Sunday, February 19, 2012
Saturday, February 18, 2012
Seminars in Oncology - BRCA1 and BRCA2 Variants of Uncertain Significance. Part Two: Medical Management
Article Outline (October 2011)
Seminars in Oncology: Variants of Uncertain Significance in Breast Cancer–Related Genes: Real-World Implications for a Clinical Conundrum. Part One: Clinical Genetics Recommendations
Article Outline (August 2011)
- Positive BRCA1 or BRCA2
- Negative BRCA1 and BRCA2
- Variant of Uncertain Clinical Significance
- Case No. 1: BRCA1 VUS
- Case No. 2: BRCA2 VUS
- Case No. 3: BRCA2 VUS Favoring Polymorphism
- Clinical Discussion Points (Cases No. 2 and 3)
- Clinical Geneticists' Opinions
- Cancer Geneticists' Opinions
- Clinical Geneticists' Opinions
- Discussion
- References
Denmark's CareMed says shipped fake Avastin unwittingly | Reuters (last year?)
(Reuters) - "Danish drug distributor CareMed said it was an unwitting link in the journey of fake cancer medicine Avastin from Switzerland to Britain, in the latest twist in a saga that began when the counterfeit drugs surfaced in the United States last year.
The fake version of the multi-billion dollar Roche drug had been traced back as far as Egypt before entering a complex supply chain that ended in California......
A Swissmedic spokeswoman said it looked as if the distributor had no knowledge that the drugs were fake, a view echoed by Britain's Medicines and Healthcare Products Regulatory Agency.
"There is no suggestion (CareMed and Hadicon) knew it was counterfeit," a MHRA spokesman said......."
abstract: Biological significance of plasminogen activator inhibitor-1 expression in ovarian clear cell adenocarcinoma.
| Wiki: Plasminogen activator inhibitor-1 (PAI-1) also known as endothelial plasminogen activator inhibitor or serpin E1 is a protein that in humans is encoded by the SERPINE1 gene. |
Abstract
PURPOSE: Ovarian clear cell adenocarcinoma (OCCA) has been reported to display different characteristics from other histological types of epithelial ovarian cancer, and especially differs from serous adenocarcinoma. We investigated plasminogen activator inhibitor-1 (PAI-1) expression in patients with OCCA and attempted to assess its biological significance.
METHODS: Fifty-seven patients with OCCA were enrolled. We used formalin-fixed, paraffin-embedded sections of the primary tumor obtained at the first operation to investigate the immunohistochemical expression of PAI-1 and the association of PAI-1 expression with various clinicopathologic factors.
RESULTS: The 57 patients were classified into a high PAI-1 expression group and a low expression group. Comparison between the two groups revealed that the percentage of patients with concomitant endometriosis was significantly larger in the high expression group, while the percentage of Stage I patients with positive peritoneal cytology was significantly larger in the low expression group. Comparison of cumulative 5-year survival rates showed that the high expression group had a better prognosis than the low expression group.
CONCLUSION: These data suggest an association between concomitant endometriosis and increased expression of PAI-1 in OCCA. The data also suggest that PAI-1 expression influences both peritoneal dissemination of early OCCA and the prognosis.
abstract: A rare case of the coexistence of ovarian clear cell carcinoma, mucinous cystadenoma, and endometriosis in the same ovary (Taiwan)
Abstract
Clear cell carcinomas and endometrioid carcinomas are associated with endometriosis. The association of clear cell carcinomas with mucinous lesions has only been reported infrequently, and with mucinous cystadenoma has been rarely reported.
This is the second reported case of the coexistence of ovarian clear cell carcinoma, mucinous cystadenoma, and endometriosis in the same ovary.
A 57-year-old woman presented with lower abdominal pain for three weeks. Ultrasonography revealed a 16 x 14 x 10 cm mass in the left ovary with solid and cystic components. Hysterectomy and bilateral salpingo-oophorectomy were performed. Histopathological examination of the left ovary revealed the presence of clear cell carcinoma, mucinous cystadenoma, and endometriosis. Continuity between the areas of mucinous epithelium and clear cell carcinoma were noted; this may suggest that clear cell carcinoma may arise from endometriosis or mucinous cystic tumors.
This is the second reported case of the coexistence of ovarian clear cell carcinoma, mucinous cystadenoma, and endometriosis in the same ovary.
