Friday, April 06, 2012
Cancer's epicentre - The Economist
Cancer's epicentre - The Economist:
Cancer's epicentre
The Economist THE biggest conceptual breakthrough in the war on cancer was the realisation by the 1980s that it is always a genetic disease. Sometimes the genetic flaw is inherited. Sometimes it is the result of exposure to an outside agent such as tobacco smoke or radioactivity. Sometimes it is plain bad luck; a miscopying of a piece of DNA during the normal process of cell division. Turning that breakthrough into medicine, though, is hard. No one has worked out how to repair DNA directly. It is, rather, a question of discovering the biochemical consequences of the genetic damage and trying to deal with those instead. But recently, another pattern has emerged. It is too early to call it a breakthrough as significant as the cancer-is-caused-by-broken-genes finding, but it might be....... |
abstract: Incontinence after colonoscopy - an unrecognized and preventable problem. A cross-sectional study from the Gastronet quality assurance program
Abstract
"Female patients had a higher risk of incontinence than men."
Background:
Colonoscopy requires insufflation of gas for visualization of the bowel wall. Worldwide, this is usually done using air. The aim of the present study was to assess the risk of post colonoscopy incontinence, and to investigate whether insufflation of CO2 instead of air may reduce this risk, since it is easily absorbed through the bowel mucosa.
Conclusion:
About every 20th patient undergoing colonoscopy using standard air insufflation experiences post examination incontinence. This proportion can be reduced by 60 % by converting from air insufflation to insufflation with the absorbable CO2.
abstract: The effect of hysterectomy on survival of patients with borderline ovarian tumors (repost)
The effect of hysterectomy on survival of patients with borderline ovarian tumor
Objective
The classically recommended surgical treatment of borderline ovarian tumors (BOTs) includes hysterectomy in addition to bilateral adnexectomy. Possible reasons for hysterectomy might be a high frequency of uterine involvement and its favorable effect on survival. The purpose of the present study was to assess the frequency of uterine involvement in patients with BOTs and the effect of hysterectomy on survival.
Methods
All incident cases of histological confirmed BOTs diagnosed in Israeli Jewish women between March 1 1994 and June 30 1999, were identified. Clinical and pathological characteristics were abstracted from medical records. Patients with tumors grossly confined to the ovaries (apparently stage I) were considered to have had surgical staging when at least hysterectomy, bilateral salpingooophorectomy, omentectomy and pelvic lymph node sampling were done.
Results
The study group comprised 225 patients. Hysterectomy was performed in 147 (65.31%) patients and uterine involvement was present in only 3 (2.0%) of them. The 13 year survival of the total group of patients was 85.8% and of those in apparent stage I, 88.5%. Among patients with tumors apparently confined to the ovaries, no significant survival difference was observed between unstaged and surgically staged patients. There was also no survival difference between the overall staged and unstaged patients and between patients in stages II–III who did and did not undergo hysterectomy.
Conclusions
Our data indicate that the rate of uterine involvement in BOT is low and that hysterectomy does not favorably affect survival. The necessity of hysterectomy in BOT patients is questioned.
abstract: A phase II evaluation of belinostat and carboplatin in the treatment of recurrent or persistent platinum-resistant ovarian, fallopian tube, or primary peritoneal carcinoma: A gynecologic oncology group study
A phase II evaluation of belinostat and carboplatin in the treatment of recurrent or persistent platinum-resistant ovarian, fallopian tube, or primary peritoneal carcinoma: A gynecologic oncology group study:
Background
Patients with recurrent ovarian cancer have limited options, especially in the context of relapse less than six months from primary platinum-based therapy. This Gynecologic Oncology Group (GOG) study was conducted to evaluate the impact of the histone deacetylase inhibitor, belinostat, in combination with carboplatin in women with platinum-resistant ovarian cancer.
Methods
Eligible patients had measurable, recurrent disease within six months of their last dose of a platinum-based combination. Belinostat was dosed at 1000mg/m2 daily for five days with carboplatin AUC 5 on day three of 21-day cycles. The primary endpoint was overall response rate (ORR), using a two-stage design.
Results
Twenty-nine women enrolled on study and 27 were evaluable. The median number of cycles given was two (range 1–10). One patient had a complete response and one had a partial response, for an ORR of 7.4% (95% CI, .9%–24.3%). Twelve patients had stable disease while eight had increasing disease. Response could not be assessed in five (18.5%). Grade 3 and 4 events occurring in more than 10% of treated patients were uncommon and limited to neutropenia (22.2%), thrombocytopenia (14.8%), and vomiting (11.1%). The median progression-free survival (PFS) was 3.3months and overall survival was 13.7months. PFS of at least six months was noted in 29.6% of patients. Due to the lack of drug activity, the study was closed after the first-stage.
