(2nd article) Medicare's Readmissions-Reduction Program — A Positive Alternative — NEJM

Medicare's Readmissions-Reduction Program — A Positive Alternative — NEJM

Hospital readmissions are receiving increasing attention as a largely correctable source of poor quality of care and excessive spending. According to a 2009 study, nearly 20% of Medicare beneficiaries are rehospitalized within 30 days after discharge, at an annual cost of $17 billion.1 Causes of avoidable readmissions include hospital-acquired infections and other complications; premature discharge; failure to coordinate and reconcile medications; inadequate communication among hospital personnel, patients, caregivers, and community-based clinicians; and poor planning for care transitions........

Thirty-Day Readmissions — Truth and Consequences — NEJM

Thirty-Day Readmissions — Truth and Consequences — NEJM

Reducing hospital readmission rates has captured the imagination of U.S. policymakers because readmissions are common and costly and their rates vary — and at least in theory, a reasonable fraction of readmissions should be preventable. Policymakers therefore believe that reducing readmission rates represents a unique opportunity to simultaneously improve care and reduce costs. As part of the Affordable Care Act (ACA), Congress directed the Centers for Medicare and Medicaid Services (CMS) to penalize hospitals with “worse than expected” 30-day readmission rates. This part of the law has stimulated hospitals, professional societies, and independent organizations to invest substantial resources in finding and implementing solutions for the “readmissions problem.”..........

Medscape: Targeting the Epigenome in Ovarian Cancer: Abstract and Introduction

Targeting the Epigenome in Ovarian Cancer: Abstract and Introduction

From Future Oncology

Targeting the Epigenome in Ovarian Cancer

Susan K Murphy

Authors and Disclosures

Posted: 03/28/2012; Future Oncology. 2012;8(2):151-164. © 2012 Future Medicine Ltd.

• Abstract and Introduction
• Ovarian Cancer
• Treatment
• Potential for Epigenetic Therapies
• Epigenome Characterization & Clinical Utility
• Progress in Using Epigenetic Therapies
• Current Limitations of Epigenetic Therapy
• Conclusion
• Future Perspective

• References

Consumer Reports targets medical devices' safety - latimes.com

 Blogger's Note: search blog for other posts regarding 'surgical mesh' issues/concerns

Consumer Reports targets medical devices' safety - latimes.com

"In a report issued Wednesday the consumer magazine also expressed concerns about risks related to surgical mesh, metal hips and certain cardiac devices. It highlighted how the federal government allows some products to be sold with little or no advance safety testing......

reposted from Jan 2012 - worth reading - Editorial Commentary - Maurie Markman - Clinical Oncology News - Meaningful Responses To ‘We-Know-the-Answer’ Syndrome

".... The following three examples, all drawn from the field of epithelial ovarian cancer management, illustrate the dangers of simply accepting conventional wisdom, and in my opinion, serve as excellent examples of the importance of critical thinking when evaluating this type of proclamation...." (3 examples )


"Similar examples can be found in all areas of clinical oncology where conventional wisdom and “expert opinion” have inappropriately trumped the essential process of critical thinking. Unfortunately, this is not surprising: Critical thinking often is quite difficult, particularly when the outcome rejects a strong belief in some particular conventional wisdom that has been passed on by “senior leaders” or “experts in a field.”"

"....... Stressing the dangers of nonrigorously tested, overly simplistic or nonbiologically based beliefs often is not the way to win popularity contests among your peers (or within professional organizations), who may accept the conventional wisdom as being factually correct. But for those who appropriately, and even courageously, refuse to be swept up by the superficial allure and comfort of conventional wisdom, who understand that genuine progress in oncologic outcomes demands constant inquiry into our existing interpretations of biological systems and current medical practice, it is important to remember it is our patients who are the beneficiaries of our efforts........"

abstract: Harmony in drug regulation, but who's calling the tune? An examination of regulatory harmonization in health Canada [Int J Health Serv. 2012] (eg. safety, influences, industry...)

 Blogger's Note: the current federal (conservative) government is known widely for its lack of transparency (past and present), Health Canada, obviously, falls within federal mandates

Harmony in drug regulation, but who's call... [Int J Health Serv. 2012] - PubMed - NCBI

Int J Health Serv. 2012;42(1):119-36.

Source

School of Health Policy and Management, York University, Toronto, ON, Canada. jlexchin@yorku.ca

Abstract

Harmonizing standards on drug regulation makes sense, but it must protect safety, ensure that only drugs that are truly effective are marketed, and protect a country's ability to act independently. The main driving force behind international harmonization is the International Conference on Harmonization (ICH). When it comes to safety, the ICH has been harmonizing to the lowest common denominator. Examples of harmonization indicate that industry priorities have influenced the direction that Health Canada has taken. Harmonization is also intimately tied in with the policy of smart regulation, changing regulations in a way that enhances the climate for investment. Canada has introduced user fees in concert with other countries, but there are concerns that these may compromise safety standards. When it comes to transparency, Health Canada has chosen to adopt the more restrictive European Union model rather than the more open process used by the United States. Finally, there are a number of areas in which Health Canada has chosen not to harmonize, and in each case the decision is in the direction of lower safety standards. Harmonization could be of benefit to Canada, but the evidence to date suggests that Health Canada been harmonizing down rather than up.

Clinical Oncology News - Pro/Con: Money for Drugs

Clinical Oncology News - Pro/Con: Money for Drugs

Clinical Oncology News - Zoledronic Acid Debate in Breast Cancer Continues

Clinical Oncology News - Zoledronic Acid Debate in Breast Cancer Continues

San Antonio—Long-term results of the ABCSG-12 trial and subanalyses of two recently presented Phase III trials provide further evidence that bisphosphonates can improve survival in breast cancer patients with low estrogen levels. The results of the studies, presented at the recent San Antonio Breast Cancer Symposium (SABCS), have convinced some doctors of the low estrogen hypothesis, but for others the water is still very murky.....


Weighing the Evidence
In recent years, some oncologists have been prescribing bisphosphonates off-label to treat breast cancer, and the new studies may sway more doctors to do so.
“The anticancer effects of adjuvant zoledronic acid are now well established in endocrine-responsive patients,” said Dr. Gnant.
Dr. Paterson added that “inhibition of osteoclast function with bisphosphonates has an effect on cancer growth in older women, and little effect in premenopausal women.”
For other doctors, however, the jury is still out. “Subanalyses are suspect,” said Dr. Vogl. “This is interesting, but we need to study it some more. But if they study it some more, Novartis will have lost its patent protection by the time that study comes out. Novartis has some interest in it [being approved] now.”

Dr. Paterson is a consultant for GlaxoSmithKline, Amgen, Roche and Nicomed and has received a grant for a clinical trial involving denosumab. Dr. Gnant disclosed relationships with AstraZeneca, Novartis, Pfizer, Sanofi, Roche, Schering and Amgen. Dr. Möbus disclosed relationships with Amgen, Novartis and Roche. Dr. de Boer disclosed a relationship with Novartis. Drs. Ingle and Dr. Vogl have no relevant disclosures.

Seth's Blog: Why isn't it better?

Seth's Blog: Why isn't it better?

Why isn't it better?

• Perhaps you don't know enough
• Perhaps you don't care enough, or
• Perhaps you're unable to execute because of committees, the status quo and fear

These might be three ways to say the same thing.
The combination of fear and ignorance (two sides of the same coin) can be paralyzing

UK - Quality of Life and Experience of Care in Women With Metastatic Breast Cancer: A Cross-Sectional Survey

Blogger's Comment: read prior post on 'symptom clusters'

Journal of Pain and Symptom Management - Quality of Life and Experience of Care in Women With Metastatic Breast Cancer: A Cross-Sectional Survey

Conclusion

Despite improvements in treatment and survival of women with metastatic breast cancer, this group reports high symptom burden and dissatisfaction with elements of their care, indicating that alternative models of service delivery should be explored.