A 57-year-old woman presented with lower abdominal pain for three weeks. Ultrasonography revealed a 16 x 14 x 10 cm mass in the left ovary with solid and cystic components. Hysterectomy and bilateral salpingo-oophorectomy were performed. Histopathological examination of the left ovary revealed the presence of clear cell carcinoma, mucinous cystadenoma, and endometriosis. Continuity between the areas of mucinous epithelium and clear cell carcinoma were noted; this may suggest that clear cell carcinoma may arise from endometriosis or mucinous cystic tumors.
updated - link to full free paper: Review: Therapeutic strategies in epithelial ovarian cancer (references clear cell ovarian)
Blogger's Note: numerous references to clear cell ovarian cancer as per Japanese historical ovarian cancer research
direct link to pdf file
"In summary, it appears that the vast majority of what seem to be primary epithelial ovarian and primary peritoneal carcinomas are, in fact, secondary.
Previous data support the view that serous tumors develop from the fimbria, the most distal part of the fallopian tube, endometrioid and clear cell tumors from endometrial tissue passing through the fallopian tube resulting in endometriosis and mucinous and Brenner tumors from transitional-type epithelium located at the tubal-mesothelial junction where the fimbria makes contact to the peritoneum.
Although the data suggesting that epithelial ovarian carcinoma arises in extra-ovarian sites and involves the ovaries secondarily are compelling, low- and high-grade serous carcinomas involve the ovaries and other pelvic and abdominal organs, such as the omentum and mesentery, much more extensively than the fallopian tubes. Similarly, although endometrioid carcinomas develop from endometriosis, which frequently involves multiple sites in the pelvis, these tumors are usually confined to the ovaries.
It is likely that the predisposition for
growth in the ovary is multifactorial but the precise reasons for this are unknown."
abstract: Cochrane review: Cancer genetic risk assessment for individuals at risk of familial breast cancer.
Cochrane Database Syst Rev. 2012 Feb 15;2:CD003721.
Abstract
BACKGROUND:
The recognition of an inherited component to breast cancer has led to an increase in demand for information, reassurance, and genetic testing, which has resulted in the creation of genetic clinics for familial cancer. The first step for patients referred to a cancer genetic clinic is a risk assessment.OBJECTIVES:
To evaluate the impact of cancer genetic risk-assessment services on patients at risk of familial breast cancer.SELECTION CRITERIA:
We considered trials looking at interventions for cancer genetic risk-assessment services for familial breast cancer for inclusion. Trials assessed outcomes such as understanding of risk, satisfaction and psychological well-being. We excluded studies if they concerned cancers other than breast cancer or if participants were not at risk of inherited breast cancer. We also excluded trials concerning the provision of general cancer genetic information or education as this review was concerned with the delivery of genetic risk assessment. Participants could be individuals of any age or gender, with or without a known BRCA mutation, but without a previous history of breast cancer or any other serious illness.
MAIN RESULTS:
In this review update, we included five new trials, bringing the total number of included studies to eight. The included trials (pertaining to 10 papers), provided data on 1973 participants and assessed the impact of cancer genetic risk assessment on outcomes including perceived risk of inherited cancer, and psychological distress. This review suggests that cancer genetic risk-assessment services help to reduce distress, improve the accuracy of the perceived risk of breast cancer, and increase knowledge about breast cancer and genetics. The health professional delivering the risk assessment does not appear to have a significant impact on these outcomes.
AUTHORS' CONCLUSIONS:
This review found favourable outcomes for patients after risk assessment for familial breast cancer. However, there were too few papers to make any significant conclusions about how best to deliver cancer genetic risk-assessment services. Further research is needed assessing the best means of delivering cancer risk assessment, by different health professionals, in different ways and in alternative locations.Friday, February 17, 2012
update FYI: most viewed posts - Ovarian Cancer and Us Blog
Jan 16th - in order of most read/popular (top 5):
this week - in order of most read/popular (top 5):
|
Phase II trial of bryostatin-1 in combination with cisplatin in patients with recurrent or persistent epithelial ovarian cancer: a California cancer consortium study.
Phase II trial of bryostatin-1 in combination with cisplatin in patients with recurrent or persistent epithelial ovarian cancer: a California cancer consortium study.