Conclusions
The addition of belinostat to carboplatin had little activity in a population with platinum-resistant ovarian cancer.
abstract: Changes in serum CA-125 can predict optimal cytoreduction to no gross residual disease in patients with advanced stage ovarian cancer treated with neoadjuvant chemotherapy
Changes in serum CA-125 can predict optimal cytoreduction to no gross residual disease in patients with advanced stage ovarian cancer treated with neoadjuvant chemotherapy
Objective
To evaluate the predictive power of serum CA-125 changes in the management of patients undergoing neoadjuvant chemotherapy followed by interval debulking surgery (NACT-IDS) for a new diagnosis of epithelial ovarian carcinoma (EOC).
Conclusions
Patients who undergo NACT-IDS achieve a high rate of optimal cytoreduction. In our series, after treatment with taxane and platinum-based chemotherapy, patients with a preoperative CA-125 of ≤100U/mL were highly likely to be cytoreduced to no residual disease.
Witnessing, Experiencing Traumatic Events May Worsen Heart Disease - MedicineNet
Witnessing, Experiencing Traumatic Events May Worsen Heart Disease - MedicineNet
WEDNESDAY, April 4 (HealthDay News) -- Large amounts of lifetime exposure to traumatic stress -- even when it doesn't result in post-traumatic stress disorder -- boosts inflammation levels in heart disease patients, a new study suggests.......
no abstract: Obstetrics and Gynecology Clinics of North America | ScienceDirect.com
Blogger's Note: this journal is subscriber based, this article has no abstract
Obstetrics and Gynecology Clinics of North America (journal)
Trends in Gynecologic Cancer Care in North America
Review ArticleIn Press, Corrected Proof, Available online 5 April 2012
Clare Reade, Laurie Elit
Close preview | 
PDF (705 K)
| Related articles | Related reference work articles Abstract | Figures/Tables | ReferencesNo abstract is available for this article.
Thursday, April 05, 2012
abstract: Follow-up of carriers of BRCA1 and BRCA2 variants of unknown significance: variant reclassification and surgical decisions.
Blogger's Note: while this article is specific to BRCA 1/2 it also would apply to other genetic syndromes eg. Lynch Syndrome, Peutz-Jeghers
~~~~~~~~~~~~~~~
Follow-up of carriers of BRCA1 and BRCA2 variants of unknown significance: variant reclassification and surgical decisions.:
Genet Med. 2011 Dec;13(12):998-1005
Abstract
PURPOSE:
Approximately 5-10% of patients who undergo genetic testing of BRCA1 and BRCA2 receive a variant of unknown significance (VUS) result. The ambiguous nature of a VUS may increase difficulty in patient understanding and decision making regarding risk reduction and surveillance options, including cancer risk-reducing surgeries. VUS reclassification to benign or deleterious may occur in time; however, clinical decisions may need to be made expeditiously, and some patients may pursue irreversible treatments before VUS reclassification.
METHODS:
We reviewed the surgical decisions of 107 women postdisclosure of a BRCA VUS result counseled at our institute between 1998 and 2009.
CONCLUSION:
Among women receiving a BRCA VUS result at our center, 11 of 107 (10.3%) pursued cancer risk-reducing mastectomy and 22 of 107 (20.6%) pursued cancer risk-reducing bilateral salpingo-oophorectomy. Reclassification of VUS occurred up to 9 years after testing, and 5 of 22 (22.7%) women followed up for 8 or more years continue to have a VUS result. We discuss considerations for providers of genetic services to discuss with patients who receive a VUS result.
abstract: Eligibility criteria in private and public coverage policies for BRCA genetic testing and genetic counseling.
Eligibility criteria in private and public coverage policies for BRCA genetic testing and genetic counseling
Genet Med. 2011 Dec;13(12):1045-50. doi: 10.1097/GIM.0b013e31822a8113.
