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Saturday, March 31, 2012

Hartzband and Groopman on the Rise of the Medical Expertocracy - WSJ.com



 Blogger's Note: a little political commentary thrown in but overall a good article, book reference

Hartzband and Groopman on the Rise of the Medical Expertocracy - WSJ.com

Alex Nabaum


"Patients and doctors can differ with experts and not be ignorant or irrational. Policy makers need to abandon the idea that experts know what is best. In medical care, the "right" clinical decisions turn out to be those that are based on a patient's goals and values."

Screening of symptomatic women for ovarian cancer: 4 articles (correspondence -RECAP OF LINKS) : The Lancet Oncology : Volume 13, Number 4, 1 April 2012



Blogger's Note: with some exceptions, the Lancet is a subscriber based journal ($$$), registration (free) may be required to view abstracts and/or articles

The Lancet Oncology : Volume 13, Number 4, 1 April 2012


e137 - open access
Screening of symptomatic women for ovarian cancer
Christopher P Crum
e137 - open access
Screening of symptomatic women for ovarian cancer
Alicia A Tone, David G Huntsman, Dianne M Miller
e138 - open access
Screening of symptomatic women for ovarian cancer
Aleksandra Gentry-Maharaj, Jatinderpal Kalsi, Matthew Burnell, Ranjit Manchanda, Usha Menon
e139 - open access (authors' response)
Screening of symptomatic women for ovarian cancer – Authors' reply
Lucy Gilbert, Olga Basso, for the DOvE Study Group

Commentary: Aromatase inhibitors and musculoskeletal adverse events : The Lancet Oncology



Aromatase inhibitors and musculoskeletal adverse events : The Lancet Oncology

".........Because symptom collection is so variable between trials, researchers could look for correlations between changes in patient-reported quality of life and breast-cancer outcomes. Nevertheless, if clinical research confirms a link between emergent symptoms or changes in quality of life and breast-cancer outcomes, further pharmacogenomic and pharmacogenetic studies could help to elucidate the mechanisms. Although confirmation of the association between emergent symptoms with aromatase inhibitors and risk of breast-cancer recurrence would help to guide clinical advice, based on current evidence clinicians should not use the onset of musculoskeletal symptoms to infer which patient will, or will not, benefit from adjuvant treatment with aromatase inhibitors."

(Apr 2012) Commentary: Link between endometriosis and ovarian-cancer subtypes : The Lancet Oncology



Link between endometriosis and ovarian-cancer subtypes : The Lancet Oncology


"Previous large epidemiological studies have attempted to identify benign gynaecological disorders that predispose to the development of epithelial ovarian cancer. The only disorder that has been repeatedly1—4 (although not universally5) associated with this cancer is endometriosis. Results of some of these studies have suggested a specific link with endometrioid and clear-cell ovarian cancers, but until now none had the power to allow definitive subgroup analysis based on a contemporary definition of histological subtype.
 
In a study reported in the Lancet Oncology, Celeste Leigh Pearce and colleagues6 assessed self-reported endometriosis data from 13 pooled case—control studies in the Ovarian Cancer Association Consortium (OCAC). They confirm that a history of endometriosis is significantly associated with an increased risk of clear-cell (odds ratio 3·05, 95% CI 2·43—3·84) and endometrioid (2·04, CI 1·67—2·48) ovarian cancers, and for the first time show an association with low-grade serous ovarian cancer (2·11, 1·39—3·20). No association was noted between endometriosis and high-grade serous, mucinous, serous borderline, or mucinous borderline ovarian cancers.
 
With more than 23 000 participants (7911 with a diagnosis of ovarian cancer), the main strengths of this study are its statistical power and its robust methods. Incidences of reported endometriosis differ substantially between the pooled studies. Although clinicopathological and genetic differences between the populations could reasonably be expected, importantly there was no significant heterogeneity of the association with histological subtype in the different studies.
The main truly novel finding is an association between a history of endometriosis and low-grade serous ovarian cancer. Perhaps surprisingly, serous borderline tumours (from which invasive low-grade serous ovarian cancers are believed to arise7) are not also associated with a history of endometriosis.

