Wednesday, April 11, 2012

tweet cloud - Ovarian Cancer and Us

Medscape: Ovarian Cancer Clinical Presentation - overview including symptoms

Ovarian Cancer Clinical Presentation

Healthcare Quarterly Vol. 15 Special Issue | Patient Safety Papers :: Longwoods.com

ME-344/NV-128 - Marshall Edwards - Trials Open for Broad-Acting Oncology Candidate - Chemotherapy Advisor

Trials Open for Broad-Acting Oncology Candidate - Chemotherapy Advisor

April 11, 2012

abstract: High grade serous carcinoma of the ovary with a yolk sac tumour component in a postmenopausal woman: report of an extremely rare phenomenon -- yolk sac ovarian tumors usually dx'd under 30yrs age

High grade serous carcinoma of the ovary with a yolk sac tumour component in a postmenopausal woman: report of an extremely rare phenomenon

"High grade serous carcinoma is the most common ovarian epithelial malignancy.1 Ovarian yolk sac tumours (YST) are much more uncommon and are morphologically heterogeneous, primitive teratoid neoplasms differentiating into multiple endodermal structures.2 They almost always occur before age 30 and are extremely rare in perimenopausal and postmenopausal women.

Rare examples have been reported in elderly patients, sometimes associated with an ovarian surface epithelial-stromal tumour, most commonly endometrioid adenocarcinoma but occasionally carcinosarcoma, clear cell carcinoma or a mucinous neoplasm; rarely the epithelial component is benign.3–13

In a review of the literature, we have identified 18 ovarian neoplasms exhibiting a combination of YST and a surface epithelial-stromal tumour.3–13 The combination of endometrioid adenocarcinoma and YST should be distinguished from YST with endometrioid-like glands (‘pseudoendometrioid’ YST).

We describe an unusual and extremely rare ovarian neoplasm with components of high grade serous carcinoma and YST...."

open access: Quality of Clinical Trials in Gastro‐Entero‐Pancreatic Neuroendocrine Tumours

Blogger's Note:
rare ovarian cancer endocrine/carcinoid tumors exist, therefore, a possible interest in this paper, there may have been ovarian cancer tumors included in a study/ies, but without looking at each individual study, this paper does not isolate references to ovarian/ovary

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Table 2 describes the study populations which may or may not have included OC endocrine/carcinoid tumors

Description of the study population in the 46 identified trials.

Characteristic

No. of Studies %

Tumour location

Pancreatic neuroendocrine tumour only

Carcinoid tumours only

Both tumours

With other endocrine cancer

Table 6. Search strategy to identify published phase II and III NET treatment trials. (Blogger's Note: search included: carcinoid, neuroendocrine, melanoma, thyroid but no references to 'ovarian' or 'ovary' nor any specifics in the supporting references)

Quality of Clinical Trials in Gastro‐Entero‐PancreaticNeuroendocrine Tumours

"In conclusion, we found that the quality of study design and reporting in NETs treatment trials published in the last decade is poor, especially for trials testing radionuclide treatment. While poor study design and reporting has been previously described for trials in other malignancies, some unique quality issues exist for NET trials such as the inclusion of heterogenous patient populations within individual studies coupled with poor reporting of study population parameters. This has a significant impact on trial interpretability both for clinical decision‐making and future trials.
In response, we include a list of recommendations to be considered in the design of future trials in this group of tumours to ensure that future trials provide a more informative picture of the risks and benefits of systemic therapy in this patient population. We hope that our study can serve as a baseline against which improvements in clinical trial design and reporting in this patient population can be compared."

Varian Medical Systems to Showcase TrueBeam™ STx with press release: Varian Medical Systems - RapidArc® Radiosurgery - brain, spine, thorax, GI tract

Varian Medical Systems to Showcase TrueBeam™ STx with RapidArc® Radiosurgery --... -- MIAMI BEACH, Fla., April 11, 2012 /PRNewswire/ --

".....Clinicians who are gaining early experience in the clinical use of RapidArc® Radiosurgery are finding that this approach can be performed quickly and accurately in the treatment of tumors of the brain, spine, thorax, and gastrointestinal tract.[1] .......

abstract: Sequential Bevacizumab and Oral Cyclophosphami... [Gynecol Oncol. 2012] - PubMed - NCBI

Sequential Bevacizumab and Oral Cyclophosphamide for Recurrent Ovarian Cancer.

