoms
Thursday, January 05, 2012
Vermillion plans to reduce headcount, expenses - financial news (OVA1)
Vermillion Inc. VRML -2.76% plans to reduce its headcount and other expenses and focus on strengthening sales of its ovarian cancer testing product (OVA1) this year.
Epigenomics Initiates PMA Submission for Colorectal Cancer Test | GenomeWeb Daily News | MDx | GenomeWeb
For its clinical module, Epigenomics will need to demonstrate that Epi proColon performs at least as well as fecal immunochemical testing, it said, adding that it has been in discussions with FDA about the design for its clinical study, which it expects to initiate in the coming months after the study's protocol has been finalized.
The clinical module for the PMA submission will include results of the head-to-head comparison with fecal immunochemical testing, previously announced data from a clinical validation study in a cohort of prospectively collected samples, and other clinical study results.
Last month, the Berlin, Germany-based molecular diagnostics firm announced clinical validation study results for the test. The test demonstrated 68 percent sensitivity and 80 percent specificity.
Medicine's Biggest Threat - Forbes
Medicine’s biggest threat is not a highly resistant microorganism or rising costs or an aging population or workforce shortages. It is something less obvious and more dangerous: the issue of missing data.
Clinical Care Options - Oncology CME - The Right Care for the Younger Patient: Meeting the Needs of Adolescents and Young Adults With Cancer
Learning Objectives
Upon completion of this activity, participants should be able to:
- Describe the physical and psychosocial challenges facing the AYA cancer patient
- Suggest the most suitable treatment strategy for individual AYA patients with cancer based on current evidence
- Apply current evidence to select treatment centers (adult or pediatric) that optimize treatment for AYA patients
BMC Cancer | Systematic review: conservative treatments for secondary lymphedema
Results
Thirty-six English-language and eight non-English-language studies were included in the review. Most of these studies involved upper-limb lymphedema secondary to breast cancer. Despite lymphedema's chronicity, lengths of follow-up in most studies were under six months. Many trial reports contained inadequate descriptions of randomization, blinding, and methods to assess harms. Most observational studies did not control for confounding. Many studies showed that active treatments reduced the size of lymphatic limbs, although extensive between-study heterogeneity in areas such as treatment comparisons and protocols, and outcome measures, prevented us from assessing whether any one treatment was superior. This heterogeneity also precluded us from statistically pooling results. Harms were rare (<1% incidence) and mostly minor (e.g., headache, arm pain).Conclusions
The literature contains no evidence to suggest the most effective treatment for secondary lymphedema. Harms are few and unlikely to cause major clinical problems.Wednesday, January 04, 2012
Anticancer therapies in specialized palliative care—a multicenter survey (HOPE project)
In conclusion, this study shows that the use of ACT refers to a distinguishable subgroup of palliative care patients in distinct institutions and is therefore more than a mere expansion of the therapeutic (pharmacologic) spectrum in palliative care. The continuing debate about integrating ACT into palliative care concepts and about early integration of palliative care into oncology has now gained new arguments.
Jan 2012: Race, insurance influence treatment of advanced ovarian cancer
Table 1 (includes history of breast and/or ovarian cancers but not other cancers (eg. colorectal/Lynch Syndrome)
Successful treatment of adult-type granulosa cell tumor of the ovary by palliative radiotherapy - Journal of Obstetrics and Gynaecology Research - Wiley Online Library
She is still alive with no signs of tumor progression for 30 months.
JMIR-Can Tweets Predict Citations? Metrics of Social Impact Based on Twitter and Correlation with Traditional Metrics of Scientific Impact | Eysenbach | Journal of Medical Internet Research
Conclusions: Tweets can predict highly cited articles within the first 3 days of article publication.....
Metastatic Tumors to the Urinary Bladder: Clinicopathologic
Abstract
Secondary neoplasms of the urinary bladder are uncommon, with metastatic tumors being an even rarer event. The authors studied the clinicopathology of 11 cases of metastatic tumors to bladder, which were collected from their archives between 1995 and 2010. The most common metastases in this series were breast. Some unusual metastases, including several not being previously reported, were also presented, namely, ileal carcinoid tumor, ileal gastrointestinal stromal tumor, ovarian squamous carcinoma, pancreatic gastrinoma, and renal collecting duct carcinoma. Vast majority of these patients (10/11, 91%) were female. Ninety percent of the patients presented with hematuria and/or obstructive urinary symptom as well as bladder lesions in the area of trigone, posterior wall, and/or bladder neck. Seven of the 11 patients had a known history of other metastases besides the bladder. Most of the patients (4/7, 57%) died within 1 year after diagnosis of bladder metastasis. Metastasis must be distinguished from a primary bladder neoplasm. Morphology and clinical correlation supplemented with immunohistochemical study is critical for the correct diagnosis.
Narod: Should All Women With Breast Cancer Be Tested for BRCA Mutations at the Time of Diagnosis?
....For now, perhaps the simplest recommendation is to test women under age 50 years with triple-negative breast cancer and women with a family history of early-onset breast cancer or ovarian cancer......
BMJ Jan 3, 2012 - selected articles: evidence; randomized clinical trials; publication bias; meta-analyses; Medline....