Commentary: Primary care and diagnosis of cancer : The Lancet Oncology



Primary care and diagnosis of cancer : The Lancet Oncology

"..........These findings raise several questions. Do modes of cancer presentation vary systematically between different groups of patients? Are general practitioners more reluctant to refer young or non-white patients for investigation of possible cancer? Are participants in these groups less willing to accept a referral to investigate possible cancer? Lyratzopoulos and colleagues' study will raise concerns for those involved in diagnosing and treating patients with cancer. This descriptive study suggests several hypotheses concerning pathways to accessing cancer care that deserve to be tested prospectively in future research."

Biology-driven medicine: tissue matters : The Lancet Oncology



Biology-driven medicine: tissue matters : The Lancet Oncology

The Lancet Oncology, Volume 13, Issue 4, Page 319, April 2012
doi:10.1016/S1470-2045(12)70142-0

 "Deciding who to test, how, and when, will help realise the vast potential of personalised medicine for cancer. However, integration of biology-driven therapy into the clinic is becoming increasingly complex and intratumoral heterogeneity could prove to be the Achilles' heel of targeted therapy in an era in which tissue has become an extremely precious resource that must be used sparingly, pragmatically, and within a multidisciplinary decision-making team."

 The Lancet Oncology

 
"Cancer therapy has been revolutionised by the advent of targeted agents. As a result, patient selection through genetic testing is a rapidly growing industry, but this has posed extra challenges for the patient and oncological team including cost, legal obstacles, test accuracy, and management of tissue. In this context, a recent report in the New England Journal of Medicine suggests intra-tumoral heterogeneity might be an even more complex issue than previously thought. The report showed that up to two-thirds of genetic results in renal-cell carcinoma will vary throughout the tumour specimen when tissue is assessed in a multiregional sequencing analysis. So what are the consequences of this finding for the use of single biopsies to guide treatments in the clinic?............
" Furthermore, according to speakers at the 13th European Congress on Perspectives in Lung Cancer held in Amsterdam, Netherlands, on March 9—10, 2012, the role of the pathologist is paramount in ensuring not only that enough tissue is left after histological diagnosis to do essential tests—such as those to predict benefit from the EGFR inhibitors—but also that testing is not done until the evidence linking the target to the efficacy of the drug, and any potential future treatments, are considered. A multidisciplinary environment is therefore essential to ensure an appropriate discussion of the timing of any pathological testing, and, where possible, to enable tissue to be saved to help guide future decision-making. This point was affirmed in a recent comment in the Journal of Clinical Oncology in which the authors suggested that excluding patients without the proposed target for treatment of breast and gynaecological cancer with PI3K/mTOR inhibitors should not be done until “a stronger predictive relationship emerges”. The comment also acknowledged the challenge of testing for rare mutations. Resistance to therapy can also develop, necessitating further testing to select potential responders to subsequent therapy. Use of blood might help overcome some of the difficulties associated with tissue resources, and several studies have been done using serum samples to define predictors of response to treatment, but these investigations are fraught with difficulties, including linking any serum changes to the tumour itself...........

Friday, March 30, 2012

FYI: Ovarian Cancer and Us blog - top 5 most read posts this week





Broad-Novartis Cancer Cell Line Encyclopedia - CCLE



Broad-Novartis Cancer Cell Line Encyclopedia

Broad-Novartis Cancer Cell Line Encyclopedia (CCLE)

The Cancer Cell Line Encyclopedia (CCLE) project is a collaboration between the Broad Institute, and the Novartis Institutes for Biomedical Research and its Genomics Institute of the Novartis Research Foundation to conduct a detailed genetic and pharmacologic characterization of a large panel of human cancer models, to develop integrated computational analyses that link distinct pharmacologic vulnerabilities to genomic patterns and to translate cell line integrative genomics into cancer patient stratification. The CCLE provides public access analysis and visualization of DNA copy number, mRNA expression and mutation data for about 1000 cell lines.

Please be aware that the CCLE is still an ongoing project and the associated data are not final nor complete. The CCLE website will also be subject to frequent changes and improvements. Please visit regularly!