ScienceDirect.com - Journal of Pain and Symptom Management - Talking About End-of-Life Preferences With Advanced Cancer Patients: Factors Influencing Feasibility

ScienceDirect.com - Journal of Pain and Symptom Management - Talking About End-of-Life Preferences With Advanced Cancer Patients: Factors Influencing Feasibility

Conclusion

Results indicate that discussing end-of-life preferences in an earlier disease phase, such as in the OU (outpatient) setting, could be preferable but that its accomplishment in this setting may be more difficult, mainly as a result of organizational reasons. This observation could indicate that the system is not yet ready to offer patients such an opportunity and although communication on these sensitive issues cannot be reduced to a procedure, the ELPI can become a useful tool to help physicians in accomplishing this difficult task.

abstract: All’s Well That Ends Well? Quality of Life and Physical Symptom Clusters in Long-Term Cancer Survivors Across Cancer Types (Australia/Canada)

 Blogger's Note:  search blog for other posts on 'symptom cluster' research, note that the abstract does not discuss the current status of the 5/6 year survivors (eg. in treatment,  type/s of treatments, # prior treatments, stage.....

Blogger's Opinion:   short answer - no, back to the 'drawing' board on this one

 abstract: "Cancer patients also will welcome the news that only a minority of five-year survivors experience long-term and late effects."

All’s Well That Ends Well? Quality of Life and Physical Symptom Clusters in Long-Term Cancer Survivors Across Cancer Types:

Publication year: 2012

Source: Journal of Pain and Symptom Management, Volume 43, Issue 4

Context 
Little is known about the presentation of multiple concurrent symptoms (symptom clusters) in long-term cancer survivors, with few studies adequately powered to compare quality of life (QoL) and symptom presentation by cancer type.

Objectives 
This research aimed to 1) assess patient-reported QoL and 2) identify clusters of cancer-related physical symptoms by cancer type among long-term breast, prostate, colorectal, and melanoma cancer survivors.

Methods
A population-based cross-sectional sample of 863 adult cancer survivors five to six years post-diagnosis completed the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30), assessing global QoL and frequency of presentation of cancer-related physical symptoms.

Results
Long-term survivors reported higher levels of global QoL than 1) the general population (age-adjusted mean=79.4 vs. 71.1, small clinical difference) and 2) cancer patients early in the care trajectory (age-adjusted mean=77.1 vs. 61.3, moderate clinical difference). The majority (71%) did not report any cancer-related physical symptoms; 18% reported multiple (two or more) symptoms in the past month. Factor analysis found that cognitive functioning, fatigue, insomnia, pain, dyspnea, appetite loss, constipation, diarrhea, nausea, and vomiting formed a cluster (α =0.48). No symptom clusters were identified that were specific to just one cancer type. However, individual symptoms (including diarrhea, pain, constipation, and insomnia) modestly discriminated between cancer types.

Conclusion
Contrary to expectations, no symptom clusters specific to one type of cancer were identified and survivors reported few cancer-related symptoms and high QoL. These results convey a strong “good news” message, providing health professionals with a sound foundation for making encouraging predictions about their patients’ long-term physical recovery after cancer. Cancer patients also will welcome the news that only a minority of five-year survivors experience long-term and late effects.

abstract - Journal of Pain and Symptom Management - A Spicamycin Derivative (KRN5500) Provides Neuropathic Pain Relief in Patients With Advanced Cancer: A Placebo-Controlled, Proof-of-Concept Trial

ScienceDirect.com - Journal of Pain and Symptom Management - A Spicamycin Derivative (KRN5500) Provides Neuropathic Pain Relief in Patients With Advanced Cancer: A Placebo-Controlled, Proof-of-Concept Trial

Conclusion

This proof-of-concept study for KRN5500 in patients with advanced cancer and any type of neuropathic pain found gastrointestinal adverse events to be the predominant safety concern. The results also provided the first indication of clinical and statistical efficacy in reducing pain intensity.

Evidence-based Guideline Recommendations on the use of Positron Emission Tomography Imaging in Colorectal Cancer (Ontario provincial Gastrointestinal Disease Site Group)

 Blogger's Note: updated to 2010

Evidence-based Guideline Recommendations on the use of Positron Emission Tomography Imaging in Colorectal Cancer

Doctors Have Feelings, Too - NYTimes.com

Doctors Have Feelings, Too - NYTimes.com

".....Last month, an article in the journal Health Affairs made headlines in the news media — “Physicians Are Not Always Open or Honest with Patients.” A vast majority of the nearly 2,000 doctors surveyed agreed that physicians should be fully open and honest in all their communications with patients, as the Charter on Medical Professionalism requires, but more than one in 10 had specifically told a patient something that was not true within the past year. Almost one in five had not revealed a medical error. More than half had framed a prognosis in a more positive light than was warranted.

The authors expressed concern that doctors were not fully living up to the charter; patients worried that they couldn’t trust what their doctors said. I also found the data disturbing, but for different reasons. I don’t think that doctors are generally a dishonest bunch. Yes, there are a few utter miscreants out there, and many more who could use a tune-up on their communication skills. But I suspect that the dishonesty that is being uncovered in a study such as this — and frankly, I was amazed that the number of less-than-truthful instances was so low — reveals more about the diagnosis of being human than anything else.

When Julia walked out of our hospital without full knowledge of her prognosis, I had been derelict in my duty as her physician. I was fully aware that my job was to have “open and honest” communication with her, in a “patient centered” manner. But I couldn’t. I couldn’t bring myself to tell this young mother that she was going to die........"

in research: One Drug to Shrink All Tumors (CD47) in MICE - ScienceNOW

One Drug to Shrink All Tumors - ScienceNOW

open access: European cancer mortality predictions for the year 2012 (stats not included for ovarian cancer)

European cancer mortality predictions for the year 2012

March 27th: Medscape article - Olaparib for Ovarian Cancer, No Longer in Development

Olaparib for Ovarian Cancer, No Longer in Development

abstract: Economic impact of paclitaxel shortage in patients with newly diagnosed ovarian cancer (astounding figures)

Economic impact of paclitaxel shortage in patients with newly diagnosed ovarian cancer - NCBI

Abstract

OBJECTIVE:

To determine the potential economic impact of a paclitaxel drug shortage in patients with newly diagnosed, untreated ovarian cancer.

RESULTS:

...... A drug shortage that affects approximately 50% of women initiating chemotherapy is expected to impact 779 women and cost third party payers an additional $8,699,872 monthly.

CONCLUSIONS:

Our model indicates that chemotherapy drug shortages can have a significant negative impact on the average cost of primary treatment for ovarian cancer and have the potential to negatively impact health system costs.

abstract: Progression-free and overall survival of a modified outpatient regimen of primary intravenous/intraperitoneal paclitaxel and intraperitoneal cisplatin in ovarian, fallopian tube, and primary peritoneal cancer

Progression-free and overall survival of a modified outpatient regime... [Gynecol Oncol. 2012] - PubMed - NCBI

Abstract

OBJECTIVE:

GOG study 172 demonstrated improved progression-free (PFS) and overall (OS) survival for patients with stage III optimally debulked ovarian and peritoneal carcinoma treated with IV/IP paclitaxel and IP cisplatin compared to standard IV therapy. The inpatient administration, toxicity profile, and limited completion rate have been blamed for the lack of acceptance and widespread use of this regimen. We sought to evaluate the PFS, OS, toxicity, and completion rate of a modified outpatient IP regimen.


 CONCLUSIONS:
By modifying the GOG 172 treatment regimen, convenience, toxicity, and tolerability appear improved, with survival outcomes similar to those of GOG 172. This modified IV/IP regimen warrants further study.