Effect of reporting bias on meta-analyses of drug trials: reanalysis of meta-analyses
Published 3 Jan 2012
Published 3 Jan 2012
Published 3 Jan 2012
Published 3 Jan 2012
Inviting Patients to Read Their Doctors' Notes: Patients and Doctors Look Ahead
abstract plus downloadable full free access (pdf):
Inviting Patients to Read Their Doctors' Notes: Patients and Doctors Look Ahead
also (note disparities in opinions):
Figures 1; Figures 2
Pelvic Mass Associated With Raised CA 125 For Benign Condition: A Case Report
Background:
Elevated levels of CA 125 with clinical evidence of significant weight loss and associated pelvic mass is highly suggestive of ovarian malignancy, this creates a diagnostic dilemma with the knowledge that several benign pelvic conditions may present with same findings.
Conclusion:
The presence of a pelvic mass with a raised CA 125 of 1450 units/ml, lymphadenopathy and other associated suspicious features on CT scan suggested an ovarian malignancy. A subsequent fall of CA 125 to 23 units/ml pointed to an inflammatory condition as was found intraoperatively. Raised CA 125 levels can be misleading, as illustrated in this case, a differential diagnosis of inflammatory pelvic condition should always be considered in young patients. While CT and CA 125 aids in diagnosis they should not completely supplant the need to rely on clinical history and examination findings.
Tuesday, January 03, 2012
NIH launches first online genetics course for social and behavioral scientists, January 3, 2012 News Release - National Institutes of Health (NIH)
NIH launches first online genetics course for social and behavioral scientists
A new genetics educational program will provide social and behavioral scientists with sufficient genetics background to allow them to engage effectively in interdisciplinary research with genetics researchers. The Office of Behavioral and Social Sciences Research (OBSSR) at the National Institutes of Health, partnered with the National Coalition for Health Professional Education in Genetics to create the free, Web-based project...........Genetics education and resources for social scientists
Genetics vs. Genomics
In popular media and common speech, the words "genetic" and "genomic" are often used interchangeably. However, to a geneticist, these terms have specific meanings. To appreciate the difference, we must first understand something about the structure of genetic material.
Genetic information is stored in the molecule DNA, which consists of a string of chemicals called bases. The order of bases on the string, called the "sequence", determines the meaning of the genetic message. A gene is a specific stretch of bases that provides instructions for making a particular product, such as a piece of a hormone or enzyme. Humans have many thousands of genes, spaced across the entire set of DNA, which is packaged into 23 pairs of chromosomes. However, there are many DNA sequences in-between genes that do not directly encode specific products. Some of these sequences modify the way that genes are expressed. Other sequences do not have a known function.
Genetic information is stored in the molecule DNA, which consists of a string of chemicals called bases. The order of bases on the string, called the "sequence", determines the meaning of the genetic message. A gene is a specific stretch of bases that provides instructions for making a particular product, such as a piece of a hormone or enzyme. Humans have many thousands of genes, spaced across the entire set of DNA, which is packaged into 23 pairs of chromosomes. However, there are many DNA sequences in-between genes that do not directly encode specific products. Some of these sequences modify the way that genes are expressed. Other sequences do not have a known function.
Potentiation of a p53-SLP vaccine by cyclophosphamide in ovarian cancer, a single arm phase II study.
Abstract
The purpose of the current phase II single-arm clinical trial was to evaluate whether pre-treatment with low-dose cyclophosphamide improves immunogenicity of a p53-synthetic long peptide (SLP) vaccine in patients with recurrent ovarian cancer. Ovarian cancer patients with elevated serum levels of CA-125 after primary treatment were immunized four times with the p53-SLP vaccine.........The outcome of this phase II trial warrants new studies on the use of low-dose cyclophosphamide to potentiate the immunogenicity of the p53-SLP vaccine, or other anti-tumor vaccines.Attitudes of Patients With Gynecological and Breast Cancer Toward Integration of Complementary Medicine in Cancer Care
Conclusion:
Although patients with gynecological malignancies use CAM significantly more than patients with breast cancer, both groups share similar conceptions regarding the active role of their gynecologist oncologists in the process of CAM integration within supportive care and expect CAM consultation to focus on improving their well-being.
Impact of Chemotherapy-Induced Nausea and Vomiting on Quality of Life in Indonesian Patients With Gynecologic Cancer
Conclusions:
Patients reported a negative impact on the QoL of delayed emesis after chemotherapy. Poor prophylaxis of patients’ nausea and vomiting after chemotherapy interferes with patients’ QoL. Medical and behavioral interventions may help to alleviate the negative consequences of chemotherapeutic treatment in patients with gynecologic cancers treated with suboptimal antiemetics.
Intravenous/Intraperitoneal Paclitaxel and Intraperitoneal C... : International Journal of Gynecological Cancer
Objective:
This study aimed to evaluate intravenous (IV)/intraperitoneal (IP) paclitaxel and IP carboplatin (TCipTip therapy) feasibility in epithelial ovarian (EOC), fallopian tube (FTC), or peritoneal carcinoma (PC) patients.
Methods:
From December 2007 to August 2010, 20 women with histologically confirmed stage IC to IV EOC, FTC, or PC.....
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