Background
The California Cancer Consortium has performed a Phase II trial of infusional bryostatin, a protein kinase C inhibitor isolated from the marine invertebrate bryozoan, Bugula Neritina, a member of the phylum Ectoprocta, in combination with cisplatin, in patients (pts) with recurrent platinum-sensitive or resistant ovarian cancer (OC).
Methods
Pts received bryostatin 45 mcg/m(2) as a 72 h continuous infusion followed by cisplatin 50 mg/m(2). Cycles were repeated every 3 weeks. Dosages were chosen based on phase I data obtained by the CCC in a population of pts with mixed tumor types.
Results
Eight pts with recurrent or persistent epithelial OC received 23 cycles of treatment. All pts had received previous platinum-based chemotherapy; two pts had received one prior course, five had received two prior courses, and one had received three prior courses of chemotherapy. The median age was 64 (range 32-72), and Karnofsky performance status 90 (range 80-100). A median of 3 cycles of chemotherapy were delivered (range: 1-5). The median progression-free and overall survivals were 3 and 8.2 months respectively. Best responses included two partial responses (one in a platinum-resistant pt), three pts with stable disease, and three progressions. All pts experienced Grade 3 or 4 toxicities including severe myalgias/pain/fatigue/asthenia in six pts, and severe nausea/vomiting/constipation in two other pts. One pt experienced a seizure and liver function tests were elevated in one other.
Conclusions
A modest response rate is observed in pts with recurrent or persistent ovarian cancer treated with the combination of bryostatin and cisplatin. The toxicity profile, however, observed in this pt population (primarily severe myalgias), precludes tolerability and prevents this combination from further investigation at this dose and schedule. It is possible that platinum pre-exposure in OC patients exacerbates observed toxicity. Phase II dosages of investigational agents in OC pts that are determined by phase I trials in pts with other tumor types should be chosen cautiously.
Target-specific, histology-independent, randomized discontinuation study of lapatinib in patients with HER2-amplified solid tumors.
Target-specific, histology-independent, randomized discontinuation study of lapatinib in patients with HER2-amplified solid tumors.:
Background:
To explore the activity of lapatinib with a novel trial design focused on the drug target rather than on histology.
Methods:
Patients with HER2 amplified gastro-esophageal, bladder, ovarian, or uterine tumors were enrolled into a double-blinded randomized discontinuation study of lapatinib 1,500 mg PO daily. The planned sample size was 250 patients with HER2 amplified tumors, with the goal of randomizing 100 patients with stable disease (SD) at week 12 to either lapatinib or placebo. Patients responding after 12 weeks continued on lapatinib; those who progressed were discontinued from study. The primary objectives were response rate after 12 weeks and the percentage of patients who remained progression free 12 weeks after randomization to placebo versus lapatinib.
Secondary objectives were duration of response and determination of the incidence of HER2 amplification in multiple tumor types.
Results:
A total of 141 patients were screened and 32 patients with HER2 amplified tumors were enrolled.
At week 12, 1 (3%) patient had a complete response, 9 (28%) had stable disease, 20 (63%) had progressive disease, and 2 (6%) were unknown. Only 7 patients with SD underwent randomization. The low response rate coupled with slow screening and enrollment led to early study closure.
Conclusions:
Basing trial eligibility on the presence of a genetic target, versus histologic classification, is challenging. While HER2 amplifications appear to be prevalent in select non-breast tumors, lapatinib monotherapy is associated with modest activity. The target-specific histology-independent randomized discontinuation design still merits consideration for targets clearly implicated in "oncogene addiction".
abstract: Phase I clinical and pharmacokinetic study of trabectedin and carboplatin in patients with advanced solid tumors (including OC)
Phase I clinical and pharmacokinetic study of trabectedin and carboplatin in patients with advanced solid tumors.
Purpose
This study intended to determine the maximum tolerated dose (MTD) and the recommended phase II dose (RD) of trabectedin combined with carboplatin in patients with advanced solid tumors.
Patients and methods
Carboplatin-pretreated patients received carboplatin AUC 4 (Group 1), whereas carboplatin-naïve patients received carboplatin AUC 5 (Group 2) as a 1-h i.v. infusion followed by trabectedin at dose range from 0.5-1.2 mg/m(2) in the schedule of 3-h/every-3-weeks. Pharmacokinetic (PK) sampling was performed in the first 2 cycles.