This project is funded by Novartis.

News / Events

Mar 28, 2012: Due to the publication of the paper the CCLE portal is experiencing very heavy load. Please be patient if the server is slow in responding or try again later  

Mar 1, 2012: Mutation data for 1651 genes across 909 cell lines are now available. 

Cancerwise: Obesity and Cancer Risk: Our Expert Weighs In



Obesity and Cancer Risk: Our Expert Weighs In: By Jennifer Montgomery, MD Anderson Staff Writer

A new report shows that cancer death rates are still on the decline in the United States, but increasing obesity remains a concern.

The Annual Report to the Nation on the Status of Cancer, released March 28, notes that for more than three decades, too much weight, too little exercise and unhealthy eating habits have been second only to tobacco as preventable causes of disease and death.

Since the 1960s, the report says, tobacco use has declined by one-third, but obesity rates have doubled. According to the report, 2 in 3 adults and 1 in 3 kids are overweight or obese, which places them at risk for not only heart disease and diabetes, but also cancer. After reviewing more than 7,000 studies, the report's researchers have identified six cancers associated with being overweight or obese:
  • Esophageal adenocarcinoma
  • Colon and rectal cancer
  • Kidney cancer
  • Pancreatic cancer
  • Endometrial cancer
  • Breast cancer among postmenopausal women
This review also finds convincing evidence of an association between lack of sufficient physical activity and increased risk of colon cancer. A probable association is cited for post-menopausal breast and endometrial cancers.The report notes that less than half of adults get enough physical activity. Youths get even less. Lorenzo Cohen, Ph.D., professor in the Department of General Oncology and director of MD Anderson's Integrative Medicine Program, shares his reaction to the annual cancer report, as well as suggestions for how people can take action now to reduce obesity and prevent cancer.



The Annual Report to the Nation on the Status of Cancer looks at U.S. cancer numbers from 1975 and 2008. It's a collaboration of researchers from the Centers for Disease Control and Prevention, the North American Association of Central Cancer Registries, the National Cancer Institute and the American Cancer Society.

Additional highlights from the report:

  • Death rates from all cancers combined for men, women and children continued to decline in the United States between 2004 and 2008.
  • New cancer diagnoses among men fell an average of 0.6% per year over the same period. 
  • New cancer diagnoses among women declined 0.5% per year from 1998 through 2006, but rates leveled off from 2006 through 2008.
  • For the second consecutive year, mortality rates for lung cancer have decreased among women. Lung cancer death rates in men have been decreasing since the early 1990s.
  • Breast cancer incidence rates among women declined from 1999 through 2004 and plateaued from 2004 through 2008.
  • Colorectal cancer incidence rates decreased among men and women from 1999 through 2008.
  • Incidence rates of some cancers, including pancreas, kidney, thyroid, liver and melanoma, increased from 1999 through 2008.
  • Among racial and ethnic groups, the highest cancer incidence rates between 2004 and 2008 were among black men and white women. Cancer death rates from 2004 through 2008 were highest among black men and black women, but these groups showed the largest declines between 1999 and 2008, compared with other racial groups.
  • Among children age 19 or younger, cancer incidence rates increased 0.6% per year from 2004 through 2008, while death rates decreased 1.3% per year during the same period.

science daily: New breast cancer susceptibility gene (brca)



New breast cancer susceptibility gene

"....XRCC2 may also provide a new target for chemotherapy. "A type of drug called a PARP inhibitor appears to kill tumor cells that have gene mutations in a particular DNA repair pathway. XRCC2 is in this pathway, as are BRCA1 and BRCA2. It's reasonably likely that a breast cancer patient who has a mutation in XRCC2 will respond well to treatment with PARP inhibitors," said Tavtigian......."