Abstract

OBJECTIVE:

Test the safety and efficacy of sequentially blocking angiogenesis by adding oral cyclophosphamide to bevacizumab following cancer progression on bevacizumab in patients with recurrent ovarian cancer.

METHODS:

Eligibility included≤2 lines of treatment for recurrence and measurable cancer by RECIST 1.0. Patients received bevacizumab (15mg/kg every 3weeks IV) and upon RECIST progression, oral cyclophosphamide (50mg orally daily) was added. Objectives included safety, toxicities, 3- and 6-month PFS rates, response rate, PFS, and OS.

RESULTS:

20 patients were enrolled. Overall response rate was 10%, and 65% of patients had confirmed stable disease (SD). Thirteen of 20 patients received oral cyclophosphamide added to bevacizumab upon bevacizumab progression. Of these 13 patients, 1 patient subsequently achieved a PR (this patient had SD as best response during bevacizumab) and 3 patients had a confirmed SD. For all patients, median PFS was 8.41 months, 6 month PFS rate was 65%, duration of response (DOR) 7.3 months, and median OS was 22.72 months. Median DOR for patients receiving both bevacizumab and cyclophosphamide was 8.4months. Most toxicities were grade 1 and 2 and manageable. Grade 3 and grade 4 toxicities included 1 myocardial infarction, 1 gastrointestinal perforation (GIP), and 12/20 patients (60%) developed grade 3 HTN.

CONCLUSIONS:

Addition of oral cyclophosphamide to bevacizumab at the time of cancer progression on bevacizumab appears to have continued anti-cancer effects in a subgroup of patients and appears to be safe. Randomized trials testing combination versus sequential anti-angiogenic therapy for recurrent ovarian cancer are warranted.

Lilly Oncology On Canvas | 2012 Competition - registration deadline Apr 30th

Lilly Oncology On Canvas | 2012 Competition

2012 COMPETITION

COMPETITION DETAILS

FAQs

GETTING STARTED VIDEOS

The 2012 Lilly Oncology On Canvas Art Competition is now underway!

Registration Deadline: April 30, 2012
Submission Deadline: June 29, 2012

If you or someone you care for has heard the words, “You have cancer,” then you know firsthand that a cancer diagnosis can change lives – physically and emotionally.

Berwick: Six Categories Represent 20% Of Nation's Health Care Expenditures - Kaiser Health News/blogger's opinion

Blogger's Note/Opinion: the examples of fraud in healthcare (lots of examples internationally) are rarely, publicly connected to the bottom line, so congrats to Berwick on this issue; if all medical fraud activity/costs were accounted directly in healthcare financial bottom-lines, then free healthcare for all would be available, someone (not me) should take on this project; eg: Ontario e-health scandal; executive buyouts, U.S. clinics defraud of Medicare claims (not accounting errors but outright fraud) ............Berwick's estimate is most likely low but what is not in this particular article is the cost of under-treatment eg. in our case of ovarian cancer the costs of second primary debulking surgery (except to say included in poor care delivery possibly)

Berwick: Six Categories Represent 20% Of Nation's Health Care Expenditures - Kaiser Health News

Berwick: Six Categories Represent 20% Of Nation's Health Care Expenditures

Topics: Health Costs, Quality

Apr 11, 2012

Modern Healthcare: Berwick Targets Waste In Healthcare Expenditures

In an article in the April 11 issue of the Journal of the American Medical Association, Dr. Donald Berwick, former CMS administrator and current senior fellow at the Center for American Progress, and Andrew Hackbarth, an assistant policy analyst for the RAND Corp., listed six categories of waste they say represent more than 20% of the nation's ever-increasing healthcare expenditures... Those six areas—fraud and abuse, poor care coordination, failures of care delivery, overtreatment, administrative complexity and overpricing of services—represent enormous opportunities for cost-cutting and improvement, the authors said (McKinney, 4/10).