Abstract
PURPOSE:
Coverage policies for genetic services for hereditary cancers are of interest because the services influence cancer risk reduction for both persons with cancer and their family members. We compared coverage policies for BRCA genetic testing and genetic counseling among selected payers in the United States to illuminate eligibility criteria variation that may explain differential access by insurance type. We compared these policies with policies for breast cancer screening with magnetic resonance imaging to consider whether payers apply a unique policy approach to genetic services.METHODS:
We conducted a case study of large private and public payers selected on number of covered lives. We examined coverage policies for BRCA genetic testing, genetic counseling, and screening with magnetic resonance imaging and the eligibility criteria for each. We compared eligibility criteria against National Comprehensive Cancer Network guidelines.RESULTS:
Eligibility criteria for BRCA testing were related to personal history and family history of cancer. Although private payers covered BRCA testing for persons with and without cancer, the local Medicare carrier in our study only covered testing for persons with cancer. In contrast, Arizona's Medicaid program did not cover BRCA testing. Few payers had detailed eligibility criteria for genetic counseling. Private payers have more detailed coverage policies for both genetic services and screening with magnetic resonance imaging in comparison with public payers.CONCLUSION:
Despite clinical guidelines establishing standards for BRCA testing, we found differences in coverage policies particularly between private and public payers. Future research and policy discussions can consider how differences in private and public payer policies influence access to genetic technologies and health outcomes.abstract: Microsatellite Instability in Saliva from Patients with Hereditary Non-polyposis Colon Cancer (HNPCC/Lynch Syndrome) and Siblings Carrying Germline Mismatch Repair Gene Mutations
Microsatellite Instability in Saliva from Patients with Hereditary Non-polyposis Colon Cancer and Siblings Carrying Germline Mismatch Repair Gene Mutations
"Saliva testing, a less-invasive procedure than PBL ( peripheral blood lymphocytes) testing, is more sensitive and appears to be a viable alternative for identifying MSI in carriers with MMR mutations."
abstract: Assessing residents' disclosure of adverse events: traditional objective structured clinical examinations versus mixed reality.
Assessing residents' disclosure of adv... [J Obstet Gynaecol Can. 2012] - PubMed - NCBI
J Obstet Gynaecol Can. 2012 Apr;34(4):367-73.
Department of Obstetrics and Gynecology, University of Ottawa, Ottawa ON.
Abstract
Objective:The skill of disclosing adverse events is difficult to assess. Assessment of this competency in medical trainees is commonly achieved via the objective structured clinical examination (OSCE) using a standardized patient (SP). We hypothesized that the addition of a simulated clinical adverse event prior to the SP encounter could increase trainees' engagement and empathy, thereby improving performance. The objective of this study was to explore whether experiencing a simulated adverse event prior to an SP encounter alters resident performance on a disclosure OSCE.
Conclusion:
The assessment of adverse event disclosure was not enhanced by the addition of a simulated experience. Study participants reported that the simulation did not provide the contextual information required to elicit empathy and a sense of being emotionally invested in the adverse event.
Community Oncology Practice Impact Report Apr 4, 2013 (U.S. closures etc by state)_4-4-12F.pdf (application/pdf Object)
Community_Oncology_Practice_Impact_Report_4-4-12F.pdf (application/pdf Object)
"This is an update to the last Community Oncology Alliance (COA) Practice Impact Report, which was issued on 3/31/11. This report is derived from a tracking database on the changing oncology treatment landscape. The database is compiled from private and public sources.
Included in this report are a table of impacted practices by state and a map depicting the impact.
• As of the date of this update, 1,254 clinics/practices during the past 4½ years have been impacted as follows:
— 241 Clinics Closed — Denotes individual clinic sites that have closed.
— 442 Practices Struggling Financially — Denotes practices (possibly comprised of multiple clinic sites) that have financial difficulties......
Aprl 5th, 2012: Who Gets Ovarian Cancer? | Mayo Clinic Podcasts
Who Gets Ovarian Cancer? | Mayo Clinic Podcasts
Medical and Health Podcasts from Mayo Clinic
Who Gets Ovarian Cancer?
When it comes to ovarian cancer, are you at risk? In this Medical Edge Radio episode, Mayo Clinic Dr. Paul Haluska provides some insight.
To listen, click the link below.
Who Gets Ovarian Cancer
Google Scholar search: Low-Grade Ovarian Serous Neoplasms (Low-Grade Serous Carcinoma and Serous Borderline Tumor) Associated With High-Grade Serous Carcinoma - Google Scholar
Blogger's Note: search results may not be totally specific
| Scholar Create email alert | Results 1 - 10 of about 72. |
abstract: Suicide and Cardiovascular Death after a Cancer Diagnosis — NEJM
Suicide and Cardiovascular Death after a Cancer Diagnosis — NEJM
Free Preview
Background
Receiving a diagnosis of cancer is a traumatic experience that may trigger immediate adverse health consequences beyond the effects of the disease or treatment.Conclusions
In this large cohort study, patients who had recently received a cancer diagnosis had increased risks of both suicide and death from cardiovascular causes, as compared with cancer-free persons.abstract: Phase II Study of Gemcitabine and Docetaxel in Recurrent Platinum Resistant Ovarian Cancer
Abstract
To evaluate the activity of gemcitabine and docetaxel in patients with recurrent ovarian cancer.
Methods:
Patients with platinum-resistant disease and prior treatment with paclitaxel received treatment with docetaxel on day 1 and gemcitabine on days 1 and 8, repeated every three weeks.
Results:
Twenty patients, with a platinum-free interval of three months, were enrolled. Overall response rate was 25%. Treatment was associated with significant myelosuppression.