Results
Forty-four patients were treated and evaluable for safety and dose-limiting toxicities (DLTs). In Group 1, at trabectedin 1.0 mg/m(2), cumulative hematological toxicity was found in all patients and 1/10 patients had DLTs. The RD was considered trabectedin 0.8 mg/m(2) combined with carboplatin AUC 4. Although no DLT occurred at this dose level, frequent dose delays (28.6%) and the 4-week cycle re-scheduling (66.7%) were required. In Group 2, DLTs occurred at trabectedin 0.8 mg/m(2) (3/8 patients), 1.0 mg/m(2) (3/10 patients) and 1.2 mg/m(2) (2/2 patients) with cumulative hematological toxicity associated with an important number of transfusions. In this group, neither the MTD nor the RD were established. Promising antitumor activity was found for this carboplatin/trabectedin combination; especially in patients with advanced ovarian cancer and soft tissue sarcoma. No significant PK drug-drug interaction occurred.
Conclusions
This study established a trabectedin dose of 0.8 mg/m(2) combined with carboplatin AUC 4 and given every 4 weeks as the most feasible schedule in carboplatin-pretreated patients. Dose and cycle recommendations for carboplatin-naïve patients warrant further evaluation.
Clinical Oncology News - Finding an Avastin (Bevacizumab) Biomarker: An Elusive Target
"On a basic level, it is still somewhat unclear why bevacizumab works on some cancers and not on others because seemingly, all tumors need to be fed by blood vessels."
Still waiting for the world to catch up - Ignace Vergote - Cancer World - including comments on CA-125/biomarkers
"When Ignace Vergote opted to specialise in gynaecological oncology, his country wasn't ready, and he's been waiting for the world to catch up with him ever since....."
~~~~~~~
"....The problem is well illustrated by Vergote’s own experience. When asked
about the research he is most proud of, Vergote points to an academic
study published a year ago in the New England Journal of Medicine,
which was independently funded and has already had a global impact.
Sponsored by the EORTC, it analysed outcomes in advanced ovarian cancer
surgery according to whether the debulking surgery was timed before or
during chemotherapy.
“I was very proud of this. But it took us ten years. We had to randomise
720 patients and, because it wasn’t sponsored, people had to be very
committed and give their time for free – talking to patients, gaining
informed consent, all these things without financial support. It’s very
difficult. So I am proud of that.”...
~~~~~
" He believes that more accurate tumour markers than CA125 need to be found – and his department is working on this problem.
“In 20 years, I think that maybe we will have a marker that will be more
specific and good enough for screening. But I think it’s still too
early to conclude that we have found it.” "
abstract: Preferences for place of death if faced with advanced cancer: a population survey in England, Flanders, Germany, Italy, the Netherlands, Portugal and Spain
Blogger' Note: implications (and distortions) for policy makers continue on this issue aside from this specific paper; assumptions on place of death are generally faulty (IMHO)
~~~~~~~~~~~~~~~
Background: Cancer end-of-life care (EoLC) policies assume people want to die at home. We aimed to examine variations in preferences
for place of death cross-nationally.
Methods: A telephone
survey of a random sample of individuals aged ≥16 in England, Flanders,
Germany, Italy, the Netherlands, Portugal
and Spain. We determined where people would
prefer to die if they had a serious illness such as advanced cancer,
facilitating
circumstances, personal values and experiences
of illness, death and dying.
Thursday, February 16, 2012
Living with grief : The Lancet (DSM-5 and ICD-11)
"Grief is not an illness; it is more usefully thought of as part of being human and a normal response to death of a loved one. Putting a timeframe on grief is inappropriate—DSM-5 and ICD-11 please take note. Occasionally, prolonged grief disorder or depression develops, which may need treatment, but most people who experience the death of someone they love do not need treatment by a psychiatrist or indeed by any doctor. For those who are grieving, doctors would do better to offer time, compassion, remembrance, and empathy, than pills."
abstract: A Prospective Study on the Efficacy of Octreotide in the Management of Malignant Bowel Obstruction in Gynecologic Cancer
A Prospective Study on the Efficacy of Octreotide in the Management of Malignant Bowel Obstruction in Gynecologic Cancer:
Objective:
Malignant bowel obstruction (MBO), of which symptoms lead to a poor quality of life, is a common and distressing clinical complication in advanced gynecologic cancer. The aim of this study was to prospectively assess the clinical efficacy of octreotide to control vomiting in patients with advanced gynecologic cancer with inoperable gastrointestinal obstruction.