AOS9 Mortality in children of women diagnosed with cancer: A population based cohort study (abstract)

Blogger's Note: this paper is subscription based ($$$)

AOS9 Mortality in children of women diagnosed with cancer: A population based cohort study: Publication year: 2012

Source:European Journal of Cancer, Volume 48, Supplement 4

Background 
With increasing risks of cancer and improving chances of survival, an increasing number of female survivors are starting or extending their family post-diagnosis. The mortality risks in the offspring of mothers with a history of cancer were evaluated.

Methods
From the Swedish Multi-generation Register and the Cancer Register, we identified all 174,893 children whose mothers had been diagnosed with invasive cancer between 1958 and 2001. For these children, we calculated relative risks of death (standardised mortality ratios, SMRs) compared with the background population and assessed trends in SMRs.

Findings
With the exception of offspring of mothers with tobacco-related cancers (head and neck, thoracic, cervical; SMR 1.23 [95% confidence interval (CI) 1.13–1.33]), offspring of mothers with a history of cancer did not have increased mortality risk (SMR 1.00 [95% CI 0.97–1.03]). Children born within 1 year of their mother’s diagnosis had an increased mortality risk (SMR 1.66 [95% CI 1.25–2.13]), particularly if their mother was primiparous at diagnosis of breast cancer (SMR of 11.07 [95% CI 2.09–27.13]). Offspring born more than 1 year after their mother’s diagnosis of haemopoietic cancer were also at increased risk of death (SMR 2.07 [95% CI 1.10–3.35]).

Interpretation 
Timing of childbirth in relation to the mother’s diagnosis and type of cancer modifies mortality risks in the offspring. The increased mortality risk in children conceived around the time of the mother’s diagnosis suggests a negative effect of the cytotoxic treatment on the offspring, which primiparous women are more likely to accept than women who have given birth before. Despite the high relative risks, absolute increases in mortality risks are small.

Funding M. Hartman was supported by NMRC/1180/2008 and NUS Start-up Fund DPRT (Grant No. R-186-000-108-133). This study was also funded by the Swedish Research Council (SIMSAM Grant No. 80748301). The authors declared no conflicts of interest.

research news: When we test, do we stress?

Blogger's Note:  interesting article, reminds me of the 'white coat' factor

"On the basis of these results, the CSHS team questioned over 150 older people, asking them to describe the situations they find stressful when they have to go to various medical environments. On March 29, during the scientific day “When we test, do we stress?” ( http://bit.ly/H9UdLn ), the CSHS researchers will reveal the results of this survey on stress induced in older people by medical settings and the testing environments......

When we test, do we stress?

open access: ecancer - Phase 0 clinical trials: towards a more complete ethics critique

Phase 0 clinical trials: towards a more complete ethics critique

Summary

In efforts to modernise the entire drug-development process, making it more efficient, less costly, and ultimately of real benefit to patients, The Federal Drug Administration (FDA) authorised the use of exploratory IND or early Phase I (Phase 0) studies. Quite different in structure from Phase I, II, and III studies, the Phase 0 construct understandably poses a set of ethical problems not seen in the other research phases and so far not adequately addressed by ethicists. In an effort to deal with this deficiency, this paper proposes an ethics critique, based not on the usual concept of benefit, but on the means–end relation, and placed within an ethic of science derived from the practice of science.

---

To date, the ethics analysis of Phase 0 clinical trials has remained incomplete [1–3]. Focusing, for the most part, on the Phase 0 construct itself, the analysis has neglected the larger economic context in relation to which Phase 0 trials must be understood for any complete analysis.......

"The Ethics of the Phase 0 Construct
It is clear from the way the Phase 0 construct is described in both the Critical Path Initiative and the Guidance that the FDA is promoting it as a means to achieve an end, namely, solving the “pipeline problem”. If so, then an ethics assessment of the construct should start by asking whether the end justifies the means in moral terms.......

open access: Olaparib Maintenance Therapy in Platinum-Sensitive Relapsed Ovarian Cancer — NEJM

Olaparib Maintenance Therapy in Platinum-Sensitive Relapsed Ovarian Cancer — NEJM

......"We evaluated the efficacy of olaparib monotherapy as maintenance treatment in patients with platinum-sensitive, relapsed, high-grade serous ovarian cancer who had had a response to their most recent platinum-based chemotherapy......"

In conclusion, the results from this randomized, phase 2 study show that maintenance treatment with olaparib was associated with a significant improvement in progression-free survival among patients with platinum-sensitive, relapsed, high-grade serous ovarian cancer. However, at the interim analysis, this did not translate into an overall survival benefit. As of this writing, 21% of the patients were still receiving olaparib (and 3% were still receiving placebo), which indicates that the disease is controlled for a prolonged period in some patients.

(2nd item) New Data Updating Overall Survival Rate in Olaparib Study -- SGO conference

New Data Updating Overall Survival Rate in Olaparib Study -- AUSTIN, Texas, March 27, 2012 /PRNewswire-USNewswire/ --SGO conference

media: AMP Optimistic in Suit to invalidate Patents on Breast Cancer Genes (BRCA/ovarian....)

Blogger's Note: typical reminder that the Myriad 'breast cancer' genetic testing is not only for breast cancer

AMP Optimistic in Suit to invalidate Patents on Breast Cancer Genes

Medical News:Data Confirm PARP Inhibitor (Olaparib) Slows Ovarian Ca - in Meeting Coverage, SGO from MedPage Today

Medical News:Data Confirm PARP Inhibitor Slows Ovarian Ca - in Meeting Coverage, SGO from MedPage Today

Action Points

Note that this randomized, placebo controlled study demonstrates that olaparib, an oral poly(adenosine diphosphate [ADP]-ribose) polymerase inhibitor, significantly improved progression-free survival but not overall survival, in patients with platinum-sensitive, relapsed, high-grade serous ovarian cancer.

press release: Bioethics gets personal with Hastings' consumer website and Hastings-NOVA special PBS March 28th

Bioethics gets personal with Hastings' consumer website and Hastings-NOVA special

The Hastings Center

Bioethics gets personal with Hastings' consumer website and Hastings-NOVA special

(Garrison, NY) Will genetic testing and personalized medicine change the way you think about your life? Should it? What can you really learn about your future from direct-to-consumer genetic tests–or even from whole genome scanning, which is becoming increasingly affordable? And what about your privacy: how well is your genetic information protected?
These and other bioethics issues are raised in Cracking Your Genetic Code, a NOVA special produced in association with The Hastings Center that airs on PBS on March 28, at 9 pm/8c. And the discussion continues at Help with Hard Questions, The Hastings Center's first website created for the general public. Help With hard Questions is an online community that aims to help people think through the ethical dimensions of dilemmas arising from advances in science and medicine–advances like genetic screening and personalized medicine, as well as reproductive technologies, children's mental health, and advanced illness.
"Advances in medicine and science hold tremendous promise," says Mary Crowley, Director of Public Affairs and Communications at The Hastings Center. "But they also raise new questions about such issues as sharing the results of genetic tests with family and balancing caretaking with other responsibilities

Scientists Reprogram Cancer Cells With Low Doses of Epigenetic Drugs (azacitidine, decitabine, epigenetic drugs)

Scientists Reprogram Cancer Cells With Low Doses of Epigenetic Drugs:

• Drugs previously considered too toxic for human use.
• Cancer stem cells were a target of these agents.
• Study by Stand Up To Cancer Dream Team published in Cancer Cell.