This is part of Kaiser Health News' Daily Report - a summary of health policy coverage from more than 300 news organizations. The full summary of the day's news can be found here and you can sign up for e-mail subscriptions to the Daily Report here. In addition, our staff of reporters and correspondents file original stories each day, which you can find on our home pag

Clinical trial designs for testing biomarker-based personalized therapies

Clinical trial designs for testing biomarker-based personalized therapies

Abstract:

Background
Advances in molecular therapeutics in the past decade have opened up new possibilities for treating cancer patients with personalized therapies, using biomarkers to determine which treatments are most likely to benefit them, but there are difficulties and unresolved issues in the development and validation of biomarker-based personalized therapies. We develop a new clinical trial design to address some of these issues...

Conclusion
Innovative clinical trial designs are needed to address the difficulties and issues in the development and validation of biomarker-based personalized therapies. The article shows the advantages of using likelihood inference and interim analysis to meet the challenges in the sample size needed and in the constantly evolving biomarker landscape and genomic and proteomic technologies.

abstract: Role of Fluorine 18 Fluorodeoxyglucose Positron Emission Tomography–Computed Tomography in Focal and Generalized Infectious and Inflammatory Disorders

Role of Fluorine 18 Fluorodeoxyglucose Positron Emission Tomography–Computed Tomography in Focal and Generalized Infectious and Inflammatory Disorders

Abstract

"Several advances in imaging have become part of the work-up for localization, diagnosis, and management of infectious diseases and inflammatory disorders. Utility of multiple imaging modalities is a time-consuming step, and significant numbers of patients remain undiagnosed despite utilization of series of tests. Inflammatory cells have avidity for fluorine 18–labeled fluorodeoxyglucose (¹⁸F-FDG), and thus positron emission tomographic–computed tomographic (PET-CT) hybrid imaging provides anatomical and metabolic information that can be used to define the extent of infectious and inflammatory diseases and assess response to treatment. PET-CT provides a “one-stop test” in which use of hybrid imaging provides anatomical and metabolic information. The extent of disease is defined quickly, and response to treatment can be assessed. This modality also helps define the metastatic and/or septic foci where there is lack of localizing symptoms. More recently, there is increasing awareness among clinicians regarding the ability of PET-CT to help in diagnosing, characterizing, and assessing inflammatory disorders. This article reviews the usefulness of this imaging modality."

Drug Formulary - Avastin - Cancer Care Ontario (compared to Australia) - see notes

Blogger's Notes:

incidence rates ovarian cancer:
Australia: 1,488 (2015 projection)
Canada: 2,600 (annual estimates)

Australia population (census) 22 million
Canada population (census) 34 million
Ontario population (census) 13 million

Drug Formulary - Ontario

SEARCH - 'avastin' (null results for ovarian cancer)

For Health Professionals					For Patients
	Drug Monographs		Chemotherapy Regimens			Medication Information Sheets		Regimen Information Sheets

To refine your search, use Category Search or Advanced Search

CATEGORY SEARCH

ADVANCED SEARCH

Document	Description	Document Type	Publish Date	Download
BEVA Gastrointestinal - Colorectal Advanced Regimen category: Standard	Drug(s) used: Bevacizumab (with fluoropyrimidine-based chemotherapy)	Regimen Monograph	2011-12-16
bevacizumab (patient)	Other names: Avastin®	Medication Information Sheet	2011-05-10

1-2 of 2 result(s)

(CCS) Clinical Trials - Canada: ovarian cancer/Avastin

	Recruiting in 1 of 2 locations
A Study of the Addition of Avastin (Bevacizumab) to Carboplatin and Paclitaxel Therapy in Patients With Ovarian Cancer	Recruiting in 2 of 4 locations

(first line treatment approved) - New treatment (Avastin) option for ovarian cancer in Australia - News

New treatment option for ovarian cancer in Australia - News

"Australian women with advanced ovarian cancer have a new treatment option for their disease. The anti-cancer treatment, Avastin (bevacizumab), is now approved by the Therapeutic Goods Administration (TGA) in combination with chemotherapy (carboplatin and paclitaxel) for the treatment of patients with newly diagnosed (first-line) advanced epithelial ovarian, fallopian tube or primary peritoneal cancer......

media: Canadians OK with higher taxes to fight inequality (preserve social programs/health)

Canadians OK with higher taxes to fight inequality

"This attitude toward paying slightly higher taxes is reflected

equally in high-income and middle income Canadian households.