Results: .....No major adverse events related to octreotide were reported.
Conclusions: We conclude that 300-[mu]g/d dose of octreotide was effective and safe for Japanese patients with MBO by advanced gynecologic cancer. Octreotide could contribute to better quality of life by avoiding placement of nasogastric tube.
IGCS and ESGO
abstract: Does the FIGO 2009 Endometrial Cancer Staging System More Accurately Correlate With Clinical Outcome in Different Histologies?: Revised Staging, Endometrial Cancer, Histology
Blogger's Note: of interest to our ovarian cancer communities eg. dual/concurrent malignancies; Lynch Syndrome
~~~~~~~~~~~~~~~~
Does the FIGO 2009 Endometrial Cancer Staging System More Accurately Correlate With Clinical Outcome in Different Histologies?: Revised Staging, Endometrial Cancer, Histology:
Objective:In 2009, the International Federation of Gynecology and Obstetrics (FIGO) staging system was revised for endometrial cancers. Different histologies were examined in a large population database. The FIGO 1988 and 2009 staging systems were compared for stage at presentation, differences in patient populations, and disease-specific survival (DSS).
Methods/Materials:
A total of 10,839 cases from 1998 to 2006 were analyzed from the Surveillance, Epidemiology, and End Results (SEER) Program. Examined histologies included 1377 cases of clear cell carcinoma (CC), 2304 cases of uterine papillary serous carcinoma (PS), 755 cases of carcinosarcoma (CS), and 6403 cases of grade 3 endometrial adenocarcinoma (G3A). The median follow-up was 26 months. For each stage and histology, DSS for patient characteristics was examined.
Results:
Of the 10,839 women with CC, PS, CS, and G3A had a median age of 67 years. White, black, and other ethnicities composed 87.5%, 12%, and 7% of this group, respectively.
A higher percentage of non-G3A histology (CS, PS, and CC) was found in 58% of black women versus 39% of white women. The best to worst 5-year DSS was G3A (76.2%), CC (68.8%), PS (59%), and CS (53.4%). Patients with FIGO IIIC2 disease had inferior survival outcomes in CC (P = 0.0079) and G3A (P = 0.047) compared with FIGO IIIC1 disease, whereas DSS was not significantly different for CS and PS between stages IIIC1 and IIIC2.
Conclusions:
These findings describe differences in the DSS of various aggressive histologies of EC, with poorer DSS in PS, CC, or CS histologies. Analysis demonstrated the usefulness of the new FIGO staging for DSS prediction between stages IIIC1 and IIIC2 for CC and G3A, and 2 divisions for stage I rather than three.
IGCS and ESGO
open access: Tool Used To Assess How Well Community Health Centers Function As Medical Homes May Be Flawed
Blogger's Note:
this paper is specific to the care of those with diabetes (our under-served populations), however, the concept of 'medical homes' expands beyond a singular disease...so it is therefore worth reading
"In the United States, more than 8,000 community health center sites provide comprehensive primary care services, mainly serving a minority and low-income population.1 This article focuses on community health centers that meet accountability standards set by the Health Resources and Services Administration (HRSA) and are designated as federally qualified health centers.2...........In selecting our sample within this consortium, we applied two inclusion criteria, both NCQA prerequisites at the time for becoming a patient-centered medical home. The practice had to provide primary care services, and it had to employ at least one physician. When the research team approached the medical directors of the member organizations, none had previously completed the NCQA medical home tool. "
open access: Peripheral Neuropathy In Ovarian Cancer | InTechOpen (pdf file) - should be a priority read
Blogger's Note: should be a priority reading:
~~~~~~~~~~~~~~~~~
Peripheral Neuropathy in Ovarian Cancer
Yi Pan
Source: Ovarian Cancer - Clinical and Therapeutic Perspectives
ISBN 978-953-307-810-6
Edited by: Samir Farghaly
Publisher: InTech, February 2012
ISBN 978-953-307-810-6
Edited by: Samir Farghaly
Publisher: InTech, February 2012
Peripheral Neuropathy in Ovarian Cancer
(Dr.) Yi Pan
Department of Neurology & Psychiatry, Saint Louis University
USA
1. Introduction
Peripheral neuropathy is not uncommon in ovarian cancer. The incidence density of peripheral neuropathy was 21.5 per 1000 person-years in ovarian cancer, 15.3 per 1000 person-years in breast cancer and 18.3 per 1000 person-years in lung cancer for patients who
received platinum-taxane combination chemotherapy (Nurgalieva et al., 2010).