( Clinical trials in breast and lung cancer have begun in patients with advanced disease, and trials in colon cancer are planned. )

CHICAGO — Experimenting with cells in culture, researchers at the Johns Hopkins Kimmel Cancer Center have breathed possible new life into two drugs once considered too toxic for human cancer treatment. The drugs, azacitidine and decitabine, are epigenetic drugs and work to correct cancer-causing alterations that modify DNA.
The researchers also found that the drugs took aim at a small but dangerous subpopulation of self-renewing cells, sometimes referred to as cancer stem cells, which evade most cancer drugs and cause disease recurrence and spread.
In a report published in the March 16, 2012, issue of Cancer Cell, the Johns Hopkins team said their study provides evidence that low doses of the drugs cause antitumor responses in breast, lung and colon cancer cells. They will discuss their work at a Stand Up To Cancer press event on April 1, 2012, at 1:00 p.m. CT in Room 10 A/B/C of the Hyatt Conference Center, adjacent to the McCormick Place Conference Center.
Conventional chemotherapy agents indiscriminately poison and kill rapidly dividing cells, including cancer cells, by damaging cellular machinery and DNA.
“In contrast, low doses of azacitidine (AZA) and decitabine (DAC) may reactivate genes that stop cancer growth without causing immediate cell killing or DNA damage,” said Stephen Baylin, M.D., Ludwig professor of oncology and deputy director of the Johns Hopkins Kimmel Cancer Center in Baltimore, Md.

Why Healthcare Is Different | The Health Care Blog

Why Healthcare Is Different | The Health Care Blog

Canadian Medical Association Journal: Consent requirements for pelvic examinations performed for training purposes

Blogger's Note: to read full article subscription required ($$$), see blog for numerous past posts on this (significant) womens' health issue

Canadian Medical Association Journal

ANALYSIS

Consent requirements for pelvic examinations performed for training purposes

March 26, 2012
 
In 2010, Canada’s two obstetrics and gynecology associations updated the policy statement concerning pelvic examinations performed on women under anesthesia. The previous guideline applied to medical students and residents, whereas the new one applies to medical students only. According to Gibson and Downie, pelvic examinations performed for training purposes presumably constitute a battery in law, subject to defence of consent. They argue that either the statement needs to be revised to include residents or a new statement specific to residents needs to be drafted.  Full article  (requires subscripiton $$$)

Hospitals' unsubstantiated marketing claims for robotic surgery (robotic gynecologic surgery)

 

 Hospitals' unsubstantiated marketing claims for robotic surgery

medical news: Improved clinical quality leads to decline in quality of patients' experiences

Improved clinical quality leads to decline in quality of patients' experiences

....."Clinical quality is about doing things correctly - strict guidelines, standardization and checklists, for example - so when you consider experiential quality is about customizing health-care delivery to an individual patient's needs, there is a tension there," said Aravind Chandrasekaran, assistant professor of management sciences at Ohio State and lead author of the study.
How might this tension play out?......

Morphotek®, Inc. Announces Completion of Enrollment in the FAR-131 Trial for Relapsed Ovarian Cancer

Morphotek®, Inc. Announces Completion of Enrollment in the FAR-131 Trial for Relapsed... -- EXTON, Pa., March 27, 2012 /PRNewswire/ --

Clinical Study Seeks to Evaluate Farletuzumab in Combination with Standard of Care in First-Relapse Patients with Platinum-Sensitive Ovarian Cancer

EXTON, Pa., March 27, 2012 /PRNewswire/ -- Morphotek®, Inc., a subsidiary of Eisai Inc., announced today it has completed enrollment of the FAR-131 clinical trial. The study is a pivotal Phase 3 randomized trial of farletuzumab in first-relapsed patients with platinum-sensitive ovarian cancer. Farletuzumab is a humanized monoclonal antibody that targets folate receptor alpha (FRA), which is expressed on the majority of non-mucinous epithelial ovarian cancers as well as a subset of other carcinomas.
The trial is designed as a three-armed, randomized, double-blinded, controlled study in patients with platinum-sensitive ovarian cancer who relapse after first-line treatment with standard of care. FAR-131 tests the ability of farletuzumab at two different dosages in combination with second-line standard-of-care (carboplatin or cisplatin plus paclitaxel or docetaxel) for patients with platinum-sensitive disease to improve progression-free survival as compared to those treated with standard-of-care and placebo. Secondary endpoints include improvements in overall survival, objective tumor responses and the number of patients exhibiting longer second remission periods as compared to their primary remission.

FAR-131 was initiated in March 2009, and has reached its randomization target of 1080 patients at clinical sites in 30 countries located in North America, South America, Europe, Asia, Australia and the Middle East.

Farletuzumab is a monoclonal antibody that binds to and blocks the function of FRA, a cell surface protein on tumor cells that confers a growth advantage to tumorigenic ovarian cells in vitro. FRA has been demonstrated by several independent studies to be expressed on a variety of cancer types. The antibody also is being tested in a randomized Phase 2 study to assess its effect in patients with FRA⁺ non-small-cell lung adenocarcinoma in combination with standard of care in first-line therapy.

Further information on the clinical study can be found at www.clinicaltrials.gov, study number NCT00849667.

Found 1 study with search of:

NCT00849667

 

	Active, not recruiting	Efficacy and Safety of MORAb-003 in Subjects With Platinum-sensitive Ovarian Cancer in First Relapse Condition: Ovarian Cancer Interventions: Drug: MORAb-003 (farletuzumab);   Drug: 0.9% Saline

Advanced cancer patients' self-assessed physical and emotional problems on admission and discharge from hospital general wards – a questionnaire study

Advanced cancer patients' self-assessed physical and emotional problems on admission and discharge from hospital general wards – a questionnaire study

 (2012) European Journal of Cancer Care

Most cancer patients receiving life-prolonging or palliative treatment are offered non-specialist palliative services. There is a lack of knowledge about their problem profile. The aim of this article is to describe the incidence of patient-reported physical and emotional problems on admission and discharge from general hospital wards and health staff's reported intervention.

A prospective study was undertaken over 12 months, where advanced cancer patients completed a patient questionnaire, EORTC QLQ C15-PAL, on admission (n= 97) and discharge (n= 46). The incidences of the problems were dichotomised in intensity categories. The average number of ‘clinically relevant problems’ on admission was 5 (SD 2) and on discharge 4 (SD 2).

A Wilcoxon signed rank test showed significant change in mean score for six out of nine problem areas, but the majority of the patients did not move to the lower intensity category. The highest concurrence was between patient-reported problems and reported intervention for physical function, pain, constipation and loss of appetite. Palliative cancer patients' self-reported problem profile on admission and discharge from hospital has not previously been described and the results indicate a need to focus on improvements to palliative services and for a special service for pain and constipation that could prevent some admissions.

Future Medicine - Biomarkers in Medicine - numerous items of interest

Future Medicine - Biomarkers in Medicine 

eg.:

Use of molecular diagnostic tests for peripheral neuropathy called into question

Noninvasive test  (ColonSentry^®) for colorectal cancer risk now available in the USA

Virtual tool could aid detection of genetic mutations

Potential advances in the detection of circulating tumor cells with advent of new blood test

 

 

Calcijex Injection (Calcitrol) Drug Information: Warnings and Precautions - (Calcitriol/Vitamin D/Hypercalcemia)

Calcijex Injection (Calcitrol) Drug Information: Warnings and Precautions - Prescribing Information at RxList

WARNINGS

Since calcitriol is the most potent metabolite of vitamin D available, prescription-based doses of vitamin D and its derivatives should be withheld or used with caution during treatment to avoid the risk of hypercalcemia.
A non-aluminum phosphate-binding compound should be used to control serum phosphorus levels in patients undergoing dialysis.
Overdosage of any form of vitamin D is dangerous (see also OVERDOSAGE).

open access (pdf) Underestimating Cardiac Toxicity in Cancer Trials: Lessons Learned?

Underestimating Cardiac Toxicity in Cancer Trials:Lessons Learned?