It's only their governments who are offside," the report, the first

from the newly established think tank, said......

open access: Multiple Associations Between a Broad Spectrum of Autoimmune Diseases, Chronic Inflammatory Diseases and Cancer

Blogger's Note: two specific references to ovarian cancer - MS (multiple sclerosis)/ovarian cancer; paraneoplastic syndromes/ovarian cancer;
~~~~~~~~~~~~~~~

open access: Multiple Associations Between a Broad Spectrum of Autoimmune Diseases, Chronic Inflammatory Diseases and Cancer

Abstract

Background: Many recent studies suggest the immune system plays a significant role in the pathogenesis of autoimmune diseases, chronic inflammatory diseases, and cancer.

Materials and Methods: Literature published between 2001 and 2011 was reviewed for risk of cancer development in patients with autoimmune and chronic inflammatory diseases. Mode of risk assessment employed did not limit inclusion of studies. Autoimmune conditions developing after diagnosis of a pre-existing cancer were also considered.

Results: We report a pervasive, largely positive association between 23 autoimmune and inflammatory diseases and subsequent cancer development. We discuss associations for celiac disease, inflammatory bowel disease rheumatoid arthritis, systemic lupus erythematosus, and multiple sclerosis in detail. We also address the less frequently reported development of some autoimmune conditions within the course of some malignancies, such as vitiligo developing in the course of melanoma. Conclusion: Evidence demonstrates that chronic inflammation and autoimmunity are associated with the development of malignancy. Additionally, patients with a primary malignancy may develop autoimmune like disease. These relationships imply a need for surveillance of patients on immunomodulatory therapies for potential secondary disease processes.

open access: (journal) Cancer - Supplement: A Prospective Surveillance Model for Rehabilitation for Women With Breast Cancer - 15 April 2012

Blogger's Note: no mention of genetics? (ovarian cancer risk/BRCA.......)?

Cancer - Volume 118, Issue Supplement 8 - 15 April 2012 - Wiley Online Library

Abstract: Adherence to Colorectal Cancer Screening: A Randomized Clinical Trial of Competing Strategies

Abstract: Adherence to Colorectal Cancer Screening: A Randomized Clinical Trial of Competing Strategies

""We have seen benefit from colon cancer screening with fewer people dying from it," said Dr. Theodore Levin, (MedicineNet quote) a gastroenterologist at the Kaiser Permanente Medical Center in Walnut Creek, Calif., and the author of an accompanying journal editorial. "If we want to raise our screening rates then we need to offer people choices other than colonoscopy."

Adherence to Colorectal Cancer Screening
A Randomized Clinical Trial of Competing Strategies

Background Despite evidence that several colorectal cancer (CRC) screening strategies can reduce CRC mortality, screening rates remain low. This study aimed to determine whether the approach by which screening is recommended influences adherence.

Methods We used a cluster randomization design with clinic time block as the unit of randomization. Persons at average risk for development of CRC in a racially/ethnically diverse urban setting were randomized to receive recommendation for screening by fecal occult blood testing (FOBT), colonoscopy, or their choice of FOBT or colonoscopy. The primary outcome was completion of CRC screening within 12 months after enrollment, defined as performance of colonoscopy, or 3 FOBT cards plus colonoscopy for any positive FOBT result. Secondary analyses evaluated sociodemographic factors associated with completion of screening.

Results A total of 997 participants were enrolled; 58% completed the CRC screening strategy they were assigned or chose. However, participants who were recommended colonoscopy completed screening at a significantly lower rate (38%) than participants who were recommended FOBT (67%) (P < .001) or given a choice between FOBT or colonoscopy (69%) (P < .001). Latinos and Asians (primarily Chinese) completed screening more often than African Americans. Moreover, nonwhite participants adhered more often to FOBT, while white participants adhered more often to colonoscopy.

Conclusions The common practice of universally recommending colonoscopy may reduce adherence to CRC screening, especially among racial/ethnic minorities. Significant variation in overall and strategy-specific adherence exists between racial/ethnic groups; however, this may be a proxy for health beliefs and/or language. These results suggest that patient preferences should be considered when making CRC screening recommendations.

health media: Cancer Care Costs Higher in U.S. Than Europe, But Survival Longer - MedicineNet

Cancer Care Costs Higher in U.S. Than Europe, But Survival Longer - MedicineNet

MONDAY, April 9 (HealthDay News) -- The United States spends more on health care than any other country, but those high costs may be paying off in cancer survival, a new report suggests.