Carboplatin/paclitaxel is the chemotherapy of choice for advanced ovarian cancer, which has been reported to associate with chemotherapy induced neurotoxicity in as high as 54% of patients after their first-line 6 cycles of treatment and with 23% of patients with residual neuropathy after a median follow up of 18 months (Pignata et al., 2006 ).
However, peripheral neuropathy in ovarian cancer is not always due to chemotherapeutic agents. Other etiologies of neuropathy in ovarian cancer patients are focal compression, nutritional
deficiency, ......cont'd
5. Conclusion
Peripheral neuropathy in ovarian cancer is complex. When patients develop neuropathy symptoms in ovarian cancer, we cannot simply conclude that it is chemotherapy-induce neuropathy. It is a challenge to treat this condition. Diagnosis of the etiology of the neuropathy, treating the underlying disease, correction of metabolic, nutritional, endocrine abnormalities, and decompression of the nerve entrapment will preserve nerve function. The goals of treatment are reduction of symptoms, improvement of function and patient’s quality of life.
free app: THE ONCOLOGIST New App - The Oncologist Community
THE ONCOLOGIST New App - The Oncologist Community
The Oncologist Journal is freely available on iPad, iPhone, Android and Kindle Fire.
Gynecologic cancers Drugs - monograms - Chemotherapy Advisor
Genetic & Pathological Studies of BRCA1/BRCA2: Associated Tumors & Blood Samples - Full Text View - ClinicalTrials.gov
This study is currently recruiting participants.
Verified October 2010 by Stanford University
First Received on December 16, 2009. Last Updated on October 7, 2010 History of Change
Medical News:Oral Nutrition Supplements Give Little Help to Cancer Patients - in Oncology/Hematology, Other Cancers from MedPage Today
Medical News:Oral Nutrition Supplements Give Little Help to Cancer Patients - in Oncology/Hematology, Other Cancers from MedPage Today
Primary source: Journal of the National Cancer Institute
Source reference:
Baldwin C, et al "Oral nutritional interventions in malnourished patients with cancer: A systematic review and meta-analysis" J Natl Cancer Inst 2012; DOI: 10.1093/jnci/djr556.
Additional source: Journal of the National Cancer Institute
Source reference:
O'Mara A, St. Germain D "Improved outcomes in the malnourished patient: We're not there yet" J Natl Cancer Inst 2012; DOI: 10.1093/jnci/djs031
abstract: A randomized parallel-group dietary study for stages II–IV ovarian cancer survivors Gynecologic Oncology
Objective
Few studies have examined the dietary habits of ovarian cancer survivors. Therefore, we conducted a study to assess the feasibility and impact of two dietary interventions for ovarian cancer survivors.
Methods
In this randomized, parallel-group study, 51 women (mean age, 53 years) diagnosed with stages II–IV ovarian cancer were recruited and randomly assigned to a low fat, high fiber (LFHF) diet or a modified National Cancer Institute diet supplemented with a soy-based beverage and encapsulated fruit and vegetable juice concentrates (FVJCs). Changes in clinical measures, serum carotenoid and tocopherol levels, dietary intake, anthropometry, and health-related quality of life (HRQOL) were assessed with paired t-tests.
Results
The recruitment rate was 25%, and the retention rate was 75% at 6 months. At baseline, 28% and 45% of women met guidelines for intake of fiber and of fruits and vegetables, respectively. After 6 months, total serum carotenoid levels and α- and β-carotene concentrations were significantly increased in both groups (P < 0.01); however, β-carotene concentrations were increased more in the FVJC group. Serum β-cryptoxanthin levels, fiber intake (+ 5.2 g/day), and daily servings of juice (+ 0.9 servings/day) and vegetables (+ 1.3 servings/day) were all significantly increased in the LFHF group (all P < 0.05). Serum levels of albumin, lutein and zeaxanthin, retinol, and retinyl palmitate were significantly increased in the FVJC group (all P < 0.05).