Sunitinib (Sutent; Pfizer, New York, NY) represents one of the
most successful cancer therapies, with US Food and Drug Administration (FDA) approval for three malignancies and ongoing trials in more than 30 tumor types.1,2 It also represents an instructive example revealing how adverse events can be vastly underestimated. The purpose of this article is to critically evaluate the history of the underrecognition of the cardiac toxicity of sunitinib and to propose solutions to improve adverse event monitoring for future therapies.......

"Cardiac toxicity from a wide variety of tyrosine kinase inhibitors
is now recognized to be of importance, with toxicity observed
from both on- and off-target effects. In the case of sunitinib, which
inhibits more than 50 kinases, mechanisms likely include inhibition
of angiogenesis and disturbances of mitochondrial structure
and energy metabolism—both potentially similarly important for
tumor proliferation.11,13"

abstract: Funding Oncology Clinical Trials: Are Cooperative Group Trials Sustainable?

Funding Oncology Clinical Trials: Are Cooperative Group Trials Sustainable?

Conclusion
The negative trough in the lifetime net income of a cooperative group trial occurs because follow-up costs are typically not funded or are underfunded. CTDs accrue more patients in new trials to offset that deficit. The CTD uses revenue from accrual to existing trials to cross-subsidize past trials in follow-up. As the number of patients on follow-up increases, the fiscal deficit grows larger each year, perpetuating the cycle. 

JCO (pdf) Comment - Robbing Peter to Pay Paul: Financing Clinical Trial Follow-Up

 Robbing Peter to Pay Paul: Financing Clinical Trial Follow-Up

David M. Dilts, Oregon Health and Science University, Knight Cancer Institute, Portland, OR
See accompanying article doi: 10.1200/JCO.2011.37.2698

"....With this total-cost knowledge, sites should be able to
do a better job of selecting trials that match their scientific interests,
their patient populations, and their fiscal necessities, and stop cross subsidizing old trials with new trials—in essence, stop robbing Peter to
pay Paul."

Study: Patient information leaflets for cancer trials are not up to the job

Study: Patient information leaflets for cancer trials are not up to the job

Single antibody (CD47 ) shrinks variety of human tumors transplanted into mice, Stanford study shows | e! Science News

Single antibody shrinks variety of human tumors transplanted into mice, Stanford study shows | e! Science News

Human tumors transplanted into laboratory mice disappeared or shrank when scientists treated the animals with a single antibody, according to a new study from the Stanford University School of Medicine. The antibody works by masking a protein flag on cancer cells that protects them from macrophages and other cells in the immune system. The scientists achieved the findings with human breast, ovarian, colon, bladder, brain, liver and prostate cancer samples. It is the first antibody treatment shown to be broadly effective against a variety of human solid tumors, and the dramatic response -- including some overt cures in the laboratory animals -- has the investigators eager to begin phase-1 and -2 human clinical trials within the next two years.........

abstract: Critical Reviews in Oncology/Hematology - Chemotherapy-induced peripheral neurotoxicity (CIPN): An update

Critical Reviews in Oncology/Hematology - Chemotherapy-induced peripheral neurotoxicity (CIPN): An update

Abstract

The peripheral nervous system can be vulnerable to the toxic action of several drugs since it is not protected as effectively as the central nervous system from noxious exogenous agents. Drug-induced neurotoxicity can affect the nerve fibers or the neuronal bodies (generally the dorsal root ganglia of the primary sensory neurons). Among the neurotoxic drugs antineoplastic agents represent a major clinical problem, given their widespread use and the potential severity of their toxicity. In fact, the peripheral neurotoxicity of antineoplastic agents frequently represents one of their dose-limiting side effects. 

Moreover, even when antineoplastic agents’ peripheral neurotoxicity is not dose-limiting, its onset may severely affect the quality of life of cancer patients and cause chronic discomfort. 

Among the anticancer chemotherapy drugs, platinum derivates, antitubulins, thalidomide and bortezomib can induce the most severe effects on the peripheral nervous system of the treated patients. Therefore, we will review the features of chemotherapy-induced peripheral neurotoxicity (CIPN) resulting from the administration of these drugs with a focus on new classes of promising antineoplastic agents, such as epothilones and proteasome inhibitors.

Patterns of referral and knowledge of palliative radiotherapy in Alberta (and Northern Alberta and parts of British Columbia, Saskatchewan, the Northwest Territories, and Nunavut)

Patterns of referral and knowledge of palliative radiotherapy in Alberta [Can Fam Physician. 2012]

Abstract

OBJECTIVE:

To assess practitioners' referral patterns and knowledge of palliative radiotherapy (PRT).

DESIGN:

A 23-item questionnaire.

SETTING:

Northern Alberta and parts of British Columbia, Saskatchewan, the Northwest Territories, and Nunavut.

PARTICIPANTS:

A total of 1360 health practitioners, including primary care physicians and nurse clinicians in rural, remote, or far northern regions; FP-oncologists working in community cancer centres; palliative care (PC)specialists; and medical oncologists.

Joint Conference of HGM 2013 and 21st International Congress of Genetics (Singapore)

Blogger's Note: exceptional/interesting progra/Singapore April 13-18, 2013



Joint Conference of HGM 2013 and 21st International Congress of Genetics

 Highlights
In 2013, the joint forces of HGM 2013 and 21^st International Congress of Genetics will definitely ensure a highly prominent knowledge platform, discussing a wider span of topical issues faced by the industry. Themed "Genetics & Genomics of Global Health and Sustainability", the conference features various international expert speakers that will provide great insights on the latest trends and findings.
The key topics of the conference include:

• Human Genetics Medicine
• Sustainability
• Genome Medicine
• ELSI, Policy and Biobanking
• Genomes & Technologies
• Genetic Mechanisms
• Non-Human Genetics (Model Systems)

Click here for more details on the preliminary programme

Bridging Anticoagulation: Is it Needed When Warfarin Is Interrupted Around the Time of a Surgery or Procedure?

Bridging Anticoagulation
 Cardiology Patient Page

Is it Needed When Warfarin Is Interrupted Around the Time of a Surgery or Procedure?

1. The BRIDGE Study Investigators

Research Newsletter | update - Ovarian Cancer Academy Award – Early-Career Investigator pre-application deadline Apr 17th

Research Newsletter | Ovarian Cancer Academy Award – Early-Career Investigator
 Funding Opportunity: Ovarian Cancer Academy Award – Early-Career Investigator

• Sponsor: DoD
• Pre-Application Deadline: April 17, 2012
• Application Deadline (by invitation): July 18, 2012
• Posted Date: March 26, 2012
• Agency Code: W81XWH-12-OCRP-OCA
• Link: http://cdmrp.army.mil/funding/pa/12ocrpoca_pa.pdf

Summary

The Ovarian Cancer Academy provides provides the Early-Career Investigator with funding, networking opportunities, and research experience necessary to develop and sustain a successful, independent career at the forefront of ovarian cancer research. This award also provides support and protected time for 5 years of intensive research under the guidance of a Designated Mentor experienced in ovarian cancer research.
Maximum allowable cost is $750,000 for five years. Cost sharing is required.

Last updated: March 26, 2012
Filed under: External Funding Opportunities, Health, Behavioral and Biomedical Science

newswise: Pox Vaccines Extend Survival for Patients with Melanoma, Ovarian Cancer in U.S., German Studies

Pox Vaccines Extend Survival for Patients with Melanoma, Ovarian Cancer in U.S., German Studies

Released: 3/26/2012 3:05 PM EDT
Source: Roswell Park Cancer Institute

 

Newswise — BUFFALO, NY — An immunotherapy regimen incorporating poxviruses and targeting a particular tumor antigen, NY-ESO-1, has shown promise in treating two types of cancers. Kunle Odunsi, MD, PhD, Chair of the Department of Gynecologic Oncology and Director of the Center for Immunotherapy at Roswell Park Cancer Institute (RPCI), Elke Jäger, MD, Head of the Department of Oncology and Hematology at Krankenhaus Nordwest, Frankfurt, and colleagues today published results from two studies testing this approach in PNAS, the Proceedings of the National Academy of Sciences of the United States of America...........