U.S. cancer patients often live almost two years longer than similar patients in Europe, arguing for the dollar value of care given, researchers say.
However, Dr. Otis Brawley, the chief medical officer and executive vice president at the American Cancer Society, who was not involved in the study, said that "this paper has a huge fatal flaw in it."
"When you look at survival from time of diagnosis to time of death and you have a screened population that has a lot of diagnoses, you're filling that population with people who don't need treatment and because they are over-diagnosed, they have very long survival," he added.
These researchers attribute increased survival to the treatment, when it is really over-diagnosis, Brawley said. "So they are looking at a bunch of wasted, unnecessary treatment and then saying it was money well spent," he said.
"You don't look at survival rates -- this is a classic misuse of survival rates," Brawley said. "You have to look at death rates for each disease and not survival rates. The measurement should not be expense versus survival -- it should be expense versus mortality rate."
On that scale, the United States does well for some cancers and as well as they do in most of Europe for others, he said. "Mortality rates for breast and colon cancer are close to the mortality rates in Europe, but that may include the effect of over-treatment," Brawley said.
The report was published in the April issue of Health Affairs.
For the study, Tomas Philipson, the chair in public policy at the University of Chicago, and colleagues looked at cancer care in the United States and in 10 European countries from 1983 to 1999.
The investigators found that for most cancers, U.S. patients lived longer than Europeans. Americans lived an average of 11.1 years after diagnosis, compared with 9.3 years for Europeans, they said.
When the authors translated survival data to dollars, they found those extra years were worth $598 billion, which is an average of $61,000 per cancer patient.
The value of these survival gains was highest for prostate cancer ($627 billion) and breast cancer ($173 billion), the findings indicated.
To put a monetary value on survival, the researchers used a "statistical-life concept." In many such studies, they said, estimates are based on how much income a person would exchange for a lower risk of mortality.
"Our findings bear on the larger question of whether higher U.S. health care spending is worth it, suggesting -- although not confirming -- that it is," the researchers wrote.
"Further research is required to examine the drivers of spending and their effects on outcomes, including assessing the relative contributions of treatments, screening, the skill of health care personnel and other factors in improving patient outcomes," they concluded.
On the larger issue of the costs of cancer treatment, Brawley said that "we spend money in an irrational way. We harm people by over-treating them and over-treatment costs money."
Many patients are getting treatments that cause harm, but don't really prolong life, Brawley said. It's hard for a doctor to tell a patient there is nothing that can be done.
"That is the kind of thing doctors need to be developing skills in -- it's an emotional hurdle to say 'I can't stop this,'" he said.
Many patients think that giving up is admitting defeat, and want to be treated even if the treatment will do more harm than good, Brawley said.
"We all need to take a step back and take a look at reality and ask whether the patient stands a good chance of benefiting from a particular treatment. If there aren't benefits, then we ought to, perhaps, stop," he said.
"Instead of talking about rationing care, we need to talk about the rational use of care," Brawley added.

Abstract: B Vitamin and/or {omega}-3 Fatty Acid Supplementation and Cancer: Ancillary Findings From the Supplementation With Folate, Vitamins B6 and B12, and/or Omega-3 Fatty Acids (SU.FOL.OM3) Randomized Trial

Abstract: B Vitamin and/or {omega}-3 Fatty Acid Supplementation and Cancer: Ancillary Findings From the Supplementation With Folate, Vitamins B6 and B12, and/or Omega-3 Fatty Acids (SU.FOL.OM3) Randomized Trial

Conclusion We found no beneficial effects of supplementation with relatively low doses of B vitamins and/or {omega}

-3 fatty acids on cancer outcomes in individuals with prior cardiovascular disease.

Tuesday, April 10, 2012

open access: BMC Complementary and Alternative Medicine | Abstract | Consumers' experiences and values in conventional and alternative medicine paradigms: a problem detection study (PDS)

BMC Complementary and Alternative Medicine | Abstract | Consumers' experiences and values in conventional and alternative medicine paradigms: a problem detection study (PDS)

"Of 300 questionnaires distributed (Brisbane, Australia), 83 consumers responded."

"A 28% response (83 of 300 questionnaires distributed) was obtained for the consumer participants. More females (58) than males (25) responded. The majority of the consumers were middle-aged (47% aged 35–54 years, n = 47; 21 consumers were 34 or under and 15