Conclusions:
In chemotherapy-resistant patients, this regimen exhibited encouraging activity. Excessive myelosuppression led to early closure. This was prevented by administering docetaxel on day 8 (instead of day 1) and prophylactic use of G-CSF. (blood products)
Methods:
Patients with platinum-resistant disease and prior treatment with paclitaxel received treatment with docetaxel on day 1 and gemcitabine on days 1 and 8, repeated every three weeks.
Results:
Twenty patients, with a platinum-free interval of three months, were enrolled. Overall response rate was 25%. Treatment was associated with significant myelosuppression.
Conclusions:
In chemotherapy-resistant patients, this regimen exhibited encouraging activity. Excessive myelosuppression led to early closure. This was prevented by administering docetaxel on day 8 (instead of day 1) and prophylactic use of G-CSF. (blood products)
abstract: Ovarian cancer: insights into genetics and pathogeny
Abstract
".......The classic conception of ovarian cancer pathogeny, based on the role of the ovarian surface epithelium, is currently reconsidered, and a novel hypothesis is formulated, which supports direct involvement of the Fallopian tubes for the serous type. Although recent research suggests the implication of immune/inflammatory cells by specific mechanisms in ovarian cancer pathogenesis, there is yet reliable evidence concerning their modality of direct action and/or modulation of tumoral growth. Thus, ovarian carcinogenesis remains a research challenge....
abstract: Meta-analysis on the association between non-steroidal anti-inflammatory drug use and ovarian cancer.
Br J Clin Pharmacol. 2012 Apr 3
Abstract
Aim:Animal and in vitro studies suggest that the use of non-steroidal anti-inflammatory drugs (NSAIDs) may be associated with reduced risk for ovarian cancer; however, results from these studies have been inconsistent. The aim of our study is to review and summarize the evidence provided by longitudinal studies on the association between NSAID use and ovarian cancer risk.
Methods:
A comprehensive literature search for articles published up to December 2011 was performed. Prior to performing a meta-analysis, the studies were evaluated for publication bias and heterogeneity. Relative risk (RR) or odds ratio (OR) were calculated.
Conclusions:
Our findings indicate that there is no strong evidence of an association between Aspirin/NA-NSAID use and ovarian cancer. However, this subject deserves further investigation.
Wednesday, April 04, 2012
financial news: Arrayit Diagnostics, Inc. Reports Results of Research Study for Ovarian Cancer Diagnostic Test (OvaDx)
Arrayit Diagnostics, Inc. Reports Results of Research Study for Ovarian Cancer Diagnostic Test
" Arrayit Corporation and Arrayit Diagnostics, Inc. ("AD") report significant results from a 257 patient research study on its pre-symptomatic ovarian cancer molecular diagnostic test in development, OvaDx(R). In this study, OvaDx(R) recorded sensitivity of 79.7%, correctly identifying patients known to have cancer, and specificity approaching 100%, correctly identifying the healthy controls, patients known not to have cancer......
NCCN Guidelines: Ovarian Cancer March 2012
Blogger's Note: the pdf link below requires registration (free), alternatively go to: http://www.nccn.org and click on guidelines 3/2012 version shows (pages 4/5) changes from 2/2012 version; most recent version includes 'language' changes, category recommendations (eg. highly recommended, neoadjuvant therapy, CA125/clinical relapse/re-treatment, LMP, fertility issues, 'malignant' sex chord stromal, stage 1 added (stages 11-1V) to certain pages....)
NCCN Guidelines: Ovarian Cancer 2012
Phase 2 Study Update of Selumetinib for Ovarian Cancer - MPR
Blogger's Note: more info req'd eg. side effects....
Phase 2 Study Update of Selumetinib for Ovarian Cancer - MPR
Array BioPharma announced results of a Phase 2 trial of selumetinib in women with recurrent low-grade serous ovarian or peritoneal cancer.
In the trial, 52 women each received 100mg doses of selumetinib orally twice daily in four-week cycles until disease progression or toxicity. The median number of cycles received was 4.5; 33% underwent ≥12 cycles. Prior to the trial, 58% of the patients in the trial had received three or more rounds of chemotherapy.
A disease control rate, defined as either complete or partial response or progression-free survival or progression-free survival of greater than 6 months, occurred in 81% of patients. Eight patients had complete (1) or partial (7) responses, and 34 (63%) had progression-free survival of >6 months. The median survival rate without cancer progression was 11 months.
Selumetinib is an anti-cancer drug in Phase 2 development in a range of tumors. It is a small molecule MEK inhibitor that targets a key position in the Ras-Raf-MEK-ERK signaling pathway. MEK has been shown to be frequently activated in cancer, in particular in tumors that have mutations in the RAS and RAF pathways.
For more information call (877) MED-CHEM or visit www.arraybiopharma.com
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