Reuters: Myriad gene patent ruling sent back to lower court

 Reuters: Myriad gene patent ruling sent back to lower court

"The move is expected to delay a verdict in the Myriad case by as much as several years."

Fertility Help Not Equal for Cancer Patients - in OB/Gyn, Infertility from MedPage Today

Fertility Help Not Equal for Cancer Patients - in OB/Gyn, Infertility from MedPage Today

 Action Points

• Note that in a retrospective study of women diagnosed with cancer between the ages of 18 and 40 years and treated with modalities with potential to affect fertility, women who had not attained a bachelor's degree were less likely to be counseled about fertility preservation.
• Note that counseling on and use of preservation services appeared to increase over time, although, as recently as 2007, nearly 40% of patients were not offered such counseling.

Supreme Court Ruling Creates Uncertainty for Diagnostics Companies - 03/23/2012 - The Burrill Report

Supreme Court Ruling Creates Uncertainty for Diagnostics Companies - 03/23/2012 - The Burrill Report

Ottawa opens up its drug stockpile - media (Sandoz-sole supplier......)

Ottawa opens up its drug stockpile

"Sandoz is the sole supplier to Canadian hospitals of 90 per cent of all injectable drugs, including more than 100 pain-killers and sedatives."

Journal of Cancer Education: abstract - Online Evaluation Programs: Benefits and Limitations (Patient Navigation Programs)

Journal of Cancer Education, Online First™ -

Online Evaluation Programs: Benefits and Limitations

Abstract

Patient navigation programs are increasing throughout the USA, yet some evaluation measures are too vague to determine what and how navigation functions. Through collaborative efforts an online evaluation program was developed. The goal of this evaluation program is to make data entry accurate, simple, and efficient. This comprehensive program includes major components on staff, mentoring, committees, partnerships, grants/studies, products, dissemination, patient navigation, and reports. Pull down menus, radio buttons, and check boxes are incorporated whenever possible. Although the program has limitations, the benefits of having access to current, up-to-date program data 24/7 are worth overcoming the challenges. Of major benefit is the ability of the staff to tailor summary reports to provide anonymous feedback in a timely manner to community partners and participants. The tailored data are useful for the partners to generate summaries for inclusion in new grant applications.

Quest, Lab Corp. Fall (financial) After Fraud Whistle-Blower Interview - Bloomberg

Quest, Lab Corp. Fall After Fraud Whistle-Blower Interview - Bloomberg

open access: Resolving the variable genome and epigenome in human disease - Knight - 2012 - Journal of Internal Medicine - Wiley Online Library

Resolving the variable genome and epigenome in human disease - Knight - 2012 - Journal of Internal Medicine

pdf file

Conclusions

There is no doubt that recent advances in genomics, currently driven by new high-throughput sequencing techniques, are taking us to remarkable new levels in our understanding of the human genome, and the genetic and epigenetic variation that exists, with important implications for our understanding of human disease. As this knowledge grows, our appreciation of the complexity with which we are faced is also underlined. For common multifactorial traits, GWAs have been very informative but leave much heritable risk unresolved. Rarer variants may prove important but in general, more integrated approaches are needed in which environmental risk factors are considered and combined with functional genomic analyses. Moreover, we need to derive functional genomic data in a disease-relevant setting as the consequences of underlying genetic and epigenetic diversity are increasingly recognized to be highly context specific.

Current technologies that can interrogate the whole genome carry with them significant caveats: these tools are new, and successful application to important biological problems requires careful experimental design and consideration of the limitations inherent in such approaches. The data sets involved are highly complex, and analysis remains extremely challenging with significant risks of false positive and negative results until the field matures. High-throughput sequencing is not a panacea but a critical tool in current genomics.  

Used wisely, it is resolving the individual genome and epigenome, at a structural and functional level, and will radically advance our understanding of disease. For Mendelian traits (Wiki) , the impact is already being felt. For common multifactorial diseases, this may take a little longer.

open access - Revie: Unravelling modifiers of breast and ovarian cancer risk for BRCA1 and BRCA2 mutation carriers: update on genetic modifiers - Journal of Internal Medicine (references to Lynch Syndrome/Familial Melanoma)

Unravelling modifiers of breast and ovarian cancer risk for BRCA1 and BRCA2 mutation carriers: update on genetic modifiers - Journal of Internal Medicine

pdf file

Genetic variants associated with breast cancer risk for BRCA1 mutations carriers

Genetic variants associated with breast cancer risk for BRCA2 mutations carriers

Patterns of association and tumour characteristics

Genetic modifiers of ovarian cancer risk

Environmental, hormonal and reproductive modifiers of risk

Common alleles and cancer risks for mutation carriers

Future challenges     "Over the past 5 years, there has been substantial progress in our understanding of genetic factors that modify breast and ovarian cancer risk for BRCA1 and BRCA2 mutation carriers. This was made possible to a great extent because of the availability of large numbers of mutation carriers from the CIMBA consortium and GWAS data. However, the five loci described in this review that are associated with breast cancer risk for BRCA1 mutation carriers are estimated to explain only approximately 3% of the genetic variability in breast cancer risk for BRCA1 mutation carriers. Similarly, the 11 SNPs associated with breast cancer risk for BRCA2 mutation carriers are estimated to account for approximately 6% of the genetic variability in breast cancer risk for BRCA2 mutation carriers. Therefore, the majority of the genetic variability in breast cancer risk for mutation carriers still remains unexplained. Several more breast and ovarian cancer susceptibility alleles have been identified through GWAS in the general population, but have not yet been investigated in mutation carriers [61, 63, 72, 75]. Given the observed association patterns in mutation carriers with previously identified loci, it is expected that at least a subset of these will also be associated with breast or ovarian cancer risk for mutation carriers. Additional genetic modifiers of risk may also be identified through not only the ongoing GWAS in BRCA1 and BRCA2 mutation carriers but also other GWAS from the general population or by GWAS focusing on specific cancer subtypes such as oestrogen-receptor-negative or triple-negative breast cancers, or serous ovarian cancer. However, it is likely that several of the alleles identified through population-based GWAS may be associated with modest relative risks in the range of 1.05–1.10. Despite sample sizes of approximately 15 000 BRCA1 and 10 000 BRCA2 mutation carriers, CIMBA would still be underpowered to detect modifying polymorphisms conferring such modest relative risks. Given the rarity of BRCA1 and BRCA2 mutations, increasing sample sizes is currently only possible through increased collaboration between studies and through continued recruitment of mutation carriers........

Conclusions

As more cost-effective mutation screening techniques become available, the number of identified BRCA1 and BRCA2 mutation carriers in the population is likely to increase. Therefore, it will be important that all mutation carriers are provided with accurate information on their risk of developing breast and ovarian cancer, so that informed decisions on clinical management are made. Our understanding of factors influencing cancer risk variability in mutation carriers has increased over the last few years and is likely to improve further in the near future. Therefore, we are getting closer to the goal of being able to provide more individualized clinical management. Understanding how cancer risks are modified in BRCA1 and BRCA2 mutation carriers will also provide further insights for studying the biological mechanisms of cancer development in mutation carriers. These may lead to the development of novel therapies and more accurate prediction of breast and ovarian cancer progression in mutation carriers.

Studying genetic modifiers of breast and ovarian cancer risk for BRCA1 and BRCA2 mutation carriers has provided useful insights in study design, analytical methodology and applications, which could be used for studying modifiers of disease in carriers of other high-risk mutations such as the mismatch repair genes MSH2, MLH1, MSH6, PMS2 in colorectal cancer (Lynch Syndrome) and CDKN2A in melanoma but also other noncancer-related diseases.