In cancer science, many discoveries don't hold up | Reuters



In cancer science, many discoveries don't hold up | Reuters

abstract: Histology and prevalence of ovarian tumours in postmenopausal women: Is follow-up required in all cases?, Journal of Obstetrics & Gynaecology



Histology and prevalence of ovarian tumours in postmenopausal women: Is follow-up required in all cases? Journal of Obstetrics & Gynaecology, Informa Healthcare

The objective of this study was to determine if follow-up is required for all ovarian tumours incidentally diagnosed in postmenopausal women, by studying the prevalence and histology of ovarian tumours in postmenopausal women undergoing hysterectomy. The histopathology of adnexa in 100 consecutive postmenopausal women who underwent an abdominal hysterectomy with bilateral salpingo-oophorectomy for various indications, was reviewed. A total of 200 adnexa were examined. Ovarian pathology was found in 62/200 (31%). Of these 34/62 (53%) were unilocular cystic tumours, 9/62 (15%) were multilocular tumours, 11/62 (18%) were solid tumours and 8/62 (11%) were uni or multilocular with solid elements. The prevalence of borderline tumours was 4% and that of malignant tumours was 5%. All tumours < 2 cm were found to be benign. All unilocular cysts < 5 cm were benign. In conclusion, a vast majority of ovarian tumours in this group of women were benign. It may be reasonable not to follow-up women with unilocular ovarian tumours < 5 cm who have a normal CA125.



Efficacy of an Educational Material on Second Primary Cancer Screening Practice for Cancer Survivors: A Randomized Controlled Trial



Efficacy of an Educational Material on Second Primary Cancer Screening Practice for Cancer Survivors: A Randomized Controlled Trial:

Conclusion
While the educational material was effective for increasing knowledge of SPC screening, it did not promote cancer screening practice among cancer survivors. More effective interventions are needed to increase SPC screening rates in this population.

Trial Registration
ClinicalTrial.gov NCT00948337

Cancer Connect: Decoding Annie Parker - 2012 film (breast, ovarian, BRCA...)



Decoding Annie Parker:

A cancer survivor’s personal mission to educate others about genetic testing brings her story to the big screen.

The film is produced by Dorado Media and Capital and Media House Capital and initially will be presented at international film festivals before it is broadly distributed. For more information visit www.doradomedia.com.


When Anne Parker was diagnosed with first breast and, later, ovarian cancer, she knew in her heart that, as she says, “there was something more than ‘bad luck’ involved” in her diagnoses. Having lost both her mother and her sister to the disease, she had grown up in the shadow of cancer, convinced that her family shared a deadly link. As she confronted her own diagnoses, her search for answers about the role the disease played in her family became, in her words, “all-consuming and obsessive.”
In 1998 Anne underwent genetic testing and discovered that she carries the BRCA1 genetic mutation. Armed with what she considered invaluable information about the role of genetics in predicting cancer risk, she felt compelled to share her story and educate other families about the value of genetic testing. “I wanted to write about the advantages of being tested for the BRCA1 and BRCA2 mutations with the hope it would inspire women who have a family history of breast cancer to be tested,” Anne says.
Propelled by the memory of her mother and sister, Anne began to write about her experiences, embarking on a project that, she hoped, would culminate in a book that could serve as a resource for families struggling with the decision about whether to undergo genetic testing. But in November 2008, a twist of fate sent Anne’s story on a different path when she was introduced to Steven Bernstein, who was looking for a new project. That initial meeting set the wheels in motion for Anne’s story to move beyond the page to the big screen: a film adaptation of her story, titled Decoding Annie Parker, will be released in late 2012.
Michael Moss, MD (who co-wrote the screenplay for the movie with Steven Bernstein and Adam Bernstein), was drawn to Anne’s story. Their script melded her personal journey with the scientific story of geneticist Mary-Claire King’s work to discover the BRCA1 and 2 genetic mutations. The result, Dr. Moss says, is a film that follows both Anne’s story, as she loses her mother and sister and confronts her own diagnosis, and also that of Dr. King, who is working to prove a genetic link to high rates of breast cancer incidence among some family members. Throughout, Dr. Moss says, the strength and the perseverance of both women shine through as they “seek to prove something that runs counter to prevailing opinion: King faces a lack of support from the medical establishment in obtaining adequate funding for her research, while Anne’s own search for answers is dismissed as pointless obsession.”
“It has been surreal,” Anne says, of the process of watching her story transformed into a screenplay and brought to life on-screen. Exposing her and her family’s story in such a public way wasn’t an easy decision, but the opportunity to inform so many people about issues related to genetic testing was too powerful to ignore. Her surviving family members, who have all been faced with the decision about whether to undergo genetic testing, stood behind her. “My family understands firsthand the emotional impact of loss,” Anne says, “and that the more people know about the genetic mutation, and about where to turn for information, the less anxious and fearful they will be.”
Steven Bernstein, who in addition to serving as one of the film’s producers is making his directorial debut with Decoding Annie Parker, says that Anne’s experience presented a unique opportunity to share a powerful story that will be relevant for a wide audience. “The film is about a great many things—as much about what sustains us as about what makes us ill,” he says, noting that it provides valuable insight into early-detection topics.
Executive producer Johnathan Brownlee agrees that the film provides an opportunity to educate the audience and says that the script is unique in another sense too: “The story has two female lead characters, which is a rarity in film today.”
For Anne, seeing her story reach so many is a “powerful privilege.” She hopes that the movie will both entertain and provoke discussions that will lead to early detection and cancer prevention. “It is my wish to arm people in a high-risk family with information that could help them either dodge the cancer bullet or at least have it diagnosed in early stages before it spreads.”