were older than 55)." (Blogger's Note: null search results for 'cancer')

Conclusions

This PDS (problem detection study) has emphasized the perceived importance of open communication between consumers, CAM and conventional providers, and has exposed areas where CAM consumers perceive that issues exist across the CAM and conventional medicine paradigms. There is a lot of information which is perceived as not being shared at present and there are issues of discomfort and distrust which require resolution to develop concordant relationships in healthcare. Further research should be based on optimisation of information sharing, spanning both conventional and CAM fields of healthcare, due to both the relevance of concordance principles within CAM modalities and the widespread use of CAM by consumers.

2012 April Screening for Ovarian Cancer: Evidence Update for the U.S. Preventive Services Task Force Reaffirmation Recommendation Statement

Screening for Ovarian Cancer: Evidence Update for the U.S. Preventive Services Task Force Reaffirmation Recommendation Statement

Screening for Ovarian Cancer

Evidence Update for the U.S. Preventive Services Task Force Reaffirmation Recommendation Statement

Release Date: April 2012

By Mary B. Barton, MD, MP, and Kenneth Lin, MD.

This report is based on research conducted by staff at the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD. The investigators involved have declared no conflicts of interest with objectively conducting this research. The findings and conclusions in this document are those of the authors, who are responsible for its content, and do not necessarily represent the views of AHRQ. No statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.
The information in this report is intended to help clinicians, employers, policymakers, and others make informed decisions about the provision of health care services. This report is intended as a reference and not as a substitute for clinical judgment.
This report may be used, in whole or in part, as the basis for the development of clinical practice guidelines and other quality enhancement tools, or as a basis for reimbursement and coverage policies. AHRQ or U.S. Department of Health and Human Services endorsement of such derivative products may not be stated or implied.

Abstract
Introduction
Methods
Results
Conclusion
References

Abstract

Background: Ovarian cancer has the highest mortality rate of all gynecologic malignancies, and was the fifth leading cause of cancer death among women in 2004.

Purpose: To perform a literature search for new, substantial evidence that would inform the reaffirmation of the U.S. Preventive Services Task Force's recommendation on screening for ovarian cancer.

Data Sources: We searched the MEDLINE and Cochrane databases. The searches were limited to English-language articles on studies of adult humans (age >18 years) that were published between July 1, 2002 and January 15, 2008 in core clinical journals.

Study Selection: For the literature on benefits of screening, we included controlled trials as well as systematic reviews and meta-analyses. For harms, we included controlled trials, cohort studies, case-control studies, and case series, as well as systematic reviews and meta-analyses. Two reviewers independently reviewed titles, abstracts, and full articles for inclusion.
(Results: Our literature search returned 64 potentially relevant titles that were entered into a reference database. A total of 60 articles were excluded after title and abstract review, and two more were excluded after full article review. We excluded 18 studies not related to ovarian cancer, 34 studies that did not describe screening, two studies that described no relevant outcomes, two studies that described a high-risk or special patient population, and three studies that were an inappropriate study type. One additional report of a prospective screening study that was included in the evidence for harms was identified after a supplemental search of MEDLINE for publications by selected authors)

Data Extraction: No new evidence was found on the benefits of screening for ovarian cancer. A single reviewer extracted data from studies on the harms of screening.

Data Synthesis: No new evidence was found on the benefits of screening for ovarian cancer. New evidence on the combination of ultrasonography and cancer antigen-125 blood tests for screening suggests that abnormal test results may result in surgery for a substantial proportion of women who do not have cancer.

Limitations: The search strategy employed may have missed some smaller studies on the benefits and harms of screening for ovarian cancer.

Conclusion: No new evidence was found on the benefits of screening for ovarian cancer. Screening asymptomatic women can result in unnecessary interventions, including surgery.

Platinum Resistance is in the Eye of the Beholder « Dr. Robert A. Nagourney – Rational Therapeutics – Blog including comments from Liz Mane +

Blogger's Note: pls read the whole article including comments for an accurate view of the opinions expressed
~~~~~~~~~~~~~~~~~~~~~~