 

 

 

 

 

 

open access: Apr 2012 -Role of common genetic variants in ovarian cancer susceptibility and outcome: progress to date from the ovarian cancer association consortium (OCAC) - Journal of Internal Medicine (BRCA, Lynch, high/low penetrance mutations....)

Role of common genetic variants in ovarian cancer susceptibility and outcome: progress to date from the ovarian cancer association consortium (OCAC) -  Journal of Internal Medicine

open access pdf file


 "In this article, we review the current knowledge of the inherited genetics of epithelial ovarian cancer (EOC) susceptibility and clinical outcome. We focus on recent developments in identifying low-penetrance susceptibility genes and the role of the ovarian cancer association consortium (OCAC) in these discoveries. The OCAC was established to facilitate large-scale replication analyses for reported genetic associations for EOC. Since its inception, the OCAC has conducted both candidate gene and genome-wide association studies (GWAS); the latter has identified six established loci for EOC susceptibility, most of which showed stronger association with the serous histological subtype. Future GWAS and sequencing studies are likely to result in the discovery of additional susceptibility loci and may result in established associations with clinical outcome. Additional rare and uncommon ovarian cancer loci will likely be uncovered from high-throughput next-generation sequencing studies. Applying these novel findings to establish improved preventative and clinical intervention strategies will be one of the major challenges of future work....

abstract: Retrospective study comparing irinotecan (CPT-11) and pegylated liposomal doxorubicin in treatment of recurrent platinum-refractory/resistant epithelial ovarian cancer (Japan)

Blogger's Note: older studies have also included efficacy in clear cell ovarian tumors

 Abstract

PURPOSE:

The standard regimen for platinum-resistant/refractory recurrent epithelial ovarian cancer (EOC) remains to be determined. In this study, we retrospectively compared the effect of irinotecan (CPT-11) and pegylated liposomal doxorubicin (PLD) in the treatment of platinum-resistant recurrent EOC.

METHODS:

Thirty patients who received salvage chemotherapy with CPT-11 or PLD were included in the study. CPT-11 (100 mg/m2) was administered intravenously on days 1, 8 and 15 every four weeks. PLD (50 mg/m2) was administered on day 1 every four weeks. Treatment was repeated, provided that no disease progression or intolerable toxicity occurred.

RESULTS:

Response rate in the CPT-11 group and PLD group showed no difference at 26.7% in both, while non-PD rate was 73.3% vs. 33.3%, respectively. Progression-free survival after CPT-11 treatment and PLD treatment was 28.4 weeks and 16.8 weeks, respectively. Hand-foot syndrome and mucositis were more common in the PLD group than in the CPT-11 group.

CONCLUSIONS:

The results indicate that CPT-11 is a promising drug for the treatment of platinum-resistant recurrent EOC.

abstract: Primary gynaecological tumours mistaken for metastases: report of two cases with review of literature

Primary gynaecological tumours mistaken... [Eur J Gynaecol Oncol. 2012] - PubMed - NCBI

 Abstract

We describe two neoplasms of rare occurrence, one of ovarian and the other of uterine origin that were sent for consultation. Both lesions were diagnosed as metastatic carcinomas by pathologists with special interest in gynaecological pathology. The cases were referred for a second opinion because of subsequent failure to identify the primary source. We discuss the differential diagnoses, the need for generous sampling particularly in ovarian mucinous neoplasms and the value of including particular antibodies in the panel to aid the diagnostic process. Metastatic tumours mimicking primary tumours are always challenging. These two cases illustrate the need to be vigilant against the reverse scenario as well.

abstract: Coffee and tea consumption and the risk of ovarian cancer: a prospective cohort study and updated meta-analysis - EU/UK

Coffee and tea consumption and the risk of ovarian cancer: a prospective cohort study and updated meta-analysis
  Abstract

Background: In 2007 the World Cancer Research Fund Report concluded that there was limited and inconsistent evidence for an effect of coffee and tea consumption on the risk of epithelial ovarian cancer (EOC). 

Objective: In the European Prospective Investigation into Cancer and Nutrition (EPIC), we aimed to investigate whether coffee intakes, tea intakes, or both are associated with the risk of EOC. 

Design: All women participating in the EPIC (n = 330,849) were included in this study. Data on coffee and tea consumption were collected through validated food-frequency questionnaires at baseline. HRs and 95% CIs were estimated by using Cox proportional hazards models. Furthermore, we performed an updated meta-analysis of all previous prospective studies until April 2011 by comparing the highest and lowest coffee- and tea-consumption categories as well as by using dose-response random-effects meta-regression analyses. 

Results: During a median follow-up of 11.7 y, 1244 women developed EOC. No association was observed between the risk of EOC and coffee consumption for the top quintile compared with no intake] or tea consumption for the top quintile compared with no intake]. This lack of association between coffee and tea intake and EOC risk was confirmed by the results of our meta-analysis.

Conclusion: Epidemiologic studies do not provide sufficient evidence to support an association between coffee and tea consumption and risk of ovarian cancer.

abstract: Too Early To Determine Cancer Risk from Infertility Treatments

Too Early To Determine Cancer Risk from Infertility Treatments

As more and more women wait to have children, the use of fertility drugs is rapidly rising, along with concerns about the possible association with increased risk of certain cancers, primarily of the breast, ovary, and uterus.

Such interest was on display when Elizabeth Edwards, the wife of former Sen. John Edwards, died from a recurrence of breast cancer in 2010, years after she had used fertility treatments. Researchers agree that the issue is important, given the millions of women who have been treated with fertility drugs. By one estimate, that number will climb to 7 million by 2025. 

But the findings from the few studies that have tried to address the issue have been mixed. Most have been conducted outside the U.S., primarily in European countries with centralized health care systems that can track pharmacy and cancer registries. These studies can have methodological limitations, but researchers say the largest drawback is that, usually, it is too early to tell whether an association exists, especially for drugs used for in vitro fertilization (IVF). 

“We are just really now getting into an era where we have enough women who are in the right age range to be able to evaluate their cancer risk,” said Louise Brinton, Ph.D., M.P.H., chief of the hormonal and reproductive epidemiology branch of the Division of Cancer Epidemiology and Genetics at the National Cancer Institute.

But it won’t ever be completely clear whether these drugs cause even a slight increase in cancer risk, says Jennifer Litton, M.D., an assistant professor in the department of breast medical oncology at the University of Texas M. D. Anderson Cancer Center in Houston. “Infertility itself is a risk factor for increases in breast and ovarian cancers, so it is going to be difficult, if …(Blogger's Note: to read further subscription required $$$)

Guidelines needed to address cancer survivorship care, says oncologist - NCCN conference

Guidelines needed to address cancer survivorship care, says oncologist

A medical oncologist from the prestigious Fox Chase Cancer Center presented an argument at the ongoing National Comprehensive Cancer Network's 17th Annual Conference that, in light of people with cancer who are living much longer than ever, that they have special health needs that ought to be addressed by national standards of care.

Cancer survivors face a lot of unique and very specific challenges," says Crystal S. Denlinger, M.D., from Fox Chase Cancer Center. "In oncology medicine, there has been a much more concerted effort to address these needs in a systematic way."

For the last five years Denlinger has been the driving force at Fox for the establishment of of such guidelines, developing the Center for Survivorship at Fox Chase to address this for patients of that cancer center.

Together with colleagues from other NCCN institutions, Denlinger would like to see cancer accreditation organizations include survivorship care plans in their accreditation requirements.
Source: NCCN

abstract: Reduction of population-based cancer survival estimates by trace back of death certificate notifications: An empirical illustration

Reduction of population-based cancer survival estimates by trace back of death certificate notifications: An empirical illustration

Source:European Journal of Cancer, Volume 48, Issue 6


Background 
Survival studies using data from population-based cancer registries allow assessing effectiveness of cancer care on a population level. However, population-based cancer registries differ in the proportion of cases first notified by death certificate, as well as in the efforts to trace back such death certificate notifications (DCN). We aimed to assess the impact of such trace back on population-based cancer survival estimates.