Decoding Annie Parker
Scheduled for release in late 2012, Decoding Annie Parker features an ensemble cast that includes Helen Hunt as Mary-Claire King; Samantha Morton as Annie Parker; Aaron Paul as Annie’s first husband, Paul; Alice Eve as Annie’s friend, Louise; Marley Shelton as Annie’s sister, Joan; Rashida Jones as Annie’s friend, Kim; Corey Stoll as a doctor and friend, Sean; Bradley Whitford as Annie’s second husband, Marshall; and Bob Gunton as a physician, Dr. Benton.
The film is produced by Dorado Media and Capital and Media House Capital and initially will be presented at international film festivals before it is broadly distributed. For more information visit www.doradomedia.com.

open access: PLoS ONE: March 29th Integrated Analyses of microRNAs Demonstrate Their Widespread Influence on Gene Expression in High-Grade Serous Ovarian Carcinoma



PLoS ONE: Integrated Analyses of microRNAs Demonstrate Their Widespread Influence on Gene Expression in High-Grade Serous Ovarian Carcinoma

Background

The Cancer Genome Atlas (TCGA) Network recently comprehensively catalogued the molecular aberrations in 487 high-grade serous ovarian cancers, with much remaining to be elucidated regarding the microRNAs (miRNAs). Here, using TCGA ovarian data, we surveyed the miRNAs, in the context of their predicted gene targets.

Conclusions

This study establishes miRNAs as having a widespread impact on gene expression programs in ovarian cancer, further strengthening our understanding of miRNA biology as it applies to human cancer. As with gene transcripts, miRNAs exhibit high diversity reflecting the genomic heterogeneity within a clinically homogeneous disease population. Putative miRNA:mRNA interactions, as identified using integrative analysis, can be validated. TCGA data are a valuable resource for the identification of novel tumor suppressive miRNAs in ovarian as well as other cancers.




abstract: Serum HE4 levels are less frequently elevated than CA125 in women with benign gynecologic disorders



Serum HE4 levels are less frequently elevated than CA125 in women with benign gynecologic disorders: Publication year: 2012


Objective
The human epididymis protein 4 (HE4) is a novel biomarker for ovarian cancer. This study measured the HE4 and CA125 levels in women with benign gynecological disorders. 

Study Design 
Sera were obtained from women prior to surgery for a pelvic mass and HE4 and CA125 levels were determined. The proportions of patients with elevated biomarker levels were compared.

Results 
There were 1042 women with benign disease. HE4 levels were less often elevated than CA125 (8% vs 29%) . A marked difference was observed in patients with endometriosis in which HE4 was elevated in 3% of patients and CA125 in 67% . Serous ovarian tumors were associated with elevated levels of HE4 in 8% of patients and CA125 in 20%; uterine fibroids in 8% vs 26% ; dermoids in 1% vs 21% ; and inflammatory disease in 10% vs 37% .