No changes in cancer antigen-125, anthropometry, or HRQOL were observed.
Conclusion
Overall, this study supports the feasibility of designing dietary interventions for stages II–IV ovarian cancer survivors and provides preliminary evidence that a low fat high fiber diet and a diet supplemented with encapsulated FVJC may increase phytonutrients in ovarian cancer survivors.
Highlights
► Many ovarian cancer survivors fail to meet current guidelines for dietary intake.
► A low-fat diet supplemented with encapsulated fruit and vegetable juice concentrates can improve carotenoid levels.
► Encapsulated fruit and vegetable juice concentrates may help bridge the gap between what is consumed and what is needed.
► A low-fat diet supplemented with encapsulated fruit and vegetable juice concentrates can improve carotenoid levels.
► Encapsulated fruit and vegetable juice concentrates may help bridge the gap between what is consumed and what is needed.
abstract: Cognitive function and quality of life in ovarian cancer- Gynecologic Oncology (chemobrain)
Objectives
As advances in treatment have prolonged survival for many patients with ovarian cancer, there has been growing interest in assessing the adverse effects of disease and treatment. The aim of this study was to review the literature on cognitive function and quality of life (QOL) in this population.
Results
The small number of studies including formal evaluations of neurocognitive function suggests that many ovarian cancer patients experience cognitive difficulties associated with their disease and treatment. Several studies described declines in self-reported cognitive function that may impact QOL, but the results were not consistent across studies.
Highlights
► The literature suggests that many patients with ovarian cancer experience cognitive difficulties associated with their disease and treatment.
► Several studies reported declines in self-reported cognitive function that may impact QOL, but the results were inconsistent across studies.
► Several studies reported declines in self-reported cognitive function that may impact QOL, but the results were inconsistent across studies.
abstract: Characteristics of medication errors with parenteral cytotoxic drugs
Abstract:
Characteristics of medication errors with parenteral cytotoxic drugs
Characteristics of medication errors with parenteral cytotoxic drugs
"Errors involving cytotoxic drugs have the potential of being fatal and should therefore be prevented. The objective of this article is to identify the characteristics of medication errors involving parenteral cytotoxic drugs in Sweden.
A total of 60 cases reported to the national error reporting systems from 1996 to 2008 were reviewed.
Classification was made to identify cytotoxic drugs involved, type of error, where the error occurred, error detection mechanism, and consequences for the patient.
The most commonly involved cytotoxic drugs were fluorouracil, carboplatin, cytarabine and doxorubicin. The platinum-containing drugs often caused serious consequences for the patients. The most common error type were too high doses (45%) followed by wrong drug (30%). Twenty-five of the medication errors (42%) occurred when doctors were prescribing. All of the preparations were delivered to the patient causing temporary or life-threatening harm. Another 25 of the medication errors (42%) started with preparation at the pharmacies. The remaining 10 medication errors (16%) were due to errors during preparation by nurses (5/60) and administration by nurses to the wrong patient (5/60). It is of utmost importance to minimise the potential for errors in the prescribing stage. The identification of drugs and patients should also be improved."
A total of 60 cases reported to the national error reporting systems from 1996 to 2008 were reviewed.
Classification was made to identify cytotoxic drugs involved, type of error, where the error occurred, error detection mechanism, and consequences for the patient.
The most commonly involved cytotoxic drugs were fluorouracil, carboplatin, cytarabine and doxorubicin. The platinum-containing drugs often caused serious consequences for the patients. The most common error type were too high doses (45%) followed by wrong drug (30%). Twenty-five of the medication errors (42%) occurred when doctors were prescribing. All of the preparations were delivered to the patient causing temporary or life-threatening harm. Another 25 of the medication errors (42%) started with preparation at the pharmacies. The remaining 10 medication errors (16%) were due to errors during preparation by nurses (5/60) and administration by nurses to the wrong patient (5/60). It is of utmost importance to minimise the potential for errors in the prescribing stage. The identification of drugs and patients should also be improved."