Materials and methods 
In this study from the population-based Saarland Cancer Registry (Germany) we investigated the survival experience of successfully traced back DCN cases from 1994 to 2003. Five-year relative survival of patients with DCN cancers and the effect of trace back on population-based 5-year relative survival estimates were analysed by age and tumour site.

Results 
Twelve percent of all cancers were DCN and such cases occurred most often amongst sites with poor prognosis and amongst elderly patients. Approximately half of DCN cases could be successfully traced back. Five-year relative survival of patients with DCN cancers with trace back was 2%. The inclusion of DCN cancers with additional registrations reduced the 5-year relative survival estimate for all cancers combined by 4% points. Reductions were stronger for older patients and highly fatal cancers.

Conclusions
Trace back results in increased inclusion of patients with very poor prognosis. Varying extent of trace back across registries may compromise comparability of cancer survival estimates and should be taken into account in comparative cancer survival studies.

Dirty Hospitals - Canada CBC.ca

Factbox: Healthcare by the numbers | Reuters U.S. edition (international comparisons)

Factbox: Healthcare by the numbers | Reuters

Poor hospital cleaning revealed as major problem - News Canada

Poor hospital cleaning revealed as major problem - News Canada

open access: Cancer-related hypercalcemia

Cancer-related hypercalcemia

"Hypercalcemia affects up to 10% to 30% of cancer patients, and cancer-related hypercalcemia is the leading cause of hypercalcemia in hospitalized patients.^1,2 Patients with breast cancer, lung cancer, and myeloma are most commonly affected, but hypercalcemia can also occur with other malignancies, including renal, gynecologic, and head and neck cancers.^3,4 Unfortunately, cancer-related hypercalcemia has a poor prognosis, as it is most often associated with disseminated disease. Eighty percent of patients will die within a year, and there is a median survival of 3 to 4 months.............

"There are a number of clinical features that can accompany hypercalcemia and many of them are nonspecific (eg, fatigue, nausea, constipation, and confusion). The rapidity of onset is more likely to correlate with the severity of the symptoms rather than the degree of hypercalcemia.³ Untreated severe hypercalcemia can be fatal, but treatment can bring relief of many symptoms and positively affect quality of life. Common clinical features can be general (eg, dehydration, polyuria, polydipsia), gastrointestinal (eg, nausea, vomiting, constipation, anorexia), or neurologic (eg, fatigue, delirium, myopathy). In very severe cases, patients can experience seizures, coma, or cardiovascular collapse.^1,4......

abstract: The practice of pathology in Canada: decreasing pathologist supply and uncertain outcomes

The practice of pathology in Canada: dec... [Arch Pathol Lab Med. 2012]
Sections of Gynecological and Cytopathology Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, Canada.

 Abstract

CONTEXT:

Pathology organizations in the United States are preparing for a new era of health care reform. Trends in the supply of pathologists in Canada's managed care system may provide some useful insights in any analysis and projection of future pathologist needs in the United States.

OBJECTIVE:

In this study, population-based Canadian databases were used to devise a parameter for physician supply, cancer cases per physician. The trend in this supply parameter for pathologists was compared to that for radiation oncologists.

DESIGN:

The number of Canadian pathologists and radiation oncologists and the annual number of new cancer cases in each of 2 years, 1999 and 2009, were extracted from reliable databases. Cancer cases per pathologist and oncologist were calculated, and relative trends in supply of physicians in both specialties were identified.

RESULTS:

The annual number of new cancer cases increased from 129,300 to 171,000 from 1999 to 2009. The absolute numbers of both pathologists and oncologists also increased in this time period. However, while the increase in the number of radiation oncologists led to an 8.2% decrease in cancer cases per radiation oncologist, the modest increase in the number of pathologists led to an increase of 17.1% in cancer cases per pathologist.

CONCLUSIONS:

There is a trend toward a decreasing supply of Canadian pathologists relative to that of cancer demands. This finding confirms an earlier population-based study showing a decreased supply relative to population and number of clinical physicians. It is uncertain whether this decreased supply is a result of appropriate application of new, efficient methods or whether health care has been rationed or adversely impacted. Outcome measures to monitor Canadian pathology practice quality are clearly needed.

Bulletin du Cancer - What management for the asymptomatic men carriers of BRCA1 or 2 mutation? Results of a survey in the French oncogenetic centers

Bulletin du Cancer

Summary : The aim of this survey of practice was to define, in the absence of guideline, the management in France of asymptomatic men bearing a mutation of BRCA1 or 2 genes. A questionnaire was addressed to 90 oncogenetics centers. We obtained the answers of 34 practitioners working in 58 centers. Among the responders, 85.3% offered a systematic genetic test in all cases to determine the risk of transmission to the children and to offer a personal follow-up in 79.4 % of cases. This screening was directed towards prostate cancer, breast cancer and pancreatic cancer in respectively 94.1, 67.6 and 47.1% of cases. The screening of prostate cancer was mainly proposed to men bearing a BRCA2 mutation and from the age of 40 years. It was based on clinical examination and testing of prostate specific antigen. The screening of breast cancer was mainly proposed to men bearing a BRCA2 mutation and based on clinical examination and self-palpation without stating a started age. The screening of pancreatic cancer was mainly proposed to men with familial history of pancreatic cancer and from the age of 40 years. It was based on tomography and MRI. For the majority of answerers, the general practitioner was the best to perform all these screenings. These experts’ opinions can help to establish guidelines for the global management of asymptomatic men carriers of BRCA1 or 2 mutations.

(U.S.) Patient Advocate Foundation Welcomes You! - PAF

Patient Advocate Foundation Welcomes You! - PAF

Our Mission:
to provide effective mediation and arbitration services to patients to remove obstacles to healthcare including medical debt crisis, insurance access issues and employment issues for patients with chronic, debilitating and life-threatening illnesses.

We assist patients with:
 •  Medical Debt Crisis
 •  Insurance Access Issues
 •  Job Retention Issues

Access

The Process is Simple. Patient Advocate Foundation's Patient Services provides patients with arbitration, mediation and negotiation to settle issues with access to care, medical debt, and job retention related to their illness. Select one of the following to learn more about how PAF Patient Services may assist you......

Contact PAF :: 1-800-532-5274

open access: PLoS ONE: Hormone Treatment, Estrogen Receptor Polymorphisms and Mortality: A Prospective Cohort Study (in women 65yrs+)

PLoS ONE: Hormone Treatment, Estrogen Receptor Polymorphisms and Mortality: A Prospective Cohort Study

Conclusions/Significance

The risk of mortality was not associated with HT duration, type or age at initiation. It was however not equal across all women, with some women appearing genetically more vulnerable to the effects of HT in terms of their estrogen receptor genotype. These findings, if confirmed in another independent study, may help explain the differential susceptibility of women to the beneficial or adverse effects of HT.

RELEASE: The Center for American Progress Expands Health Care Policy Team with the Addition of Dr. Donald M. Berwick (patient safety groups)

RELEASE: The Center for American Progress Expands Health Care Policy Team with the Addition of Dr. Donald M. Berwick

NCCN Breast Cancer Guidelines Have 'Major' Changes

NCCN Breast Cancer Guidelines Have 'Major' Changes

MATTER by Matter — Kickstarter

MATTER by Matter — Kickstarter

 # THE PROBLEM

The web is the future of journalism, but let's be honest: the future isn’t living up to expectations. Newspapers and magazines have cut back on in-depth reporting. Gossip sites have proliferated. The web has become a byword for fast and cheap. Why isn’t it synonymous with fearless, investigative and enthralling writing?.........