Platinum Resistance is in the Eye of the Beholder « Dr. Robert A. Nagourney – Rational Therapeutics – Blog

"I was recently apprised of an online conversation surrounding the treatment of platinum refractory and platinum resistant ovarian cancer. To clarify our terminology, platinum refractory disease refers to cancer that progresses during platinum therapy. This would be considered the most platinum resistant of the ovarian patients. The term “platinum resistant” developed over the last two decades, by Markman and others, is used to describe patients who initially respond to platinum-based chemotherapy and then relapse within six months of treatment.
While platinum refractory seems intuitively obvious, it has been suggested that platinum resistance is somewhat more arbitrary........
included comment from
Liz Mane says:

March 30, 2012 at 7:24 pm

"Dr. N.
I am the one who opined on a chat room that most oncologists won’t redeploy carbo to platinum refractory patients right after unsuccessful front line platinum therapy. However, whoever alerted this comment to you omitted a crucial qualifying aspect of my argument.
...........(I have a Ph.D. in research science though not in bio medical field). My conclusion was,.......

open access: Evidenced based indications for the use of PET/CT in the United Kingdom 2012 (includes ovarian/gyn/cancers)

BFCR(12)3_PETCT.pdf (application/pdf Object)

abstract: Medium-sized deletion in the BRCA1 gene: Limitations of Sanger sequencing and MLPA analyses.

Medium-sized deletion in the BRCA1 gene: Limitations of Sanger sequencing and MLPA analyses

Sanger sequencing and MLPA analyses.
Genet Mol Biol. 2012

Abstract
We describe a family with a history of breast and ovarian cancer in which MLPA analysis of the BRCA1 gene pointed to a deletion including a part of exon 11. Further characterization confirmed a loss of 374 bp in a region completely covered by conventional sequencing which had not revealed the deletion. Because this alteration was only detected serendipitously with an MLPA probe, we calculated the probabilities of detecting medium-sized deletions in large exons by methods including initial PCR amplification. This showed that a considerable fraction of medium-sized deletions are undetectable by currently used standard methods of mutation analyses. We conclude that long, widely overlapping amplicons should be used to minimize the risk of missing medium-sized deletions. Alternatively, large exons could be completely covered by narrow-spaced MLPA probes.

abstract: Physician characteristics and beliefs associated with use of pelvic examinations in asymptomatic women.

Physician characteristics and beliefs associated with use of pelvic examinations in asymptomatic women.

Physician characteristics and beliefs associated with use of pelvic examinations in asymptomatic women.

Abstract

OBJECTIVE:
To examine physicians' beliefs about the pelvic examination and identify physician characteristics associated with routine use of this procedure in the United States.

METHODS:
A total of 1250 United States family/general practitioners, internists, and obstetrician/gynecologists who participated in the 2009 DocStyles survey completed questions on beliefs regarding the utility of routine pelvic examinations for cancer screening. The survey also asked participants how often they performed this procedure as part of a well-woman exam, to screen for ovarian and other gynecologic cancers, to screen for sexually transmitted infections, and as a prerequisite for prescribing hormonal contraception.

RESULTS:
A total of 68.0% of obstetrician/gynecologists, 39.2% of family/general practitioners, and 18.7% of internists reported routinely performing pelvic examinations for all the purposes examined (<0.001). Adjusted analyses revealed that the factors most strongly associated with use of pelvic examinations for all purposes were being an obstetrician/gynecologist (odds ratio 8.5; 95% confidence interval 5.8-12.6) and believing that this procedure is useful to screen for gynecologic cancers (odds ratio 3.8; 95% confidence interval 2.6-5.5).

CONCLUSION:
Misconceptions about the utility of pelvic examinations to screen for gynecologic cancers are common. More effective strategies to change physicians' beliefs regarding the value of performing pelvic examinations in asymptomatic women are needed.

PMID: 22484240 [PubMed - as supplied by publisher]