abstract: Pregnant woman with an extremely small uterus due to pelvic irradiation in childhood (very sad)
Pregnant woman with an extremely small uterus due to pelvic irradiation in childhood:
Abstract
"A female cancer survivor, having suffered malignant lymphoma during childhood and received radio- and chemotherapy, became pregnant. Her uterus was extremely small and in the 22nd week of gestation, acute uterine contractions occurred, leading to preterm delivery and resulting in the death of the infant. Pelvic irradiation in childhood was considered to have caused a small uterus and thus brought on preterm delivery. The younger the patient, the more vulnerable the uterus is to irradiation. The exposure dose to the uterus in pediatric cancer patients should therefore be reduced, especially in younger patients. The cooperation of pediatric cancer specialists and obstetricians is necessary to preserve the future fertility of female cancer survivors."
abstract: Vinblastine, cisplatin, cyclophosphamide, bleomycin, doxorubicin, and etoposide (VPCBAE) in the management of three patients with small-cell carcinoma of the ovary
Vinblastine, cisplatin, cyclophosphamide, bleomycin, doxorubicin, and etoposide (VPCBAE) in the management of three patients with small-cell carcinoma of the ovary: Publication year: 2012
Source: Gynecologic Oncology Case Reports, Available online 13 February 2012
abstract
Highlights
► Ovarian small-cell carcinoma of the hypercalcemic type is a rare neoplasm with no standard treatment.► The chemotherapy regimen including vinblastine, cisplatin, cyclophosphamide, bleomycin, doxorubicin and etoposide (VPCBAE) is safe and effective.has limited toxicities and was effective in the 3 patients described in this case report.
Abstract: Simple ovarian cysts in postmenopausal women: scope of conservative management
Simple ovarian cysts in postmenopausal women: scope of conservative management:
Publication year: 2012
Source: European Journal of Obstetrics & Gynecology and Reproductive Biology, Available online 15 February 2012
Abstract:
Objective
This study was done to evaluate/investigate the natural history of simple ovarian cysts in postmenopausal women and to determine the risk for malignant transformation of these cysts.
Study design
Ultrasound reports of all the postmenopausal women who attended St. Francis Hospital and Medical Center, Hartford, USA from January 1997 to April 2010 with an ultrasound diagnosis of simple cysts of ovary were reviewed retrospectively. A total of 619 patients with 743 simple ovarian cysts were evaluated. It was found that 305 out of 619 patients (49.27%) were lost in follow-up. Therefore, 314 patients (50.73%) with 378 cysts could be followed further by ultrasound study.
Results
One hundred and seventy-five (46.30%) of the 378 cysts that could be followed further had spontaneous resolution and 166 cysts (43.91%) persisted unchanged over the follow-up period. Thirty cysts (7.94%) turned into complex cysts and four cysts (1.06%) significantly increased in size. One cyst significantly decreased in size, though it did not resolve. Only one patient developed papillary serous carcinoma (high grade) of the ovary. This occurred three years after her last ultrasound for simple cyst surveillance.
Conclusion
Simple ovarian cysts during the menopause can be followed conservatively because their risk for malignant transformation is low. The majority of these cysts either resolve spontaneously or persist unaltered on follow-up.
abstract: The pathophysiology of menopausal symptoms
Blogger's Note: search blog (or elsewhere for post-WHI studies as well as the minority of studies on surgically-induced menopause eg. natural menopause vs surgery/treatment related menopause); requires paid subscription to view full paper
The pathophysiology of menopausal symptoms:
Publication year: 2012
Source: Obstetrics, Gynaecology & Reproductive Medicine, Volume 22, Issue 3, March 2012
Abstract:
"Increasing life expectancy means that most Western women will experience the menopausal transition. This phase of reproductive life involves a biopsychosocial process where the majority of women experience physiological changes, influenced by a wide range of ethnic, psychological, social and cultural factors. With relatively similar endocrine changes, symptom reporting should be generalized, yet more women in Western cultures report vasomotor symptoms (hot flushes and night sweats) compared to women in Asian cultures. Different approaches to menopause based on biological/medical, psychological or psychosocial premises result in different treatments for women who have troublesome symptoms.Hormone replacement therapy (HRT) is widely used in the management of symptoms associated with oestrogen withdrawal (hot flushes, night sweats, sleep disturbance, vaginal dryness and dyspareunia), but has no known role in the treatment of midlife depression or arthritis. HRT prevents menopausal bone loss and osteoporotic fracture, though long-term use remains controversial because of the increased risk of breast cancer, myocardial infarction and stroke, as reported by the Women’s Health Initiative."
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