Conclusion
HE4 is elevated less frequently than CA125 in benign disease, particularly in premenopausal patients.

Medpage SGO news: :Combo Promising for Resistant Ovarian Cancer - in Meeting Coverage, SGO from MedPage Today



Medical News:Combo Promising for Resistant Ovarian Cancer - in Meeting Coverage, SGO from MedPage Today

"....The between-group difference increased to 4 months in the subgroup of patients whose lesions had imaging-confirmed folate-receptor expression.
Overall survival did not differ between the groups, due in part to an unusually prolonged survival in the control arm, R. Wendel Naumann, MD, said here at the Society of Gynecologic Oncology meeting.
"This is the first clinical trial that has shown a benefit in progression-free survival over standardized therapy in a randomized trial in patients with platinum-resistant ovarian cancer, and we think it's pretty exciting," said Naumann, of Carolinas Medical Center in Charlotte, N.C.
"We know that EC20 scanning identifies patients who will benefit most from the combination of pegylated liposomal doxorubicin and vintafolide, as well as those who will not benefit. It appears that patients in whom all lesions are folate-receptor positive benefit the most from this combination."
A phase III randomized trial of PLD plus vintafolide has already begun, he added.............



Action Points


  • This study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.
  • Note that a compound which binds with high affinity to the folate receptor, which is expressed on the majority of epithelial ovarian cancers, and releases a cytotoxic component significantly increased progression-free survival in this phase two study.

Thursday, March 29, 2012

open access (U.S.) Annual Report to the Nation on the status of cancer, 1975-2008, featuring cancers associated with excess weight and lack of sufficient physical activity - Eheman - 2012 - Cancer - Wiley Online Library



Annual Report to the Nation on the status of cancer, 1975-2008, featuring cancers associated with excess weight and lack of sufficient physical activity - 2012 - Cancer

BACKGROUND:

Annual updates on cancer occurrence and trends in the United States are provided through collaboration between the American Cancer Society (ACS), the Centers for Disease Control and Prevention (CDC), the National Cancer Institute (NCI), and the North American Association of Central Cancer Registries (NAACCR). This year's report highlights the increased cancer risk associated with excess weight (overweight or obesity) and lack of sufficient physical activity (<150 minutes of physical activity per week).......

Letter: Bevacizumab in Ovarian Cancer — NEJM



Bevacizumab in Ovarian Cancer — NEJM

Correspondence

Bevacizumab in Ovarian Cancer

N Engl J Med 2012; 366:1256-1258  March 29, 2012
Article

To the Editor:

In their article on the findings of the Gynecologic Oncology Group study GOG-0218 (ClinicalTrials.gov number, NCT00262847), Burger et al. (Dec. 29 issue)1 state, as have others in a similar context,2 that the potential to see differences in overall survival in an ovarian cancer trial is limited by post-progression therapies, including crossover to the experimental agent bevacizumab. Post-progression therapies will attenuate differences in overall survival that would be seen if such therapies did not exist, but the observed attenuated differences are the correct measure of clinical benefit for the patients provided that standard-of-care post-progression therapies are used in both treatment groups.3,4

This would seem to be the case in the Gynecologic Cancer InterGroup (GCIG) International Collaboration on Ovarian Neoplasms (ICON7) bevacizumab trial (NCT00483782) reported by Perren et al. (also in the Dec. 29 issue),5 in which less than 4% of the patients in the control group received post-progression antiangiogenic treatments. To interpret the GOG-0218 results, one would need to know how many patients received post-progression antiangiogenic treatments. However, if one considered bevacizumab a standard treatment for progressing (recurrent) ovarian cancer given that it has shown activity, is recommended by National Comprehensive Cancer Network guidelines, and is covered by Medicare, then the observed difference in overall survival seen in the GOG-0218 and ICON7 trials1,5 is the appropriate estimate of clinical benefit for overall survival, regardless of post-progression treatments.

Edward L. Korn, Ph.D.
Boris Freidlin, Ph.D.
Jeffrey S. Abrams, M.D.
National Cancer Institute, Bethesda, MD

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

Wednesday, March 28, 2012

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